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Education about Adult Domestic Violence in U.S. and Canadian Medical Schools, 1987-88

Approximately 4 million spouses are beaten annually in the United States (1), and the rate of violence among college student dating partners on some campuses may approach that found within marriage (2,3). The prevalence of elder abuse is also under investigation (4). Despite substantial estimates of the magnitude of adult domestic violence (ADV), evidence exists that physicians and other health-care workers require further instruction in recognizing and treating these problems. For example, a study at a large metropolitan hospital suggested that, by using current diagnostic techniques, personnel in that hospital correctly identified fewer than 5% of episodes of domestic violence involving adult female patients (5).

The Surgeon General's Workshop on Violence and Public Health (6) and the Attorney General's Task Force on Family Violence (7) recommend that curricula of medical schools and other relevant professional schools include education about domestic violence. To determine current curriculum content about ADV, all 143 accredited U.S. and Canadian medical schools were surveyed during the 1987-88 academic year by the New Jersey Medical School Domestic Violence Prevention Project (NJMS DVPP). The surveys were mailed to curriculum contact persons* identified by the Association of American Medical Colleges. Instruction about ADV was defined as training, specified in the curriculum, that pertained to any or all types of ADV. The survey did not specifically define "adult domestic violence," but listed the following examples: physical abuse, emotional abuse, sexual abuse, spouse abuse, elder abuse, battered women, and dating violence.

Representatives of 116 schools (81%) responded to the survey. Of those 116 schools, 61 (53%) indicated that their students did not receive any instruction about ADV; 49 (42%) reported that their students received such instruction as part of at least one required course; and six (5%) reported that their students received no required instruction about ADV but could choose to receive such instruction as part of an elective.

Overall, 77 courses that included at least one session of instruction about ADV were identified. Because some of these courses devoted more than one session to such instruction, a total of 85 sessions of instruction addressing ADV were identified. For schools offering such sessions, the mean number of sessions offered was 1.5, and the mean number of hours per session was 1.9 (range, 0.5-6.0).

Of all sessions addressing ADV, 68% were offered in the first 2 years of medical school. Departments of psychiatry or other behavioral sciences taught 63% of all sessios on ADV; family practice, 7%; geriatrics, 7%; and internal medicine, 7%. The remaining 16% were either interdepartmental or under the auspices of the Dean or departments of community/environmental health, obstetrics and gynecology, pathology, or surgery. The format of instruction varied widely, sometimes including use of films or direct contact with domestic violence victims to supplement lectures and discussions. Reported by: HA Holtz, MD, C Hanes, MPH, New Jersey Medical School, Univ of Medicine and Dentistry of New Jersey. MA Safran, College of Medicine, State Univ of New York Health Science Center, Syracuse. Intentional Injuries Section, Epidemiology Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Within the past decade, ADV has been identified as a major public health problem in the United States (5,6,8). No surveillance of ADV exists, and assessment of the magnitude and impact of this problem is difficult. To help physicians better detect and properly refer victims and potential victims of domestic violence, the American College of Obstetricians and Gynecologists (ACOG) recently sent information about battered women to its 28,000 members (9,10).** This mate rial suggests that women identified as domestic abuse victims should be provided information about women's rights, available community resources, and strategies to deal with abusive relationships. This survey may be the first attempt to determine the prevalence of medical school instruction about ADV. The finding that 58% of the responding schools do not require instruction about ADV may be conservative because schools were classified as offering such instruction even if such training was limited to one category of abuse, such as elder abuse or spouse abuse. No attempt was made to determine whether schools that offer ADV instruction were more likely to respond to the survey, nor was any attempt made to evaluate the prevalence of instruction that may not be specified in the curriculum (e.g., direct clinical contact with abuse victims).

An increase in demand for protective and rehabilitative services occurred when reporting of child abuse became more common after the widespread adoption of mandatory reporting laws in the 1960s (11). Similarly, curricular changes that increase detection and referral rates for ADV might further increase demand for community services. Medical education and community efforts in both child abuse and ADV should promote not only effective recognition, treatment, and referral of victims but also primary prevention. As a first step, a suggested hospital protocol (12) and a curriculum description and training manual for health educators (13) will be distributed by the NJMS DVPP to the surveyed faculty members requesting them. Further examination of medical school curricula about ADV and evaluation of methods of such instrution are needed. The methods that best promote effective treatment and prevention should then be disseminated to all programs and/or facilities that train health professionals.

Additional information may be obtained from the NJMS DVPP, University Hospital, I-246150 Bergen St., Newark, NJ 07103-2757; or from the Jersey Battered Women's Service, Inc., (201) 455-1256.


  1. Straus MA, Gelles RJ, Steinmetz SK. Behind closed doors: violence in the American family. Garden City, New York: Anchor Press/Doubleday, 1980.
  2. Makepeace JM. Life events stress and courtship violence. Fam Relations 1983;32:101-9.
  3. Cate RM, Henton JM, Koval J, Christopher FS, Lloyd S. Premarital abuse: a social psychological perspective. J Fam Issues 1982;3:79-89.
  4. Pillemer K, Finkelhor D. The prevalence of elder abuse: a random sample survey. Gerontologist 1988;28:51-7.
  5. Stark E, Flitcraft A, Zuckerman D, Grey A, Robison J, Frazier W. Wife abuse in the medical setting: an introduction for health personnel. Rockville, Maryland: National Clearinghouse on Domestic Violence, 1981. (Domestic violence monograph series no. 7).
  6. 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.
  7. US Department of Justice. Attorney General's Task Force on Family Violence: final report. Washington, DC: US Department of Justice, 1984.
  8. Rosenberg ML, Stark E, Zahn MA. Interpersonal violence: homicide and spouse abuse. In: Last JM, ed. Public health and preventive medicine. 12th ed. Norwalk, Connecticut: Appleton-Century-Crofts, 1986.
  9. American College of Obstetricians and Gynecologists. The battered woman. Washington, DC: American College of Obstetricians and Gynecologists, 1989. (ACOG technical bulletin no. 124).
  10. American College of Obstetricians and Gynecologists. The abused woman. Washington, DC: American College of Obstetricians and Gynecologists, 1988. (ACOG patient education pamphlet no. AT083).
  11. Newberger EH. The helping hand strikes again: unintended consequences of child abuse reporting. In: Newberger EH, Bourne R, eds. Unhappy families: clinical and research perspectives on family violence. Littleton, Massachusetts: PSG Publishing, 1985:171-8.
  12. Braham R, Furniss K, Holtz H, Stevens ME. Hospital protocol on domestic iolence. Morristown, New Jersey: Jersey Battered Women's Service, Inc, 1986.
  13. Braham R, Furniss K, Holtz H. Hospital training on domestic violence. Morristown, New Jersey: Jersey Battered Women's Service, Inc, 1986.

 *If a designated curriculum contact suggested an additional contact, information from both contacts was combined.

 **For more information, contact: ACOG, Resource Center, 409 12th St., SW, Washington, D.C., 20024-2188.

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