Ensuring students' well-being as they learn to support victims of violence.

PIP: As medical schools in the US incorporate domestic violence into their curriculum, they must also create mechanisms to assist medical students who have personal histories of domestic violence. In addition, all students must receive the support they will need to confront the psychological difficulties of working with survivors of domestic violence. It is only within the past decade that the extent of domestic violence and its effects on health have been recognized. The few surveys that have examined the prevalence of a history of domestic violence among health care providers have revealed that figures for this population mirror those for the general population. One reason for this is that more women are becoming medical students, and significantly more women than men have violence in their histories. Because it is a caring profession, medicine also attracts those who were exposed to family violence. Some of these individuals become high achievers to alleviate their pain but find it impossible to maintain perfectionism in medical school. When survivors are ultimately unable to feel good about themselves, they are unable to deal with patients objectively. As patients begin to discuss experiences of violence with medical students, the students may react by withdrawal, denial, or "intrusive" actions such as rescue attempts or boundary violations. These situations may be particularly problematic for medical students who have survived violence. Medical schools, therefore, should offer self-care training as they address the presence of family violence experiences among their students.^ieng

A survey of family-violence curricula in Virginia medical schools and residencies at university medical centers.

PURPOSE: To examine the status (as of 1995) of family violence curricula at Virginia's three medical schools and their affiliated residencies. METHOD: Questionnaires were sent in the fall of 1995 to the deans of undergraduate medical education at the three schools and the directors of the 69 fully accredited residencies at the university medical center. The questionnaires inquired about the presence of particular family-violence topics in the curricula (battered women, child abuse, elder abuse) and whether teaching about family violence was required or elective. In addition, the medical schools' departments were asked to identify faculty who were experts in the area of family violence. RESULTS: All three schools responded about undergraduate education, showing considerable variability among departments concerning whether instruction was required or elective and what instructional methods were used. A total of 48 (70%) of the 69 residencies responded. Twenty-six (54%) indicated that they had at least some curriculum content related to particular family-violence topics: child abuse, 20 (42%); battered women, 13 (27%); and elder abuse, nine (19%). A total of 27 faculty with expertise in family violence were identified, and 16 were experts in identifying and treating injuries related to family violence. No expert was identified in such areas as mental health sequelae or violence prevention. CONCLUSION: The results allowed for the development of recommendations regarding medical education about family violence in Virginia, including the formal integration of family-violence curricula into medical school and internship and residency programs, and the coordination of disciplines within Virginia in family-violence prevention.

Survivors of abuse. Health care issues.

This article has discussed the most common sequelae of victimization with regard to incest, rape, and battering. Although legislators and law-enforcement officials have traditionally been viewed as having primary responsibility for the prevention and control of violence, it is now known that physicians must also act in this regard. Their action is especially required with regard to victim assessment and treatment. Physicians serve as the entry points not only to the health care system, but also to other resources for victims of violence. By identifying their victimized patients and by understanding the antecedents of their patients' symptoms, physicians can go much further in meeting their patients' needs for physical, mental, and social well-being. Given the scope and impact of violence, physicians have a moral and ethical obligation to inquire about the possibility of current violence, past violence, or both in their patients' lives.

Pseudocyesis in an adolescent incest survivor.

This case is an example of pseudocyesis in an incest survivor. Symptoms of pregnancy were unconsciously created by the patient to shield her from the memory of her incest and at the same time confront the reality of her abuse. Her symptoms allowed her entrance into the medical system. Once in the system, it was just a matter of time before she was referred for psychological evaluation. The authors recommend that family physicians consider incest when evaluating patients who present with pseudocyesis.

A survey on violence education: a report of the STFM Violence Education Task Force.

A national survey of all family practice residency directors was undertaken to assess programs' current efforts in the area of violence education. The survey also investigated directors' views about particular types of violence and beliefs about how involved family practice residency programs should be in educating physicians in these areas. The majority of respondents (59%) indicated that violence education was represented "not at all" or "very little" in their formal curricula. However, there was significantly more teaching about specific types of violence, with child physical abuse, child sexual abuse, and rape receiving the greatest amount of national teaching efforts. The results of the survey suggest that awareness of particular aspects of violence creates teaching activity about those topics in family practice residency programs.