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A Domestic Violence Course For Medical Students: A Study on Its Effectiveness

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Abstract

International health institutions emphasize the necessity of including the topic of domestic violence which is accepted as a health problem worldwide, into the training of physicians. The fact that physicians should diagnose domestic violence victims who over the years were either neglected or overlooked is also mentioned. The present study aims to measure the effectiveness of the interactive domestic violence course given to Dokuz Eylul University Faculty of Medicine (DEUFM) Year V students, with tests implemented before and after the course. The same students were given the same test during Year VI (internship). The students’ average knowledge scores were found respectively as follows: pretest 78.66 ± 10.54, second test 94.13 ± 3.95 and third test 89.65 ± 7.48. There was a statistically significant difference between tests’ average scores. It was observed that, after the course, 4 out of 19 students (21.1%) changed their answers from “no” to “yes” for the question “Have you ever been a victim of physical domestic violence?” A statistically significant difference was found between pre-course answers and the after course answers given to this question. This study showed that the course on domestic violence increased students’ knowledge level and awareness on this issue. Considering that average knowledge level will decrease over time and aiming to improve future physicians’ approach to domestic violence cases, addition of other interactive educational methods to Year V’s course program and proposal of an advanced training session to Year VI’s curriculum are being planned.

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Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Dokuz Eylul University Faculty of Medicine, 35340-Inciralti, Izmir, Turkey

    Akca Toprak Ergonen & Serpil Salacin

  2. Department of Medical Education, Dokuz Eylul University Faculty of Medicine, 35340-Inciralti, Izmir, Turkey

    Sevgi Karademir, Yucel Gursel & Berna Musal

Authors
  1. Akca Toprak Ergonen
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  2. Serpil Salacin
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  3. Sevgi Karademir
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  4. Yucel Gursel
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  5. Berna Musal
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Corresponding author

Correspondence to Akca Toprak Ergonen.

Appendices

Appendix 1

Medical Students’ Knowledge on “Domestic Violence”

Date:

.../.../2004

Age:

...

Gender:

Female

Male

Year:

Year V

Year VI

  1. 1.

    Which one/ones of the following is/are included in the concept of domestic violence? (You may thick several options).

    1. a.

      Violence between married couples.

    2. b.

      Violence between divorced couples.

    3. c.

      Violence between those sharing the same house.

    4. d.

      Violence between lovers.

  2. 2.

    Domestic violence includes which one/ones of the following? (You may thick several options)

    1. a.

      A father’s slapping his/her child.

    2. b.

      A mother’s shouting, insulting his/her child.

    3. c.

      A married woman’s inability to see friends forbidden by her husband.

    4. d.

      A married man’s forced sexual intercourse with his wife.

  3. 3.

    According to the data obtained from World Health Organization’s investigations, what is the frequency of domestic violence against women?

    1. a.

      One out of every fifteen women.

    2. b.

      One out of every ten women.

    3. c.

      One out of every five women.

    4. d.

      One out of every two women.

  4. 4.

    Which one of the following is false regarding domestic violence against children?

    1. a.

      Any kind of bad behavior against children.

    2. b.

      In these cases, families may try to deceive the physician.

    3. c.

      Medicolegal case should be reported when diagnosed.

    4. d.

      Domestic violence is more traumatizing than street violence.

    5. e.

      The problem should be solved by talking with the child and the family.

  5. 5.

    Which one the following is false regarding the content of the Family Protection Act?

    1. a.

      It is an exclusively domestic violence-specific act.

    2. b.

      Domestic violence can only be reported by the violence-stricken wife/husband.

    3. c.

      Upon reporting domestic violence creating wife/husband may be removed from the house.

    4. d.

      Violence exerting wife/husband may be sentenced to imprisonment.

  6. 6.

    Which one of the following approaches is true regarding a patient exposed to domestic violence?

    1. a.

      Medicolegal case is reported to the police.

    2. b.

      Medicolegal case is reported to the office of the public prosecutor.

    3. c.

      Medicolegal case is not reported if the patient is not willing.

    4. d.

      The problem is attempted to be solved by talking with the patient and his wife/her husband.

  7. 7.

    Which one of the following is false while approaching a patient exposed to domestic violence?

    1. a.

      Asking the patient whether this violence was the initial incident.

    2. b.

      Asking the patient whether there is someone/are some people at home disturbing him/her.

    3. c.

      Asking the patient which one of his/her behavior may have caused this violence.

    4. d.

      Listening to patient in privacy.

    5. e.

      Informing the patient about his/her legal rights.

  8. 8.

    Which one/ones of the following is/are among the prejudices preventing physicians from dealing with domestic violence cases? (More than one option may be ticked)

    1. a.

      Domestic violence is a problem concerning private life.

    2. b.

      Dealing with a domestic violence-stricken person is a hopeless case.

    3. c.

      Domestic violence is not a health problem issue.

    4. d.

      The physician can not help a domestic violence-stricken person.

Read the following sentences and write either T (True) or F (False) in front of each sentence.

  1. 9.

    (...) Domestic violence against women is common worldwide in any kind of society.

  2. 10.

    (...) World Health Organization’s Women Health and Development Division was established in 2000.

  3. 11.

    (...) Among the reasons of mortality and disability in women of reproductive age, the severity of violence against women is equivalent to cancer.

  4. 12.

    (...) Violence is more detrimental for women of reproductive age that the total damage of traffic accidents and malaria.

  5. 13.

    (...) When compared with other types of violence; more legal action is taken for individuals exerting domestic violence.

  6. 14.

    (...) In cases of domestic violence against children, families generally tend to apply to different health institutions.

  7. 15.

    (...) In Turkey domestic violence against children is not frequent.

  8. 16.

    (...) General practitioners are not legally responsible in cases of domestic violence against children.

  9. 17.

    (...) Since domestic violence is considered within professional secrecy it can not be reported.

  10. 18.

    (...) In Turkey there is no legal regulation about domestic violence against children.

  11. 19.

    (...) When domestic violence against child is diagnosed it should be reported as a medicolegal case.

  12. 20.

    (...) The sensitivity of physicians and health staff is generally insufficient regarding patients exposed to domestic violence.

Have you ever been a victim of physical domestic violence?

 

a. Yes

 
 

b. No

 

Integration of domestic violence in medical education is

 

a. necessary.

 
 

b. partly necessary.

 
 

c. unnecessary.

 

Thank you.

Answers:

1) a, b, c, d

5) b

9) True

13) False

17) False

2) a, b, c, d

6) b

10) False

14) True

18) False

3) c

7) c

11) True

15) False

19) True

4) e

8) a, b, c, d

12) True

16) False

20) True

Appendix 2

Case 1

23 year old female patient, married, mother of one.

Complaint: Abdominal pain.

Case History: On the .../.../..., the patient claiming to have been beaten by her husband on the previous day, applies to the Emergency Unit of DEUFM. She is hospitalized in the Clinic of General Surgery for the assumed diagnosis of intraabdominal hemorrhage. While narrating her story she uses the expression “He didn’t do it on purpose, he never beats me and this was because of my fault”.

Personal History:

  • Primary school graduate, works as an insured cleaning worker since 2 years.

  • Husband secondary school graduate, works as a janitor.

  • Married for 6 years, has a 3.5 years old son, lives apart from her husband since 8 months.

  • Upon examination of her medical file, she previously applied to the hospital several times with complaints like headache, fainting, nervousness and was diagnosed as acute anxiety, nonspecific headache.

Physical Examination Signs:

  • General status medium, conscious.

  • Distension, guarding, rebound tenderness at abdominal examination.

  • Abdominal ultrasound creates the suspicion of intraabdominal hemorrhage.

Treatment:

  • The patient is operated with the assumed diagnosis of acute abdomen and splenectomy is carried out with the diagnosis of splenic rupture (Grade 1).

  • Forensic Medicine consultation is requested.

Appendix 3

Case 2

1 year old male child.

Complaint: Seizures.

Case History: On the .../.../..., the patient is brought to the Emergency Unit of DEUFM with the complaint of seizures 2 days before (Deviation in the eyes, irregular breathing, loss of consciousness, arms slightly flexed, inability to hold the head upright). The patient is said to have fallen from bed to wooden floor 10 days before the seizure.

Personal History:

  • Normal spontaneous vaginal delivery at the hospital, delivered 10 days postterm with birth weight 3900 grams.

  • Vaccinations appropriate to age and complete.

  • Motor-mental development; hold his neck at 3–4 months, sat at 7 months.

Family History:

  • Mother; 21 years old, allergic to pollens, 3 months pregnant.

  • Father; 27 years old, healthy.

  • No family history of epilepsy.

Physical Examination Signs:

  • General status restless, agitated, tendency to sleep.

  • Slightly bulging and pulsating anterior fontanel.

  • Right eye internally deviated, left eye outward look restricted?

  • Anterior molars (4/4) no sign of trauma.

  • Examinations of other systems normal.

  • Cranial CT; arachnoid cyst (+), diameter 2,5 cm., in the posterior fossa.

  • Eye examination; multiple retinal hemorrhages observed.

  • 30% below calendar age according to the Ankara Development Screening Inventory.

Treatment:

  • Upon completion of medical therapy pediatric neurology and neurosurgery follow ups are recommended.

  • Forensic Medicine consultation is requested.

Appendix 4

Case Questions

  1. 1.

    What are the problems in this case?

  2. 2.

    Who are involved in this case?

  3. 3.

    How should the physician approach this situation?

  4. 4.

    What should the physician do from a medicolegal perspective?

  5. 5.

    What are the problems from a social perspective?

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Toprak Ergonen, A., Salacin, S., Karademir, S. et al. A Domestic Violence Course For Medical Students: A Study on Its Effectiveness. J Fam Viol 22, 441–447 (2007). https://doi.org/10.1007/s10896-007-9098-7

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  • DOI: https://doi.org/10.1007/s10896-007-9098-7

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