Core Competencies for Graduate Medical Education

• Patient Care
• Medical Knowledge
• Practice-Based Learning
• Interpersonal and Communications Skills
• Professionalism
• Systems-Based Practice

Please see Core Competencies resource document for detailed information.

Clinical and Community Experience

Direct or video observation of faculty screening and diagnostic techniques during clinical encounters:

• Review of resident screening and diagnostic behaviors and techniques by faculty preceptors during resident clinical sessions
• Direct observation of community-based services for victims, survivors and perpetrators of family violence and abuse
• Provision of health screenings at community-based service organizations
• Work with victims and perpetrators through community service providers
• Standardized patient exercises

Independent Learning

• Journaling in conjunction with observations of interviews
• Selected readings on working with victims of family violence

Small-Group Learning and Problem-Based Learning

• Case-based discussions or Problem Based Learning cases
• Review of resident reactions to family violence during Balint Group debriefings or support groups
• Group OSCEs

Curricular Resources

• HP 2010 objectives and overview
• Mandatory Reporting of Domestic Violence by Health Care Providers
• State Domestic Violence Coalitions
• Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health
• National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings
• Abuse Assessment Response Course: System Approach to Partner Violence Across the Lifespan
• Domestic Violence and Health Care Protocols
• Improving the Health Care Response to Domestic Violence: A Trainer's Manual for Health Care Providers
• Position statements: U.S. Preventive Services Task Force; American Medical Association; American College of Obstetrics and Gynecology; and the American Academy of Family Physicians (websites below)
• Summary of evidence-base surrounding the manifestations, identification and treatment of family violence in the primary care setting

Lectures

• Core lectures by standing faculty
• Guest lectures by social work, criminal justice and community-based service providers

Multimedia

• Screen to End Abuse Video
• Voices of Survivors Training Video
• Resources from Physicians for a Violence Free Society
• Case-based lectures and case-based learning using video productions
• Web-based cases
• CD-ROMs and DVDs for self-directed learning

Web Sites

• Family Violence Prevention Fund
• American Academy of Family Physicians
• American Medical Association
• American College of Obstetrics and Gynecology
• American Academy of Pediatrics
• Men’s Resource International
• Men’s Resource Center
• HP 2010 objectives and overview on injury and violence

Clinical and Community Links

• Centers for Disease Control and Prevention
• Family Violence Prevention Fund
• Gay, Lesbian and Straight Education Network
• The Institute on Domestic Violence in the African American Community
• The Institute on Domestic Violence in the Asian & Pacific Islander Community
• Minnesota Center Against Violence and Abuse
• Men Can Stop Rape
• National Latino Alliance for the Elimination of Domestic Violence
• National Network to End Domestic Violence
• National Sexual Violence Resource Center
• Prevention Institute
• United States Department of Justice Office on Violence Against Women

• OSCE/SP to assess attitudes and interview skills
• Objective Testing/objective testing with visuals
• Observation
• Diaries identifying barriers and how these were approached
• Creation of short reports after observations and self-directed learning

Assessment of the effectiveness of this portion of the curriculum can be performed as a part of residents’ exit interviews from the program using qualitative questioning of the residents attitudes and plans for inclusion of care of victims of violence in their practices.

Exit interviews with patients/families re: effectiveness of resident patient education

Every residency is required to evaluate the effectiveness of its teaching strategies. Most programs survey their graduates periodically. Questions should be included that assess graduates’ comfort and experience with patients in their practices who are exposed to family violence, resources they commonly use for referral of exposed patients, and frequency of using family violence skills in their practice.

Evaluation Methods

• Evaluation Methods
• Delphi Instrument for Hospital-based Domestic Violence Programs
• Family Violence Quality Assessment Tool for Primary Care Offices

American Board of Family Medicine National Inservice

All residents take the in-service exam every year. In-service testing is used to define areas of strength and weakness for both trainees and the program. The results can be reviewed in conference or individually with each trainee and a plan is put in place to address weaknesses if necessary. The examination gives trainees the unique opportunity to gauge their knowledge (and test-taking skills) relative to the (national) peer group with whom they will be taking the examination.

Attending Rounds

Both inpatient and outpatient supervision by Attending physicians provides a venue for teachers to gauge the knowledge and practices of residents and provide patient-based instruction. Both inpatient and outpatient precepting Attendings can provide monthly written evaluations of resident knowledge and performance.

Conferences and Morning Report

Conference series or morning reports provide a venue in which family violence cases can be discussed in detail. Faculty members have the opportunity to hear trainees "think aloud" allowing the opportunity to provide substantive feed-back. It also allows an excellent opportunity for residents to teach each other.

Clinical Skills Evaluation

All trainees can be assessed during the performance of a history and physical examination as they are observed by a faculty member. The trainee completes the exercise by presenting the case and his/her assessment and plan for diagnosis and treatment.

OSCE/SP

Trainees perform an objective clinical skills evaluation (OSCE) that includes one station devoted to medical knowledge about a patient exposed to family violence. A case presentation is followed by straight-forward questions exploring knowledge and behaviors regarding resident's understanding of family violence and the effect of exposure to family violence on a patient's health.

Rotation-Specific Portfolios

Residents can keep a portfolio of their experience clinical experiences regarding family violence. During clinical and community medicine rotations, residents should seek exposure to patients with documented domestic violence exposure. Residents then describe the patient in their portfolio, using the patient's case as an opportunity to read about the condition and record seminal facts about clinical facts, diagnosis, prognosis and therapies.

Board Review Course

Conducted by the Chief Resident or core-residency faculty, is often a monthly conference in which one family violence-related subject area is reviewed through discussion of questions and answers from examinations.

Medical Staff and Other Allied Healthcare Personnel

Competency-based evaluations from inpatient and outpatient medical staff and other allied healthcare personnel can aid in the provision of 360o evaluations of resident performance regarding issues of family violence.

Journal Club and Scientific Methods Lecture Series

A series of lectures for all residents should review scientific methods, statistical techniques and how to examine the validity of a published medical study regarding family violence. Skills are then practiced in monthly journal clubs and in smaller "break-out sessions" with a faculty member, reviewing articles addressing family violence.

A coordinated faculty development program is needed to adequately train faculty in all Family Medicine residency programs about the adverse health effects of violence and abuse, and how to best care for victims.

Since many faculty in family medicine education were trained during a time that the adverse health effects of violence and abuse were not recognized as legitimate patient care issues, many faculty are not comfortable in caring for patients affected by domestic violence. A series of faculty development workshops should be funded to teach all family medicine faculty about the health effects of violence and abuse.

Funding for a faculty development program will be sought to adequate train at least one faculty member from each family medicine program in the U.S. A model for this program could be the STFM Project SAEFP (Substance Abuse Education for Famliy Physicians) funded by HHS in the early 1990s, which successfully improved the knowledge base and competency level of family medicine residency faculty across the nation.