Introducing Violence and Abuse Education into Undergraduate Medical Education Charles P. Mouton, MD, MS Howard University College of Medicine Dept. of Comm. And Family Medicine AVA Biennial Scientific Assembly April 24-25, 2009

Objectives To Identify the requirements for violence education To identify the “access points” in the standard medical curriculum To discuss innovative strategies for violence education in the medical curriculum

Why provide education on Violence Growing problem of violence worldwide Health professionals are often the initial surveillance mechanism Increasing understanding of the health effects of violence Increasing appreciation of the costs associated with violence

LCME Requirement ED-20: The curriculum must prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse.

When is violence currently taught First year ……...12.7% Second year …. 34.5% Third year ……. 48.7% Fourth year …… 3.8% 64 Schools reported a domestic violence curriculum 63 report DV is part of the required curriculum 1 school reported DV as an elective

Current Curricular “access points” Preclinical Courses “Doctoring/Patient care” Behavioral Sciences Clinical Rotations Ambulatory Medicine Psychiatry Emergency Medicine Ob/gyn Family Medicine Neurology Pediatrics Surgery Electives Dermatology

What are other or future “access points” Radiology electives Pathology electives Geriatrics electives Ethics courses Professionalism courses What should an Ideal Violence and Abuse Curriculum in Medical Schools look Like?

HU Healthcare Ethics Course Interdisciplinary course with students and faculty from medicine, dentistry, nursing, pharmacy, and allied health Taught in clinical years using large group lectures followed by small group discussion using a structured format Designed to mimic ethics committee meeting Online supplements: Mastery quizzes and group blog Audience response system used in large lectures

Innovative violence education Similar structure with large group lectures covering various types and effects of abuse as well as an appropriate response. Small group discussion can mimic Death Review Panels Visual presentations should a part Videos, photos, victim presentation, etc. Evokes emotional response with its cognitive effects All strategies need to emphasize clinical competencies

Medical Education needs to emphasize Competencies Basic competencies Professional Behavior Engage and Communicate Apply scientific method and knowledge to problem solving Component competencies Take a clinical history Perform a mental and physical exam Interpret clinical tests Perform basic procedures Manage clinical info Physician Competencies - Diagnosis Clinical Problems - Intervene - Formulate a prognosis Advance Competency - Care within the practice context

Other Strategies Service Learning Student Research Student Advocacy Work with various DV shelters, DARTs,CFRTs, etc. Student Research Student Advocacy Women in Medicine, AMSA, SNMA, Specialty Interest Groups, etc.

Conclusion Education on Violence and Abuse should be a required part of every medical school curriculum Research is needed to determine the best location in the curriculum to prepare students to address this problem Any new curricula on violence and abuse should emphasize the core competencies and provide some experiential learning