Domestic violence education in medical school: does it make a difference?

A Scoping Review of Published Intimate Partner Violence Curricula for Medical Trainees

Intimate partner violence (IPV) affects many, and health care has the potential to provide a safe space for individuals experiencing IPV. However, physicians cite lack of time and education as barriers. The aim of this study is to complete a review of published IPV curricula in medical school, residency training, and postresidency training. We performed a scoping review to provide a quantitative assessment and summary review of existing IPV curricula. In May 2020, a librarian conducted a search of Ovid MEDLINE, Ovid EMBASE, and Scopus. We evaluated each article for the following curriculum content and structure items: (1) year introduced; (2) delivery method; (3) curriculum type; (4) curriculum content; (5) curriculum effectiveness; and (6) implementation barriers. Fifty-six articles met criteria, most were for medical school learners (n = 32, 57.1%) and short-term (lasting less than one academic year) (n = 41, 73.2%). For residency, IPV curricula were most frequently taught in family medicine, internal medicine, and emergency medicine. Formal lecture and use of standardized patients were the most popular delivery methods. Most curricula taught risk factors for and identification of individuals who have experienced IPV. The most cited implementation barrier was limited time in standard medical education, followed by inability to measure the effectiveness of the curriculum. There was great variation in the methods of assessing effectiveness of IPV curricula. Published IPV curricula are varied, without consistent validated tools for assessing efficacy. Future initiatives to establish a standard of competency for medical students regarding IPV, including a standard curriculum, may better ensure that physicians are capable of identifying and caring for individuals who have experienced IPV.

Which Violence Against Women Educational Strategies Are Effective for Prequalifying Health-Care Students?: A Systematic Review

Gender-based violence (GBV) is a global public health issue which disproportionately affects women. Health-care providers have an important role in recognizing and addressing GBV in practice, yet research suggests that the issue remains underrecognized, with many qualified professionals reporting lack of confidence and a sense of unpreparedness. Prequalifying GBV educational strategies are inconsistent in both quantity and quality worldwide, and to date, there has been no comprehensive review of those programs' effectiveness. This internationally focused literature review aimed to identify best educational practices in GBV for prequalifying health-care students. A systematic search of six databases yielded 17 studies meeting the inclusion criteria, with all studies examining one or more educational intervention. Quality appraisal was undertaken and data were tabulated to capture relevant information. Thematic findings suggest that interactive educational strategies yield better results than didactic approaches. Similarly, interventions with a focus on practical application of learning are generally preferred over strictly theoretical approaches. Courses of longer duration seem to be more effective in instilling attitudinal changes. Lastly, gendered differences were noted in a number of studies, with female students consistently outperforming males. However, more research is needed before conclusions can be drawn about the effectiveness of single- versus mixed-gender audiences. This review makes a useful contribution to the literature of health education, supporting many findings from previous studies and identifying knowledge gaps to be explored in future research. There are implications for both educators and practitioners in creating discernible change for women in their care.

Medical students' clinical performance of dealing with patients in the context of domestic violence

PURPOSE

The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV).

METHODS

The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students' performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator's psychosocial state (P), checking the victim's condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I).

RESULTS

Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator's state and patient's physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N.

CONCLUSION

Medical students showed poor clinical performance in the DV station. They performed an 'event oriented interview' rather than 'patient centered' communication. An integrated educational program of DV should be set to improve students' clinical performance.

Evaluation of a women's safe shelter experience to teach internal medicine residents about intimate partner violence. A randomized controlled trial

Although intimate partner violence (IPV) remains a major public health problem, physicians often fail to screen female patients. Reported IPV training approaches suffer from weak study designs and limited outcome assessments. We hypothesized that an educational experience for residents at a women's safe shelter would have significantly greater impact on IPV competencies, screening, and care for victims than a workshop seminar alone. In a pre-post randomized controlled trial, we compared residents exposed to the workshop seminar alone (controls) to residents exposed to these methods plus an experience at a women's safe shelter (cases). Competencies were assessed by written questionnaire and included knowledge, skills, attitudes, resource awareness, and screening behaviors. Of the 36 residents in the trial, 22 (61%) completed both pre- and postquestionnaires. Compared to controls, cases showed significantly greater pre-post improvement in the knowledge composite subscale. There were no significant differences between cases and controls in the subscales of skills, attitudes, or resource awareness. Cases increased their self-reported screening frequency but this did not differ significantly from the controls. Enhancing traditional IPV curriculum with a women's safe shelter educational experience may result in small improvements in residents' knowledge about IPV.

Medical student training in domestic violence: a comparison of students entering residency training in 1995 and 2001

BACKGROUND

As domestic violence (DV) is frequently unrecognized by physicians, efforts to improve education on the topic have been undertaken.

PURPOSE

To assess changes in medical education about DV.

METHODS

Incoming residents from 1995 (N = 52) and 2001 (N = 43) were surveyed regarding education and attitudes about DV.

RESULTS

The resident-reported emphasis on DV education increased significantly from 1995 to 2001. Hours devoted to the subject experienced no significant change. The likelihood they would ask female patients about DV and their competence in dealing with DV-specific situations experienced no significant improvement-both were rated below average.

CONCLUSIONS

Although emphasis on medical education about DV has improved from 1995 to 2001, likelihood of screening and competence at dealing with DV has not improved. The content of undergraduate medical education about DV should be strengthened, and the educational process should continue during residency training.

When is the personal professional in public child welfare practice? The influence of intimate partner and child abuse histories on workers in domestic violence cases

OBJECTIVE

The objective of this article is to examine children's services workers' (CSWs') personal histories of abuse and their influence on professional responses to allegations of domestic violence.

METHOD

Using an anonymous questionnaire, data were collected from CSWs in two large urban counties in Southern California who participated in a domestic violence training program (n=303). It was hypothesized that CSWs' responses to domestic violence cases would be affected by personal histories of abuse and the degree to which the CSWs identified with battered women.

RESULTS

Approximately one-half of the respondents reported experiencing physical and/or sexual violence by an intimate partner. One-third of respondents reported physical abuse, and 22%, sexual abuse during childhood. The experience of childhood sexual abuse, especially for female CSWs, was associated with increased support for removal of children whose mother is being abused. Those CSWs with a history of partner violence who identified with battered women were less likely to approve of removing children from the battered mother than were CSWs without partner abuse history or identification with battered women.

CONCLUSIONS

Our findings provide support for expanded training efforts that recognize the ongoing impact of victimization on CSWs' professional functioning.

Intimate partner violence from the emergency medicine perspective

BACKGROUND

The incidence of acute cases of intimate partner violence (IPV) in the Emergency Department (ED) patients is between 2 and 7.2%. Ongoing IPV may be an immediate cause of presentation for medical care, or it may not be readily apparent. Over the last two decades efforts to improve identification of IPV in the ED have been successful.

METHODS

A medline literature search from 1981-2001 was performed. A review of intimate partner violence from the emergency department provider perspective is performed. A discussion of the screening/detection of intimate partner violence and the barriers to improving detection rates is provided.

RESULTS

The review of the current literature shows that IPV is a frequent cause of illness or injury in patients presenting in the ED. Screening programs for intimate partner violence have shown to increase the identification of patients experiencing acute episodes of abuse and seeking treatment. The difficulty has been in sustaining the programs and improving the screening of patients. Patient, provider and systems barriers prevent adequate recognition and management of the problem.

CONCLUSION

Detection of IPV in patients presenting to the ED can be improved by providing educational programs and screening tools to health care providers. Sustaining the screening programs is more difficult and requires a health care system-wide effort.