Motivations, barriers and enablers for medical and forensic examiners in New South Wales sexual assault services: a qualitative interview study

Objectives: To understand the motivations, barriers and enablers for doctors and nurses to work as medical and forensic examiners in New South Wales sexual assault services. Design: Qualitative interview study using semi-structured interviews. Setting: Interviews were conducted from 1 May to 31 August 2023 in NSW, Australia. Participants: Thirty-one participants (27 female; 23 doctors, 8 nurses) — who were currently working as examiners in a NSW Health sexual assault service, had left the role within the previous 3 years, or had undertaken training for this role within the previous 3 years but were not working in this capacity — were recruited by email invitation from the NSW Health Education Centre Against Violence. Main outcome measures: Key themes affecting workforce participation. Results: Using inductive thematic analysis, we determined four key themes affecting workforce participation: the responsibility burden, on-call challenges, high expectations of medicolegal expertise, and inadequate human resources affecting supervisor and peer support. The workforce was highly motivated and, in the absence of sufficient organisational support, this became a responsibility burden. For many participants, the most challenging aspect of their role was being predominantly on call, which made them feel isolated, invaded their personal time, and affected their preferred mechanisms for managing the traumatic aspects of the work, which were peer support and compartmentalisation. Medicolegal responsibilities were motivating for some participants but represented a significant barrier for many due to high expectations and unfamiliarity. Adequate staffing, opportunities for workplace-based education, and more supervisor and peer support were desired. Conclusion: Additional support for medical and forensic examiners can overcome barriers, particularly regarding the medicolegal aspects of the role. Employers should ensure the work conditions of examiners enable them to participate in the workforce safely, ensuring that the strong motivations to participate are not undone by organisational factors.