Knight R A, Remington P L
University of Wisconsin, Madison, USA.
J Womens Health Gend Based Med. 2000 Mar;9(2):167-74. doi: 10.1089/152460900318669.
Internal medicine residency programs will need to train residents about domestic violence to comply with the Residency Review Commission standards. To assess the effectiveness of an educational intervention intended to increase screening of patients for domestic violence by internal medicine resident physicians and identify characteristics associated with increased screening, we used a quasi-experimental, pretest/posttest trial. This was conducted in an internal medicine residency program and its affiliated primary care clinic with categorical internal medicine and combined medicine/pediatrics resident physicians. Exit interview surveys of patients were conducted at baseline and following the educational program. Patients were questioned about demographics and if they were asked about domestic violence during the current visit. Physicians were questioned about demographics and attitudes and beliefs related to domestic violence. Prior to the intervention, only 0.8% (1 of 122) of patients reported being asked about domestic violence. After the intervention, the percentage asked rose to 17% (20 of 116). The odds ratio (OR) for being asked about domestic violence after training was 25.2 (6.1-104). Patients who were younger than 50 years were more likely to be asked (OR 2.5, 1.5-4.6). Caucasian physicians were more likely to ask (OR 2.8, 1.1-7.6). Patients reporting they were taught breast self-examination at that day's visit were also more likely to be screened (OR 2.9, 1.1-7.9). We found evidence that moderately intense training and focusing on results can increase resident physician screening rates for domestic violence. To do so effectively, we recommend a training session similar to this one and continued monitoring of outcome in the clinical setting.
内科住院医师培训项目需要对住院医师进行家庭暴力方面的培训，以符合住院医师评审委员会的标准。为了评估一项旨在提高内科住院医师对患者家庭暴力筛查率的教育干预措施的有效性，并确定与筛查率提高相关的特征，我们采用了一项准实验性的前测/后测试验。该试验在内科住院医师培训项目及其附属的初级保健诊所进行，参与对象为内科分类住院医师以及内科/儿科联合住院医师。在基线期和教育项目结束后，对患者进行了出院访谈调查。询问患者的人口统计学信息以及在本次就诊期间是否被问及家庭暴力问题。询问医生的人口统计学信息以及与家庭暴力相关的态度和信念。干预前，只有0.8%（122人中的1人）的患者报告被问及家庭暴力问题。干预后，被问及该问题的比例上升到了17%（116人中的20人）。培训后被问及家庭暴力问题的优势比（OR）为25.2（6.1 - 104）。年龄小于50岁的患者更有可能被问及（OR 2.5，1.5 - 4.6）。白人医生更有可能询问（OR 2.8，1.1 - 7.6）。报告在当天就诊时被教导进行乳房自我检查的患者也更有可能接受筛查（OR 2.9，1.1 - 7.9）。我们发现有证据表明，适度强化培训并注重结果可以提高住院医师对家庭暴力的筛查率。为了有效做到这一点，我们建议开展类似这样的培训课程，并在临床环境中持续监测结果。
