Beruflich Dokumente
Kultur Dokumente
I
ntimate partner violence (IPV) is a persistent, in their patients lives, given that routine dental
prevalent public health care issue that has mul- examinations involve close inspection of patients
tiple catastrophic effects on individuals, families, heads and necksareas where signs of physical
and the larger community.1,2 The Centers for Dis- battering and abuse are readily visible.5-11 Typical
ease Control and Prevention (CDC) defines IPV as injuries associated with IPV that may be detected
physical and sexual violence, threats of physical and by a dental professional include intraoral bruises
sexual violence, or psychological/emotional abuse from slaps or hits; soft and hard palate bruises and
including coercive tactics that adults or adolescents abrasions; fractured teeth, nose, mandible, and/or
use against current or former intimate partners.3 maxilla; abscessed teeth; torn frenum; hair loss from
While research has shown that some men suffer pulling or other trauma and lacerations to the head;
from abuseprimarily by their male partnersthe and attempted strangulation marks on the neck.9,10
majority of partner violence occurs between men and However, research has also shown that, even when
their female partners. According to findings from head and neck injuries are evident, dentists may be
the National Violence Against Women Survey, it is less likely than other health care providers to screen
estimated that approximately 1.3 million women and for IPV,5,12 offer minimal intervention when working
835,000 men are physically assaulted by an intimate with IPV victims as patients,12,13 or address IPV with
partner annually in the United States.4 their patients.5
Dental professionals, including dentists, den- According to numerous studies, lack of training
tal hygienists, and dental assistants, are uniquely has been cited by dental professionals as a primary
qualified to address the problem of IPV as it occurs reason for shortcomings in screening, intervention,
school curricula.4,13,21 As a result, providers may ob- be standardized and incorporated into dental school
serve injuries but either do not diagnose IPV as the and continuing education curricula, thereby mak-
cause oras is often the casedo not feel confident ing intervention with victims a normal and standard
in their ability to screen and manage IPV victims.1,4 part of dental professionals responsible practice.5
The purpose of this study was to document the Indeed, IPV education has been intended to help
shortage of IPV content exposure within one dental dental students not only be aware of IPV prevalence,
school curriculum, then to utilize this information but also that they are being informed about physical
to revise an existing comprehensive family violence and behavioral indicators of IPV, thus making them
curriculum that will be fully integrated into required an invaluable part of the victims identification team
university coursework to improve competence and in the health care arena.4 However, changes with
help overcome knowledge gaps. We report on the regard to improved or increased IPV content in the
results of an IPV self-assessment tool22 originally overall dental curriculum have progressed slowly, in
designed as a comprehensive and reliable method spite of ambitious comprehensive curriculum reviews
of ascertaining physician preparedness to manage conducted by the majority of U.S. and Canadian
IPV patients. In its final form, this tool (the Physi- dental schools.25
cian Readiness to Manage Intimate Partner Violence For example, a study of dental hygiene students
Survey, or PREMIS) measured the extent of educa- surveyed by Gutmann and Solomon16 found that
tion, knowledge, and attitudes about IPV among although most dental and dental hygiene curricula
physicians by way of a fifteen-minute survey. The include the specific topics of child abuse and neglect,
PREMIS demonstrated good internal consistency other manifestations of domestic violence (e.g., elder
and reliability for ten final developed scales that abuse, teen dating abuse, or IPV) are addressed far
were closely correlated with theoretical constructs less frequently. Their findings revealed that while
and predictive of self-reported behaviors. child abuse was taught in seven-tenths of programs,
The PREMIS was modified and validated by elder abuse was taught in just over half, and IPV was
this studys authors23 in order to assess these measures taught in less than half of dental hygiene programs.
among health professions students (medical, dental, Stewart et al.,21 moreover, reported in 2002 that, of
nursing, and social work). Results from our survey forty-two U.S. and Canadian dental schools with
also document the prevalence of students lifetime predoctoral programs, 100 percent included child
personal IPV experience, which allowed us to explore abuse in their curricula, while 87 percent included
the conflicting role this exposure has in both identify- elder abuse. The authors, however, did not survey
ing IPV in patients and intervening in a manner both these institutions regarding IPV education. As well,
appropriate and safe for student and patient. Gironda et al.26 surveyed 291 predoctoral dental
students in 200608 to gather a comprehensive sam-
1. Legal requirements 0.914 3 I am aware of legal requirements in this state regarding reporting of
suspected cases of elder abuse.
2. Preparation 0.886 4 I dont have the necessary skills to discuss abuse with an IPV victim
who is from a different cultural/ethnic background
3. IPV screening 0.740 2 I would ask all new patients about abuse in their relationships.
4. Self-efficacy 0.797 7 I can recognize victims of IPV by the way they behave.
school to those without training; students with IPV some experience with IPV in their lifetime, whether
training during dental school were compared to those through personal victimization or witnessing abuse
without training; and students reporting personal or violence directed at a family member (see Table 3).
experience with IPV were compared to those with no The dental students in this study reported that
personal IPV experience. Pairwise deletion was used they received IPV training in their general graduate
to exclude students with missing data. Significance coursework, as well as through their specialized focus
was reached with an alpha less than .05. Sample sizes areas of oral and maxillofacial surgery, pediatrics,
in analyses varied due to missing data. Scale scores and prosthodontics. While these students received
were stratified only by gender, and there were no different doses of IPV training depending on their
demographic differences between male and female chosen academic concentration, our study grouped
dental students. Furthermore, given limitations due to them together as a single graduate group in order
our small sample size and age group, it is unlikely that to measure the extent of their core IPV knowledge.
categorizing by age group would add any significant
information to the analysis (see Table 2).
Knowledge, Attitudes, and
Perceptions
Results These dental students generally did not per-
ceive themselves as either well prepared to address
The majority of these dental students (62.3 IPV with patients or knowledgeable about IPV. For
percent) were male, with a mean age of twenty-seven instance, when they responded about whether they
years. Nearly three-fourths (70.0 percent) reported intended to address IPV with their patients, over
receiving no IPV training prior to dental school, and three-fourths (78.3 percent) said they would be
a quarter (25.0 percent) who were trained prior to unlikely to ask all new patients about abuse in their
dental school received between one and five hours relationships, and the remaining fifth (21.7 percent)
of training. Some IPV training was defined as one indicated they were uncertain. In addition, a low
or more hours of received training. During dental percentage of these students (16.7 percent) said they
school, these students documented much higher would feel comfortable discussing IPV with patients.
rates of IPV training, with 57.0 percent receiving Nearly a third (31.6 percent) reported that they were
between one and five hours of training, while 5.0 aware of state reporting requirements regarding IPV.
percent had between six and fifteen hours of train- Perceived effectiveness of previous IPV train-
ing and 2.0 percent received more than fifteen hours ing was measured through the Perceived Preparation
of training. Over one-third (36.0 percent) of these scale. Participants scores and responses ranged from
students reported having no IPV training in dental 1 (not prepared) to 7 (quite well prepared). The dental
school. A fifth (20.0 percent) acknowledged having students reported a Perceived Preparation score of
Effects of Training
Table 3. Dental students in study: demographics and
The dental students with IPV training prior background characteristics
to dental school had significantly higher rates
Number (Percentage)
(M=24.61; SD=3.91) of Actual Knowledge than
those who had had no IPV training prior to dental Course
school (M=21.00; SD=5.38), t(61)=2.57, p=.013. Dentistry 61 (21.3%)
The dental students who had received IPV training Age (Mean/SD) 27.4 (2.74)
during dental school also had significantly higher Range 25 to 40
Actual Knowledge rates (M=23.32; SD=4.83) than
Gender
those dental students who had received no IPV Male 38 (62.3%)
training during dental school (M=20.00; SD=5.31), Female 23 (37.7%)
t(61)=2.50, p=.015. Differences between the dental
Hours of IPV training in dental school
students reporting IPV training both prior to and None 22 (36.0%)
during dental school and those who reported no IPV 15 hours 35 (57.0%)
training prior to or during dental school were higher 615 hours 3 (5.0%)
but not significant in terms of Perceived Preparation More than 15 hours 1 (2.0%)
and Perceived Knowledge (see Table 4). Hours of IPV training prior to dental school
We were also able to verify knowledge gaps None 43 (70.0%)
by identifying questions with the lowest percentage 15 hours 15 (25.0%)
of correct answers among the thirty-eight questions 615 hours 3 (5.0%)
used to assess Actual Knowledge. Eleven questions More than 15 hours 0 (0)
were identified in which less than 50 percent of the Personal IPV experiencea
dental students gave a correct answer, out of which Self 6 (10.0%)
three questions (Victims of IPV are able to make Family 8 (13.3%)
appropriate choices about how to handle their situ- Any personal experience 12 (20.0%)
ation; Even if a child is not in immediate danger, Note: All values are total and percentages, unless otherwise
stated.
health care providers in all states are mandated to SD=standard deviation
report an instance of a child witnessing IPV to Child a
Missing data=1
Protective Services; and What is the strongest
single risk factor for becoming a victim of intimate
partner violence?) had correct answer rates of less
than 25 percent (see Table 5). Effect of Personal Experience
It should be noted with regard to differences with IPV
in summary scale rates that, at our institution, IPV
A tenth (10 percent, N=6) of all dental students
is recommended but not mandated for inclusion in
surveyed (N=61; missing data N=1) reported being
all programs. As a result, each college and depart-
the victim of some form of IPV, including physi-
ment implements IPV instruction in different ways
cal violence, sexual abuse, intimidation, economic
and with substantial variation in method, content,
deprivation, or threats of violence in an intimate
and success.
Table 5. Students responses to Actual Knowledge questions: number and percentages of correct answers
Number Percentage
What is the strongest single risk factor for becoming a victim of intimate partner violence? 3 4.9%
Which of the following are warning signs that a patient may have been abused by his/her partner?
Chronic unexplained pain 22 36.1%
Substance abuse 16 26.2%
Have you ever been afraid of your partner? 21 34.4%
Has your partner ever hit or hurt you? 26 42.6%
Alcohol consumption is the greatest single predictor of the likelihood of IPV.a 23 38.3%
Being supportive of a patients choice to remain in a violent relationship would condone the abuse.a 23 38.3%
Victims of IPV are able to make appropriate choices about how to handle their situation.a 10 16.7%
Health care providers should not pressure patients to acknowledge that they are living in an abusive 25 41.7%
relationship.a
Victims of IPV are at greater risk of injury when they leave the relationship.a 17 28.3%
Even if the child is not in immediate danger, health care providers in all states are mandated to report 8 13.3%
an instance of a child witnessing IPV to Child Protective Services.b
a
1 missing information
b
2 missing information