By Victoria Kinkaid
Female Genital Mutilation (FGM) is the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons, as defined by the World Health Organisation (WHO). Importantly, the practice has no health benefits for girls and women and stops them from reaching their full potential in society.
It is estimated that over 200 million girls and women have been subjected to the practice of FGM, and in the UK, approximately 137,000 women have undergone FGM. Be under no illusions, FGM exists in the UK. Think about your medical school education, did you have formal FGM teaching?
During my time at medical school, I was fortunate to come across the topic of FGM through a government sponsored conference. I fear I would not have been exposed to this harsh reality, had I been solely dependent on the medical school curriculum. In order to improve reporting and awareness, UK-based medical students need to be well-versed in the recognition and management of FGM.
In the UK, FGM is illegal under the Female Genital Mutilation Act 2003. The Act was further amended by the Serious Crime Act 2015 where it became illegal to take a child out of the UK to have FGM performed. Interestingly, this amended act in 2015 included “failing to protect a girl from FGM” as an offence. This means that anyone responsible for a minor who becomes a victim of FGM is criminally liable. Therefore it is paramount that anyone encountering minors must be aware of their mandatory reporting duty. Currently, I feel this is poorly communicated to both healthcare workers and the wider population.
I attended medical school during the time of this law change (2015), and I do not believe that I was adequately informed of the legal duties required of me as a future doctor. I was curious to know if I was alone in feeling this. After talking to my colleagues, I ended up conducting an award-winning national survey and found that many medical students across the UK felt the same. This shocked me and I wanted to make a change.
As healthcare professionals, we must be able to:
- Identify FGM when conducting an examination
- Respond to a disclosure of FGM
- Know the signs of children at risk of FGM and be aware of how to report these concerns
I firmly believe that education on FGM must form part of the core curriculum for medical students. Medical students must first understand “normal” female anatomy, which in itself is poorly taught, and then be shown how FGM manifests itself physically. Furthermore, medical students need to be aware of any subtle psychosocial signs of planned FGM. This must be reinforced through role play of mandatory reporting via the correct chains, to ensure that our future doctors feel equipped when they witness, suspect or have FGM disclosed to them in a clinical context.
The learning objectives of this teaching are as follows:
- Define FGM and the cultural contexts of the practice
- Recognise FGM on clinical examination
- Communicate sensitively with survivors and manage disclosure via simulation teaching
- Recognise when minors are at risk of FGM
- Understand and act upon the mandatory reporting duty for witnessing FGM on examination and for any suspicion of minors at risk
Focussed teaching will not take a lot of time out of the extensive medical school curriculum. This teaching can be built into existing aspects of the curriculum; obstetrics and gynaecology, clinical examination, history taking and communication skills. There is also scope for interesting discussions such as the differentiation between FGM and adult consented genital piercing, which under the current WHO definition is still classified as FGM.
Our FGM education team have already demonstrated that modern online-based learning can facilitate this much needed incorporation. In collaboration with the University of Aberdeen, I recently co-authored an online course on FGM. This required 16-hours from the user to complete but could be compressed to suit specific medical student requirements. There is therefore no excuse to exclude FGM teaching from the curriculum and flexibility around lecture based learning should be considered.
Medical students must be equipped with this knowledge to be able to conduct their mandatory reporting duties, not only for their own legal protection, but to protect the patients that they encounter. Without national compulsory FGM teaching in medical schools, we are not only failing the future generations of doctors, we are also failing generations of girls and young women. Introducing compulsory FGM teaching in medical schools will raise awareness of the practice and therefore be instrumental in ending the practice of FGM for good. In my opinion, it is irresponsible and illogical to continue with the current lack of FGM education in medical schools, and could lead to future doctors inadvertently breaking the law.
About the Author
Victoria is a junior doctor who is passionate about women’s health. She co-founded the FGM education project, group at the University of Aberdeen raising awareness about FGM, specifically in relation to the mandatory professional duty of reporting FGM or signs of FGM to improve safeguarding. If you wish to find more information please follow our social media accounts.