R. Curtis Bay

A Randomized Controlled Study of Brief Interventions To Teach Residents about Domestic Violence.

PURPOSE To test an educational intervention regarding domestic violence. METHOD Residents beginning their training in 1995 or 1996 were randomly assigned to attend, at their hospital orientation, either a 20-minute session emphasizing the importance of screening for domestic violence or a session on an unrelated topic. RESULTS Seventy-one percent of the residents in the experimental group diagnosed domestic violence; 52% in the control did so (RR, 1.35; 95% CI, 0.96-1.90; p = .07) in the nine to 12 months following the intervention. Rates of diagnosis differed by specialty (p <.01): 100% family practice, 90% emergency medicine, 80% obstetrics-gynecology, 63% pediatrics, 47% internal medicine, 0% surgery. Change in knowledge was assessed in 1996; significant improvement was noted (p = .002). CONCLUSION An intervention about domestic violence conducted at orientation for residents improved the rate of diagnosis of domestic violence. While the improvement was not statistically significant in this case, the intervention was brief and harmless. Other institutions should consider this kind of brief intervention.

Professionalism and professional values in orthopaedics.

During a consensus conference in Fall, 1998, the Academic Orthopaedic Society identified the values and qualities of professionalism as defined by its members. One hundred eighty-six respondents rated 20 characteristics and values describing professionalism, based on the extent to which they believed each item was appropriate. The five items receiving highest average ratings were: integrity, trustworthiness, responsibility, reliability, and accountability. Principal components analysis yielded five factors that captured 62% of the total variability. These factors were labeled respect and relationships, altruism, accountability and reliability, integrity, and excellence. The authors anticipate that the Academic Orthopaedic Society will find these data useful, and incorporate this information into their decisions concerning evaluation of current residents and applicants to their programs. An additional challenge will be to develop a values curriculum (formal curriculum) and a learning environment (informal curriculum) that will encourage residents and faculty to aspire to the highest in professional values and professional conduct.

Screening for domestic violence: practice patterns, knowledge, and attitudes of physicians in Arizona

Objectives: Victims of domestic violence presenting for health care are frequently referred to medical specialists, but little is known about domestic violence screening among specialists. The aim of this study was to evaluate attitudes and behaviors concerning domestic violence of all physicians in Arizona. Methods: A cross-sectional survey of 2,244 physicians from 13 medical specialties describes domestic violence screening practices, attitudes, and behaviors of practicing physicians in Arizona. Results: Among 976 respondents, 56% reported prior education on domestic violence screening; 50.5% rarely or never screen their female patients for domestic violence; and 52% reported their competence for providing treatment for victims as poor to fair. Physicians from emergency medicine, psychiatry, obstetrics/gynecology, and family practice reported higher rates of domestic violence education, screening, awareness of services, and competence at treating victims. Physical medicine/rehabilitation, anesthesiology/pain control, surgical subspecialty, medicine subspecialty, general surgery, and orthopedic physicians scored lowest on these characteristics. Conclusions: Differences in attitudes and behaviors regarding domestic violence screening were noted among specialty groups. Customizing physician training based on these findings may be beneficial.

Use of Home Visit and Developmental Clinic Services by High Risk Mexican-American and White Non-Hispanic Infants

Objective: To investigate whether US-born infants of mothers of Mexican descent who were enrolled in Arizona’s Newborn Intensive Care Program (NICP) received follow-up services (developmental clinic and community health nurse [(CHN)] home visits) at the rates similar to White non-Hispanic (WNH) infants. Socio-economic and health status characteristics were controlled using stepped regressions in order to assess the impact of each on service use. Methods: This population-based study used retrospective data from the NICP administrative database that were linked to birth certificates for years 1994–1998. The study population was limited to Arizona-born infants; it included 7442 infants of WNH mothers, 2612 infants of US-born Mexican American (MA) mothers and 2872 infants of Mexico-born mothers. Four service use indicators were used in the analysis. Results: Both Hispanic infant subgroups were less likely to have a CHN visit by 6 months and by 1 year, and to average fewer CHN visits. A smaller percent attended the developmental clinic by age one. After controlling for language, demographics, health status, socio-economic characteristics, and mothers’ prenatal care use, infants of US-born MA mothers had rates of use similar to WNH. However, even after controlling for the study variables, infants of Mexico-born mothers were less likely (OR =.83) to use the developmental clinic. Hispanics continued to lag behind in the use of services compared with WNHs. The disparity is not a function of ethnicity, but appears attributable to demographic and socio-economic characteristics. Infants who had a CHN visit were significantly more likely (OR = 2.51) to use the developmental clinic than those without a nurse visit. Infants whose mothers had inadequate prenatal care were less likely to use these follow-up services even after controlling for study variables. Conclusions: Infants whose mothers had inadequate prenatal care should be targeted for more intense CHN visits. Infants of mothers born in Mexico may need additional support/assistance in using the developmental clinic.

Medical student training in domestic violence: a comparison of students entering residency training in 1995 and 2001.

Background: As domestic violence (DV) is frequently unrecognized by physicians, efforts to improve education on the topic have been undertaken. Purpose: To assess changes in medical education about DV. Methods: Incoming residents from 1995 (N = 52) and 2001 (N = 43) were surveyed regarding education and attitudes about DV. Results: The resident-reported emphasis on DV education increased significantly from 1995 to 2001. Hours devoted to the subject experienced no significant change. The likelihood they would ask female patients about DV and their competence in dealing with DV-specific situations experienced no significant improvement-both were rated below average. Conclusions: Although emphasis on medical education about DV has improved from 1995 to 2001, likelihood of screening and competence at dealing with DV has not improved. The content of undergraduate medical education about DV should be strengthened, and the educational process should continue during residency training.

Knowledge regarding preconceptional folic acid use in a Mexican-American patient population

The objective of this study was to evaluate knowledge regarding folic acid among postpartum Mexican-American patients. A survey regarding folate was administered to postpartum women at a public hospital serving primarily Mexican-Americans (n = 393). English and Spanish speakers were compared. Fifty eight percent cited prevention of birth defects as a reason to take folate. English speakers were less likely to know this than Spanish speakers (p = 0.005). Fifty-one percent of women stated they had learned about folate from radio or television. Of these, 83% knew that folic acid prevents birth defects and that it should be taken prior to pregnancy. Only 16% learned about folate from a health care provider. Compared to previous research, Mexican-American women have increased awareness of the association between folate consumption and birth defects, especially Spanish speakers. Patients citing radio/television as a source of information tended to answer questions correctly, suggesting that media efforts in this area have been effective.