Learning to care for vulnerable populations, including survivors of domestic violence, is an essential part of undergraduate and graduate medical education. While classroom instruction may increase learners' knowledge, it may not teach the skills required to successfully screen and respond to survivors of violence in the office. Formal office-based teaching about domestic violence is hampered by difficulty predicting when and where survivors of violence will be seen. As a result, learners' experiences with domestic violence are fragmented and inconsistent.
Simulated patients can fill this void, reliably enabling learners to apply their knowledge to the clinical environment. This simulated patient case aims to enable learners to recognize and respond to victims of domestic violence. The patient presents with a complaint (headache) commonly encountered in the primary care setting. Triggers to encourage learners to ask about domestic violence (e.g. chronic unexplained pain, miscarriages, and possible family history of violence) are embedded within the case.
Twelve primary care internal medicine residents participated in this case. Four had participated in an 8-week seminar series in domestic violence 18 months prior to the simulated patient program that included 24-hours of classroom and community-based instruction on this topic. Eight residents had received only a one-hour conference on domestic violence. Of the 4 residents with extensive instruction in domestic violence, only 3 screened the simulated patient for domestic violence. All 3 of these residents responded appropriately to the survivor; including validating her experience, assessing her safety, and referring her for appropriate advocacy, counseling and legal services. (Reporting domestic violence is not mandatory in this state.) Of the 8 residents with minimal prior instruction in domestic violence, 5 screened the simulated patient for domestic violence. All 5 of these residents referred the patient for appropriate services, yet only 3 of the 5 validated the patient's experience and 4 out of 5 assessed her safety. Of the 12 residents who participated in this case, 10 found the case highly educational and 2 found it very educational. Eight residents found the case highly realistic, 3 found it very realistic, and 1 found it somewhat realistic. Residents felt the best components of the simulated patient program were the opportunity to obtain feedback about their communication skills, the post-clinic conference, learning about vulnerable populations, and the overall quality of the program. Eleven of the residents recommended that the residency program offer another simulated patient program in the future; one resident did not wish to participate in another simulated patient program. The post-encounter discussion and videotape review provide opportunities to reinforce and further strengthen learners' knowledge and skills.
- To recognize risk factors for domestic violence.
- To recognize chronic unexplained pain as a common presenting symptom in survivors of domestic violence.
- To demonstrate screening for domestic violence.
- To respond appropriately to survivors of violence.
None to report.
None to report.
Glick SB, Lemon M. Beyond "Call Social Work": a simulated patient program to improve residents' ability to care for vulnerable populations [Society of General Internal Medicine National Meeting, Poster, Vancouver, British Columbia, Canada]. J Gen Intern Med. 2003;18(Suppl 1):109.
Glick S, Abrams R, Buchanan D, Cohen M, Francis L, Lemon M, McAuley J, Riordan K, Rohr L, Smith J, Whitaker E. Teaching and learning about vulnerable populations. Half-day presession at: Society of General Internal Medicine National Meeting; 2002; Atlanta, GA.
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