Domestic violence recognized but not always investigated by medical students

October 17, 2004

In a new study, most medical students were able to identify domestic violence in a simulated emergency department encounter. However, say the Temple University researchers who conducted the study, some students didn't take the next step, inquiring about dangers that might remain once the patient returned home, a step that could help stop the cycle of domestic violence.

The study, "Medical Interviewing Skills of Fourth Year Medical Students Encountering a Simulated Case of Intimate Partner Violence," will be presented today at the American College of Emergency Physicians annual meeting by Sachin J. Shah, M.D., assistant professor of emergency medicine, Temple University School of Medicine.

Shah explained, "Students and physicians working in an emergency room may be in a unique position to identify victims of intimate partner violence, a significant public health problem affecting millions of women in the United States. The objective of our study was to determine the ability of fourth-year medical students to identify a victim of intimate partner violence using a simulated emergency department encounter."

Simulated patient encounters are an increasingly utilized teaching tool for medical students. The exercises help prepare students for what they'll see when they are physicians and allow them to learn in a controlled teaching environment without consequences.

"Our study was designed to measure both how we as teachers are doing and how well the students are learning. What do we need to teach better or emphasize more?" said David Wald, D.O., assistant professor of emergency medicine at Temple.

In the study, all 196 fourth-year medical students at Temple University School of Medicine completed an exercise with an actor trained to portray a 46-year-old female coming to the emergency room with lower back pain caused by intimate-partner violence. At the end of each 20-minute encounter, the patient documented how the student performed, noting the questions asked, as well as the student's manner, tone and professionalism.

"In most cases, medical students identified that the actor was portraying a victim of intimate partner violence," said Shah. "It is unclear whether this occurred by way of routine screening or as a result of deductive reasoning. Even after identification of intimate partner violence, however, few students inquired into the social history of the spouse, whether the patient has ever been sexually abused, whether she wanted to make a report to the police, or whether a firearm was present in the home."

"Some students didn't go on to ask other pertinent questions, ensuring the safety of the patient at home," said Wald. "These findings will help us shape and improve our curriculum."

As a result of these findings, a discussion regarding domestic violence screening has been incorporated into the emergency medicine clerkship orientation.

In addition to Shah and Wald, research team members included Ruth Lamdan, M.D., associate professor of psychiatry; Michael Curtis, director of the standardized patient program; and Jeffrey Barrett, M.D., assistant professor of emergency medicine.
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Temple University

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