Interpersonal violence and the education of physicians.

Physicians in every field of practice can expect to be called upon to care for patients whose lives have been affected by interpersonal violence. Although the medical profession has begun to acknowledge the appropriate role of physicians in screening, diagnosis, and treatment of interpersonal violence, these areas have not been fully addressed in the curricula of most medical schools. Competencies in the understanding of violence and its treatment are proposed for medical students, residents, and practicing physicians. By the time of graduation, all medical students should be able to demonstrate appropriate attitudes, core knowledge, and basic skills in assessment and intervention of patients at risk from or experiencing violence. During postgraduate training, residents should amass specialized knowledge and skill concerning the spectrum of injuries and illnesses they may encounter in clinical practice. Faculty development efforts should address the advancement of faculty who are well trained in a scholarly approach to teaching and research in this field. This paper describes methods by which educational efforts in interpersonal violence can be introduced into medical education. Proposed goals and objectives for curriculum development in schools of medicine, along with an implementation plan, are offered.

Helmets, injuries and cultural definitions: motorcycle injury in urban Indonesia.

This paper examines motorcycle helmet use and injuries in a developing country with a helmet law. Data were collected by systematic street observations and interviews with motorcyclists and supplemented with motorcycle injury data from a 1 month study of all patients coming to emergency departments in Yogyakarta, Indonesia. Observations show that 89% of motorcycle drivers (N = 9242) wore helmets; only 20% of the passengers (N = 3541) did. However, only 55% of the drivers wore helmets correctly (e.g. with chin strap buckled). Differences in time and place were noted in interviews when motorcyclists reported wearing helmets least at night and when no police were around; various reasons for not wearing helmets included physical discomfort and absence of police surveillance. Data from emergency departments found that motorcycles were involved in 64% of all traffic accident injuries, comprising 33% of total trauma patients presenting to emergency departments. Injury Severity Scores were calculated for the 26% of motorcycle injuries which were admitted to the hospital, with 60% having scores of 1-8, 27% 9-15, and 9% > 15. We conclude that although motorcycle drivers appear to comply with the motorcycle helmet law, it is a "token compliance." Less than 50% of riders were maximally protected by helmets and very little safety consciousness was found among drivers. Suggestions for improving helmet use that take cultural definitions of wearing helmets into account are presented for future research.