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Perspectives in Disease Prevention and Health Promotion Violence Education in Family Practice Residency Programs -- United States, 1989

In the United States, violence is a well-documented public health problem (1-3), and physicians have been urged to help reduce the impact of this problem (4). To assess efforts to educate family practice physicians about violence, in 1989, an investigator in a family practice residency program conducted a national survey of all family practice residency directors. The survey assessed the beliefs of residency directors regarding specific types of violence and the role of family practice residency programs in educating physicians about this problem. This report summarizes results of the survey (5).

In August 1989, a questionnaire approved by the Society of Teachers of Family Medicine was mailed to directors of the 382 family practice residency programs in the United States and Puerto Rico; 290 (76%) responded. Nonrespondents and respondents were similar by type of program structure and by location of the residency (5).

Most residency directors indicated that education about violence was not a formal part of the curricula (169 (59%), none or limited; 106 (36%), some; and 15 (5%), substantial). Programs with substantive content were most common in the East South Central region (eight (67%)) and least prevalent in the Mountain region (two (15%)). Eighty (28%) respondents indicated plans to incorporate violence education in the curricula; most (61 (76%)) of these planned to add conferences, lectures, or behavioral science seminars.

Most program directors believed that education regarding violence was not addressed in their residencies (nine (3%), none; and 189 (65%), limited). However, most programs were addressing physical abuse of children (270 (93%)), sexual abuse of children (249 (86%)), and rape (241 (83%)). Program directors believed the most prevalent specific types of violence in society include violence associated with substance abuse (157 (54%)), child physical abuse (133 (46%)), and child sexual abuse (125 (43%)). In addition, program directors considered child physical abuse (131 (45%)), violence and substance abuse (122 (42%)), and child sexual abuse (116 (40%)) as priority topics for education of physicians. Adapted from: Family Medicine 1991;23:194-7, as reported by MK Hendricks-Matthews, PhD, Family Practice Residency Program, Barberton Citizens Hospital, Barberton, Ohio. Program Development and Implementation Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note:

Because of the pervasive social, psychological, and physical impact of violence in the United States (6,7), many physicians provide care for patients who are victims, perpetrators, and/or witnesses of violent crimes. As a consequence of their exposure to violent crimes, many of these persons incur emotional and physical sequelae. Without addressing the underlying cause of these symptoms (i.e., the violence), symptoms may be prolonged (8), causing these patients to return to medical settings because of the need for treatment of chronic problems. Although family physicians are uniquely positioned to assist in reducing these effects of violence, the findings in this report and others (9) indicate that instruction about particular types of violence is generally limited and reflects the extent to which residency directors consider specific topics to be important. Thus, family practice residency directors must consider violence to be an important problem before educational opportunities are provided for residents.

The results of this survey of residency directors are subject to at least two limitations. First, directors were not asked to describe specific approaches used to teach about particular types of violence, nor to specify the amount of instructional time allotted for specific topics. Thus, these findings may have overestimated the prevalence of violence education in family practice residency programs. Second, the conventional division of residency programs based on program structure type (e.g., community-based and medical school-based), rather than on geographic parameters (e.g., rural/urban or suburban/inner city), may have indicated greater differences among programs.

Legislators and law enforcement officials have primary responsibility for prevention and control of violence; however, physicians are often the principal source of treatment for victims and perpetrators of violence. Therefore, if not properly trained, physicians may be limited in their abilities to recognize and screen patients who have health problems related to exposure to violence (e.g., as victims, perpetrators, or witnesses). The results of this survey may be useful for planning future curricula for physician training about violence prevention.

References

  1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

  2. US Department of Health and Human Services/US Department of Justice. Surgeon General's Workshop on Violence and Public Health: report. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

  3. Koss M, Koss P, Woodruff W. Deleterious effects of criminal victimization on women's health and medical utilization. Arch Intern Med 1991;151:342-7.

  4. American Medical News. Doctors urged to act in crisis of violence. American Medical News, March 4, 1991.

  5. Hendricks-Matthews MK. A survey on violence education: a report of the STFM Violence Education Task Force. Fam Med 1991;23:194-7.

  6. Hendricks-Matthews MK. Proposal for the development of curricular guidelines and teaching strategies in the area of violence education. Presented to the Society of Teachers of Family Medicine Board of Directors, Denver, Colorado, May 1989.

  7. Rice DP, MacKenzie EJ, Jones AS, et al. The cost of injury in the United States: a report to Congress. San Francisco: University of California, Institute of Health and Aging; Johns Hopkins University, Injury Prevention Center, 1989.

  8. Hendricks-Matthews MK. Somatic and psychological sequelae to victimization. In: Halverson K, Hendricks-Matthews MK, Elliot B, eds. Primary care clinics of North America: family violence and abusive relationships. Philadelphia: WB Saunders (in press).

9. CDC. Education about domestic violence in U.S. and Canadian medical schools, 1987-88. MMWR 1989;38:17-9.

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