MedEdPORTAL (May 2007)
Domestic Violence Simulated Patient Case
Abstract
Abstract Introduction 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. Methods 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. Results 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 1-hour conference on domestic violence. Of the four residents with extensive instruction in domestic violence, only three screened the simulated patient for domestic violence. All three 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. Of the eight residents with minimal prior instruction in domestic violence, five screened the simulated patient for domestic violence. All five of these residents referred the patient for appropriate services, yet only three of the five validated the patient's experience and four out of five assessed her safety. Of the 12 residents who participated in this case, 10 found the case highly educational and two found it very educational. Eight residents found the case highly realistic, three found it very realistic, and one 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 postclinic 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. Discussion The postencounter discussion and videotape review provide opportunities to reinforce and further strengthen learners' knowledge and skills.
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