FAMILY VIOLENCE PREVENTION AND HEALTH PRACTICE
Medical Student Exposure to Family Violence Issues:
A Model Curriculum
Robert W. Block, MD treatment, and follow-up for victims
Professor and Daniel C. Plunket Chair of violence
Department of Pediatrics • To encourage students to have
University of Oklahoma College of Medicine
increased sensitivity and appropriate
Tulsa Campus, O.U. Schusterman Center
4502 E. 41st Street responses to victims of violence
Tulsa, OK 74135-2512 throughout their future medical
Email: Robert-block@ouhsc.edu practices
The content of course experiences is
Several years ago, a group of medical directed toward specific attitudes,
students approached the pediatric knowledge, and skills. Attitudinal focus
department to inquire about establishing points include:
an experience for students that would
expose them to problems with violence • The importance of family violence
and to successful community prevention to health professionals due to the
and intervention programs. Their inquiry remarkable adverse health effects of
occurred simultaneously with a meeting of exposure to violence
several national health system experts at • The injustice of abuse even among
the University of Oklahoma, designed to patients who seem to have made
develop programs for health professions unhealthy decisions or who appear
students in the area of domestic violence. to have failed to act safely, and that
Working with the ideas generated at the students should understand the need
meeting and capitalizing on the students’ for patients to continually evaluate,
requests, an elective for medical students plan, and revise strategies in
at the University of Oklahoma, Tulsa response to their personal resources,
Campus was developed. responsibilities to family members,
community resources, and the
Fourth-year medical students may elect a behavior of abusers
one-month rotation sponsored by the • The student, as a future health
Department of Pediatrics. Their course of professional, is a member of a
study is directed by faculty, but is largely community team that may include
independent work focusing on other health care professionals,
introductions to a variety of community government agency and community
agencies and the work performed by the service personnel, survivor/victim
agencies’ professionals. The purposes of support groups, and child and adult
the elective are: protective services
• To introduce students to family • Ability to appreciate the roles of,
violence issues and to work with criminal justice
• To expose students to local agencies personnel
concerned with family violence • Ability to appreciate the roles of,
• To focus students on the need for and to work with community
prevention, diagnosis, intervention, response advocates
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• Recognition that the scholars and • Institutional resources
professionals in the field, although • Legal aspects of family violence
acting through best practices, may o State and local laws
not have good answers to all family o Medical liability issues
violence questions
• Interest in research and The skills that have been a focus of the
development of even better elective were unique during the early years
practices is an appropriate response of the experience. Fortunately, they have
for medical students become more accepted as best practices
over time, but receive little attention in
Students receive orientation to the elective traditional medical school curricula. The
that includes a preview of the knowledge most important skill is the ability to
they should expect to gain from the identify patients who are at risk for abuse
experience. The main issues they are or who are being abused. To that end,
encouraged to study include: students are encouraged to learn how to:
• Detrimental physical and mental • Word questions about abuse, when
health consequences of violence to ask, where to ask, who to ask
including but not limited to (including emphasis on universal
depression and increased suicide screening), and concern and respect
risk, poor health decisions such as during questioning
smoking and excessive alcohol • Assess an individual patient’s
use, chemical dependency, post- situation, especially the immediate
traumatic stress disorder, sexually risk of danger
transmitted infections, unintended • Intervene in an emergent, urgent, or
pregnancies, immune dysfunction, preventive manner
irritable bowel syndromes,
increased cardiovascular disease, A wide range of interactive learning
and dental injuries experiences are available to the students
• Epidemiology of family violence, including:
including links between adult and
child abuse 1. Tulsa Children’s Justice Center
• Historical and cultural context of
family violence The Tulsa Children’s Justice Center is a
• Clinical signs of possible violence community child advocacy center, unique
in adult and pediatric patients in the co-location of a medical team with
• Barriers to action: child welfare, local law enforcement, the
o For the health professional District Attorney, and a community
(time, legal involvement, lack advocacy agency. The Center serves as a
of knowledge and skills, fear single site for investigation of and
of retribution, lack of intervention with child abuse cases.
reimbursement) Students work not only with pediatric
o For the victim (fear, concern faculty who are child abuse subspecialists,
for children, love, lack of but also experience multidisciplinary team
resources, hopelessness) review of cases, law enforcement
• Community resources investigations, and court proceedings.
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2. Domestic Violence Intervention traumatic stress, and family violence
Services consequences.
Domestic Violence Intervention Services 6. Tulsa Police Department
is the community’s major not-for-profit
center for adult victims of domestic Through a partnership with the Tulsa
violence. It is home to support groups Police Department, students experience a
and treatment for both victims and “citizen ride-along” with a patrol unit,
perpetrators. It is also the agency usually during an evening or night shift
responsible for the primary shelter of when the chances of a domestic violence
victims of abuse and their children. response call are greatest. Although
Students are able to visit the shelter to protected, they may have an opportunity
learn about its mission and programs, and to see first-hand the intricacies of quelling
may be able to interview consenting a dispute, arrests if needed, and to discuss
victims about their unique situation. this type of situation with a field officer.
3. Call Rape and SANE 7. Additional Options
Call Rape provides volunteer hot-line and Other experiences include talking with
crisis response personnel. In conjunction, students at an alternative school for
the Sexual Assault Nurse Examiner educationally disenfranchised children,
(SANE) program provides emergent visiting the forensic crime laboratory to
medical assessment and evidence learn about processing rape evidence,
collection in a protected location at a local touring a child abuse and family violence
hospital. Students are “on call” to prevention agency, and sitting in on
respond to emergency assessments so they staffing of new, court-ordered cases, and
can observe the process of evaluation and treatment groups.
support.
There is no core text for the elective, but
4. Margaret Hudson Program students are given a copy of The Woman
Who Walked Into Doors, by Roddy
The Margaret Hudson Program is an Doyle, and several articles and
alternative school for pregnant teenagers. monographs about family violence.
Some of the girls in the program are During the rotation, students are expected
pregnant as a result of incest, date rape, or to write two concise papers – one as a
coercive sexual activity. Students tour and case report from their experience and
review the program’s mission, and may another as a topic review in some area of
have an opportunity to talk with students family violence.
about their personal situations.
A limitation to this report is the absence
5. Daybreak Dynamics of formal evaluation of the experience.
Daybreak Dynamics is an intensive Anecdotal feedback from students has
outpatient treatment center with a variety been quite positive, and the experience is
of programs for children, adolescents, and selected by 6 to 10 students each year.
their families. Students are exposed to Future research is planned to query the
group treatment aimed at chemical effects of the experience on students who
dependency, conduct disorders, post have now graduated and completed
residency training to determine their
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involvement, if any, with family violence
issues and the relevance of this elective to
their professional decision-making.
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