Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
J Womens Health (Larchmt). 2021 Dec;30(12):1778-1787. doi: 10.1089/jwh.2020.8685. Epub 2021 Mar 19.
Intimate partner violence (IPV) is common, yet physicians do not routinely screen patients for IPV. There are no clear recommendations for best educational practices for physician trainees that improve screening rates. We implemented an IPV curriculum combining didactics and communication skills training for internal medicine residents. Didactics included definitions, risk factors, screening recommendations, and documentation; communication skills training included developing unique screening and response phrases; and two simulated patient exercises. The primary outcome was screening documentation rates as measured through pre- and postcurriculum chart review. Secondary outcomes included knowledge, comfort, and attitudes measured through pre- and postcurriculum administration of an adapted Physician Readiness to Manage Intimate partner violence Survey (PREMIS). Postcurriculum semistructured interviews provided further details regarding behaviors and attitudes. Forty residents completed the curriculum. 29/40 (73%) completed both pre- and postsurveys. Fifteen participated in semistructured interviews. Residents demonstrated increased screening documentation postcurriculum ( < 0.05). Residents showed improvement in 80% of objective knowledge questions, and in all perceived knowledge and comfort-based questions ( < 0.01). Statistically significant improvement was noted in many attitudinal domains, including reported screening rates ( < 0.05). In the semistructured interviews, participants reported experiencing both practice-based improvements and ongoing screening barriers. Practice-based improvements included increased screening comfort and frequency, and strengthening of the doctor-patient relationship. Ongoing screening barriers included time, resistance to practice change, competing medical needs, and personal discomfort. A multifaceted IPV curriculum for residents significantly improved documentation rates, knowledge, comfort, and attitudes. Residents reported increased comfort with screening and strengthened patient relationships but acknowledged ongoing barriers to screening.
亲密伴侣暴力（IPV）很常见，但医生通常不会对患者进行 IPV 筛查。对于提高筛查率的医师培训生最佳教育实践，目前还没有明确的建议。我们为内科住院医师实施了一项 IPV 课程，该课程将教学和沟通技巧培训相结合。教学内容包括定义、风险因素、筛查建议和记录；沟通技巧培训包括制定独特的筛查和回应短语；以及两个模拟患者练习。主要结果是通过课程前后的图表审查来衡量的筛查记录率。次要结果包括通过课程前后管理亲密伴侣暴力的医生准备情况调查（PREMIS）的改编版进行的知识、舒适度和态度测量。课程结束后的半结构化访谈提供了有关行为和态度的更多详细信息。40 名住院医师完成了课程。29/40（73%）人完成了前后调查。15 人参加了半结构化访谈。住院医师在课程结束后显示出筛查记录的增加（<0.05）。住院医师在 80%的客观知识问题和所有感知知识和基于舒适度的问题上都有所提高（<0.01）。在许多态度领域，包括报告的筛查率，都有统计学意义上的显著改善（<0.05）。在半结构化访谈中，参与者报告说他们既经历了实践中的改进，也经历了持续的筛查障碍。实践中的改进包括增加筛查的舒适度和频率，以及加强医患关系。持续的筛查障碍包括时间、对实践改变的抵制、竞争的医疗需求和个人不适。针对住院医师的多方面 IPV 课程显著提高了记录率、知识、舒适度和态度。住院医师报告说，他们对筛查的舒适度有所提高，并且与患者的关系得到了加强，但也承认筛查存在持续的障碍。
