Forensic examinations are a critical yet persistently overlooked responsibility in emergency departments (EDs) across the country. Although physicians and hospitals recognize their importance in principle, the actual exams and care are all too often delayed, avoided, or transferred elsewhere, compounding the traumatic experience for survivors of violence. As emergency physicians, we are experts in handling high-stakes and high-acuity cases, yet forensic care remains obscured and deliberately circumvented in daily practice. Significant gaps in current practice underscore the need for forensic training. Studies show that most emergency health professionals know fewer than 50 percent of the required procedures for documenting, collecting, and preserving forensic evidence.¹

In many cases, actions with medicolegal implications are neglected, resulting in the loss of critical information for both the justice system and patient protection.² A pilot study in Italy evaluated a six-hour clinical forensic medicine course for emergency physicians using a 16-item assessment scale. Although performance improved, the gains were modest, suggesting that brief educational intervention alone may be insufficient, and that more structured, longitudinal training is needed.³

Despite the American Board of Emergency Medicine requiring competency in the assessment and examination of sexual assault patients, over 70 percent of U.S. emergency medicine residency programs have minimal or no specific requirements for forensic examination training.⁴ This limited exposure may fail to meet the American Board of Emergency Medicine’s Model of Clinical Practice, which explicitly requires competency in the assessment and examination of sexual assault patients.⁴ When residents complete training with such limited experience, they enter independent practice unprepared to care for a vulnerable population that relies on EDs for services.

Many EDs have forensic or Sexual Assault Nurse Examiner (SANE) programs, or will refer survivors to collaborating community programs, but this does not remove responsibility from physicians. In these settings, resident exposure to forensic care may inadvertently decrease, contributing to a generation of emergency physicians who lack fundamental competency in an essential clinical skill.⁵ Although SANE nurses offer specialized expertise, emergency physicians must retain the ability to provide comprehensive care when such specialists are unavailable, particularly in rural or under-resourced settings. Although it may not be feasible for every program to incorporate a dedicated forensic rotation, offering it as an elective would provide a meaningful opportunity for interested trainees.

While the ultimate direction of residency training remains under discussion, a potential transition of emergency medicine residency programs to four years represents an opportunity to address this long-standing educational gap. One of the key elements in the new curriculum introduced by the Accreditation Council for Graduate Medical Education (ACGME) for Emergency Medicine includes “performance of sensitive exams.”⁶ The care of sexual assault survivors clearly falls within this category, as does the evaluation of victims of interpersonal violence, child and elder abuse, strangulation, and other violent crimes.