E-learning program sharpens forensic nurses’ response to sex trafficking

Sex trafficking is one of the most pervasive health and human rights issues of our time, disproportionately affecting women and girls who are already structurally marginalized. Yet the nurses most likely to encounter trafficked persons in clinical settings have often received little or no training specifically focused on this crime. A new study published in BMC Nursing suggests that a carefully designed e-learning curriculum can change that, rapidly and measurably improving the expertise, knowledge, and skills that forensic nurses need to respond appropriately to diverse persons who have been sex trafficked.

Forensic nurse examiners occupy a unique position in the healthcare system. Working at Ontario, Canada’s 37 Sexual Assault/Domestic Violence Treatment Centres, these specialized nurses provide medical examinations, collect forensic evidence, and offer emotional support to people experiencing violence. Because trafficked persons frequently present in healthcare settings under other guises—perhaps as victims of sexual assault, or with unexplained injuries or infections—forensic nurses are often the first, and sometimes the only, healthcare professionals positioned to recognize trafficking and offer needed supports. Until now, however, comprehensive training focused specifically on sex trafficking was lacking across this network.

A research team led by Janice Du Mont of Women’s College Research and Innovation Institute and the Dalla Lana School of Public Health at the University of Toronto set out to fill this gap. Working with an advisory group of experts who had personal and/or professional experience with sex trafficking, the team developed a 1.5-hour interactive e-learning curriculum for forensic nurses across Ontario’s treatment centre network. The curriculum was designed not as a generic awareness course but as a targeted program organized around 25 learning objectives grouped into six domains: Understanding the Issue, Initial Assessment, Medical Examination and Treatment, Discharge, Follow-up Visit, and Resources. Content developers included Tara Leach, founder and clinical director of the H.E.A.L.T.H Clinic in Ottawa, and Frances Montemurro of Women’s College Hospital, with advisory committee members drawn from treatment centres, anti-trafficking organizations, and police services across the province.

The evaluation ran from September 2023 to March 2024 and produced striking results. In total, 189 nurses completed the curriculum, 97.8 percent of whom were women, and 42.6 percent of whom were aged 25 to 34 years. Notably, 58 percent reported having already provided care to a person who had been or was currently being trafficked—underscoring how frequently these nurses encounter trafficking in their day-to-day practice, even without dedicated training.

Participants rated their self-reported expertise in providing care to sex trafficked persons on a five-point scale, from no expertise to very high level expertise. Before training, the mean rating was 2.2, indicating a low level of confidence. After the 1.5-hour program, the mean jumped to 3.3, a statistically significant improvement. The researchers used paired t-tests to compare pre- and post-training ratings, and the difference was significant at p less than .001, meaning the likelihood that this improvement occurred by chance is extremely small.

Knowledge and skills also improved significantly across all six domains of the curriculum. In Understanding the Issue, mean ratings rose from 3.5 to 4.4. In Initial Assessment, they climbed from 3.1 to 4.2. Medical Examination and Treatment showed a smaller but still significant gain, from 4.0 to 4.4—likely reflecting that nurses already felt relatively competent in this area before training. Discharge ratings rose from 3.2 to 4.2, Follow-up Visit from 3.2 to 4.2, and Resources from 3.2 to 4.1. All improvements were significant at p less than .001.

The technical design of the evaluation is worth noting. By using paired t-tests, the researchers compared each nurse’s own before-and-after ratings rather than comparing different groups, which controls for individual differences in baseline knowledge. The five-point Likert-type scales ranged from strongly disagree to strongly agree for knowledge and skills items, allowing fine-grained measurement of change. The consistency of improvement across all six domains—rather than in just one or two areas—suggests the curriculum addressed genuine gaps throughout the care pathway, from first contact through follow-up and referral to community resources.

What makes this study particularly compelling is the brevity of the intervention. One and a half hours of interactive e-learning produced consistent, statistically robust gains across a large sample of practicing nurses. This has important implications for healthcare systems worldwide, where training time is scarce and staff are stretched thin. The curriculum could serve as a blueprint for training forensic nurses in other jurisdictions, the researchers conclude, offering a scalable model that does not require in-person workshops or lengthy secondments.

The study also highlights the importance of involving people with lived experience in curriculum design. The advisory group included experts with personal and/or professional experience in sex trafficking, ensuring the content reflected the realities trafficked persons face rather than abstract clinical protocols. This approach aligns with a growing movement in healthcare education to co-design training with the communities it is meant to serve, particularly for issues like trafficking where trust, trauma-informed care, and cultural safety are paramount.

Sex trafficking remains a hidden crime in many healthcare settings, and trafficked persons may not self-identify or may fear disclosure. By equipping forensic nurses with the knowledge to recognize indicators, conduct trauma-informed assessments, provide appropriate medical treatment including STI and HIV prophylaxis, and connect trafficked persons with community resources, this e-learning curriculum represents a meaningful step forward. As the researchers note, their findings show promise in improving the expertise, knowledge, and skills necessary to respond to those sex trafficked—and offer a replicable model for healthcare systems seeking to close a critical training gap.

Subject of Research: Evaluating an e-learning curriculum for forensic nurse examiners on providing supports to persons sex trafficked

Article Title: Evaluating an e-learning curriculum for forensic nurse examiners on providing supports to persons sex trafficked

Article References: Du Mont, J., Fan, S., Macdonald, S., Mason, R., & Kosa, S. D. (2026). Evaluating an e-learning curriculum for forensic nurse examiners on providing supports to persons sex trafficked. BMC Nursing. https://doi.org/10.1186/s12912-026-05515-w

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05515-w

Keywords: Evaluating, e-learning, curriculum, forensic, nurse, examiners, providing, supports, persons, trafficked, scientific research