What deters GPs from talking about sexual assault? a qualitative interview study

Fiona Elizabeth van Zyl-Bonk; Antoinette Leonarda Maria Lagro-Janssen; Anna Maria Cornelia Henrica de Klein; Theodora Alberta Maria Teunissen

doi:10.3399/BJGP.2024.0761

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What deters GPs from talking about sexual assault?
Fiona E. van Zyl-Bonk, Toine LM Lagro-Janssen and Doreth AM Teunissen

Published on: 03 June 2026
What deters GPs from talking about sexual assault? a qualitative interview study
Daniel Kane, Maeve Eogan, Karen Flood and Kieran Kennedy

Published on: 22 May 2026

Published on: (3 June 2026)
Page navigation anchor for What deters GPs from talking about sexual assault?
What deters GPs from talking about sexual assault?
Fiona E. van Zyl-Bonk, General Practitioner, PhD student, Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Nijmegen
Other Contributors:
Toine LM Lagro-Janssen, General Practitioner, PhD, emeritus professor of Gender and Women’s Health, Radboud University Medical Center

Doreth AM Teunissen, General Practitioner, PhD, senior researcher, Radboud University Medical Center
We were very pleased to read the thoughtful response by Kane and colleagues to our qualitative interview study on barriers that deter GPs from discussing sexual assault with patients. Their findings provide important complementary evidence and reinforce the need for educational interventions that support primary care professionals in addressing sexual assault in clinical practice.

We agree that education has an important role in overcoming many of the barriers identified in our study. In fact, the training program we are currently developing is explicitly informed by both our scoping review on educational interventions in this field¹ and the findings of our qualitative interview study among GPs. The program is designed not only to increase knowledge, but also to address the practical, emotional, and interpersonal challenges that GPs encounter when discussing sexual assault as found in our interview study.

The training is delivered in an interactive format to small groups of collaborating GPs. It is centred around cases brought forward by participants themselves and is facilitated by an experienced trainer with expertise in sexual violence care and communication. Depending on local circumstances and learning objectives, participants may also practise conversations with simulated patients, allowing them to rehearse how to raise the topic of sexual assault and respond to disclosures in a safe learning environment. Importantly, the training act...
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We were very pleased to read the thoughtful response by Kane and colleagues to our qualitative interview study on barriers that deter GPs from discussing sexual assault with patients. Their findings provide important complementary evidence and reinforce the need for educational interventions that support primary care professionals in addressing sexual assault in clinical practice.

We agree that education has an important role in overcoming many of the barriers identified in our study. In fact, the training program we are currently developing is explicitly informed by both our scoping review on educational interventions in this field¹ and the findings of our qualitative interview study among GPs. The program is designed not only to increase knowledge, but also to address the practical, emotional, and interpersonal challenges that GPs encounter when discussing sexual assault as found in our interview study.

The training is delivered in an interactive format to small groups of collaborating GPs. It is centred around cases brought forward by participants themselves and is facilitated by an experienced trainer with expertise in sexual violence care and communication. Depending on local circumstances and learning objectives, participants may also practise conversations with simulated patients, allowing them to rehearse how to raise the topic of sexual assault and respond to disclosures in a safe learning environment. Importantly, the training actively addresses the specific barriers identified in our interview study. By creating opportunities for reflection, peer learning, and skills practice, the program aims to increase both competence and confidence. To evaluate the implementation of learning in daily practice, participants are invited to complete a follow-up evaluation six weeks after training. This assessment explores how the training has influenced their clinical behaviour, perceived competence, and experiences discussing sexual assault with patients.

We therefore fully support the call by Kane and colleagues for enhanced education in this area. While didactic teaching can provide an important foundation, we believe that interactive, practice-oriented training that directly addresses the barriers experienced by GPs may offer additional opportunities to facilitate meaningful and sustained changes in clinical practice.

Reference

1. van Zyl-Bonk FE, Lange S, Lagro-Janssen ALM, Teunissen TAM. Diagnosing and Discussing Sexual Abuse: A Scoping Review on Training Methods for Health Care Professionals. Adv Med Educ Pract. 2024; 15:243-255. doi: 10.2147/AMEP.S444718.

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Competing Interests: None declared.
Published on: (22 May 2026)
Page navigation anchor for What deters GPs from talking about sexual assault? a qualitative interview study
What deters GPs from talking about sexual assault? a qualitative interview study
Daniel Kane, Obstetrician & Gynaecologist and Medical Forensic Examiner, Sexual Assault Treatment Unit, Rotunda Hospital, Dublin, Ireland
Other Contributors:
Maeve Eogan, Obstetrician & Gynaecologist and National Clinical Lead for SATU Services,

Karen Flood, Obstetrician & Gynaecologist, Rotunda Hospital, Dublin, Ireland

Kieran Kennedy, General Practitioner & Lecturer in School of Medicine at the National University of Galway
We read with great interest the qualitative study by van Zyl-Bonk et al. exploring the barriers that deter GPs from identifying and discussing sexual assault (SA) with their patients.¹ Their findings and conclusions resonate strongly with our own work examining GP trainees' knowledge and comfort with post-SA care in the Republic of Ireland.²
Van Zyl-Bonk et al. identified barriers including the biomedical gaze, solutionism, and dismissal of responsibility, alongside personal barriers such as emotional reluctance and gender-related hesitancy. Underpinning many of these barriers, we would argue, is a more fundamental issue: a lack of formal education on SA at both undergraduate and postgraduate levels. In our study of 75 GP trainees, only 13.2% had received teaching on post-SA care during medical school, and just 28.3% had received any formal postgraduate instruction on the subject.² Despite this, 43.4% had already been required to refer a patient for post-SA care. This highlights a striking and concerning gap between clinical exposure and educational preparation.

Importantly, our findings suggest that targeted educational intervention can meaningfully address several of the barriers described by van Zyl-Bonk et al. Following a single one-hour didactic teaching session delivered by a specialist forensic examiner, GP trainees demonstrated significant improvements in comfort with SATU referral pathways, explaining forensic exa...
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We read with great interest the qualitative study by van Zyl-Bonk et al. exploring the barriers that deter GPs from identifying and discussing sexual assault (SA) with their patients.¹ Their findings and conclusions resonate strongly with our own work examining GP trainees' knowledge and comfort with post-SA care in the Republic of Ireland.²
Van Zyl-Bonk et al. identified barriers including the biomedical gaze, solutionism, and dismissal of responsibility, alongside personal barriers such as emotional reluctance and gender-related hesitancy. Underpinning many of these barriers, we would argue, is a more fundamental issue: a lack of formal education on SA at both undergraduate and postgraduate levels. In our study of 75 GP trainees, only 13.2% had received teaching on post-SA care during medical school, and just 28.3% had received any formal postgraduate instruction on the subject.² Despite this, 43.4% had already been required to refer a patient for post-SA care. This highlights a striking and concerning gap between clinical exposure and educational preparation.

Importantly, our findings suggest that targeted educational intervention can meaningfully address several of the barriers described by van Zyl-Bonk et al. Following a single one-hour didactic teaching session delivered by a specialist forensic examiner, GP trainees demonstrated significant improvements in comfort with SATU referral pathways, explaining forensic examinations to patients, offering emergency contraception advice, and understanding HIV post-exposure prophylaxis timelines.² The solutionism barrier identified by van Zyl-Bonk et al. — whereby GPs avoid raising SA because they feel ill-equipped to act — may be directly amenable to this kind of structured, practical education. When clinicians understand what they can offer, including referral options, evidence storage without police involvement, and immediate medical care, they are better positioned to initiate these conversations.

Van Zyl-Bonk et al. rightly call for training that goes beyond knowledge acquisition to address emotional and interpersonal dimensions. We agree. However, our findings demonstrate that even a brief, reproducible didactic session represents a meaningful and accessible first step toward closing this educational gap. We would advocate for its integration into all GP postgraduate training curricula as a matter of priority.

References

1. van Zyl-Bonk FE, Lagro-Janssen ALM, de Klein AMCH, Maria Teunissen TA. What deters GPs from talking about sexual assault? a qualitative interview study. Br J Gen Pract 2025; 75(761):e862-e869. doi: 10.3399/BJGP.2024.0761.

2. Kane D, Kennedy KM, Flood K, Eogan M. General practice trainees' understanding of post-sexual assault care: the impact of a specialist educational intervention. Irish Journal of Medical Science 2024;193:1331–1336. doi 10.1007/s11845-023-03576-3
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Competing Interests: None declared.