Intimate Partner Violence: Proposed Curricular Change for Dental Schools Joan Gibson-Howell, RDH, MSEd, EdD The Ohio State University College of Dentistry April 25, 2009

Objectives 1. Describe challenges surrounding health professionals’ training in IPV 2. Discuss existing IPV topics in health professions’ curricula 3. Review results of surveys 4. Describe methods used to teach IPV in health professions training 5. Propose curricular change for dental schools

Challenges Surrounding IPV Instruction in the Health Professions 1. Limited curricular time allocated 2. Institutional culture - resistance 3. Not in accreditation standards 4. Not integrated with other disciplines 5. Need core competencies 6. Need effective training methods

Existing IPV Instruction in Health Professions’ Curricula 1. Medicine 2. Nursing 3. Dentistry 4. Social Work

Results of Surveys Pre-and post questionnaires of dental hygienists’ CE course Pre and post questionnaires of dental students – 1 hour presentation by a IPV survivor Surveys of dental schools in 1996 and 2007 about existing IPV topics in curricula

Pre and Post Questionnaire of Dental Hygienists’ CE Continuing education: n = 30 Purpose: to explore attitudes and behaviors of dental hygienists Result: 70% of participants reported increased knowledge with improved attitudes and understanding about IPV

Presentation and Role-Play with 3rd year dental students Ethics course Pre-test: n = 50; Post-test: n = 40 Purpose: assess differences in knowledge and attitudes Result: 30% of participants reported increased confidence to identify IPV and ask questions of the victim in the dental chair

Domestic Violence Topics Included in Dental School Curricula 1996 and 2007 Survey of Dental Schools Purpose: 1) to discover IPV topics included in curricula, 2) determine ranking of emphasis on topics, 3) ascertain beliefs of course directors and 4) report change in topic inclusion over the 11 year interval

Results of 1996 Study 85.9 % ( 55/64) response rate Topic included most frequently: responsibility of the health care professional Topic most emphasized: interviewing protocol Strongest belief of faculty: a trusting patient/operator rapport is important for disclosure of incidents

Results of 2007 Study 45.4 % (25/55) response rate Topic included most frequently: responsibility of the health care professional Topic most emphasized: reporting protocol Strongest belief of faculty: a trusting patient/operator rapport is important to encourage disclosure of incidents

Overall Comparison of Studies 1. Increased IPV topics in dental curricula 2. Increased awareness by dental faculty of IPV prevalence 3. Dental students are more informed about IPV identification and intervention when graduate

Pleasing Results of Study Increased strength in faculty beliefs from 1996 to 2007 for the following: Inclusion of IPV topics in dental curriculum Dentists have a professional responsibility to refer Trusting relationship encourages disclosure

Disappointing Results of Studies 1. Impact of domestic violence on society was least included topic 2. Course directors (dental faculty) believed less strongly in 2007 compared to 1996 that domestic violence is an increasing health care issue

Proposed Change: Integrated Approach Vertical and Horizontal 1. Step-ladder approach throughout the curriculum (integrated approach – vertical) And/or 2. Weaving of a common thread throughout the curriculum (integrated approach - horizontal)

Proposed Change: Educational Theory Constructivists’ view of education: Learning takes place when one experiences and then reflects to make meaning of that experience in their own life. Weil JM, 1997 Andragogy Learning strategies focused on adults that engages learners in the learning experiences Knowles MS, 1990

What Works to Change Behavior: Administrative *Top administrative support - supportive environment *Clinical decision support - support from peers *Financial incentives *Role –modeling from informed faculty to make it a routine part of care *Clinical computing systems to drive the care process – becoming more part of the equation *Accreditation Develop core competencies for dentistry * = research shows solid support

What Works to Change Behavior: Teaching Methods *Address barriers *Interactive – small group, role play, role modeling, action video *Positive Feedback and Debriefing *Reinforcement: Reminders or Booster sessions * = research shows solid support

More Andragogy Include multidisciplinary resources – encourage team approach Include community based professionals- law enforcement, legal services, victims advocacy, batterer intervention, victim as speaker Rotations: shelter home, forensics Case studies and documentation exercises Simulated patient instruction Reinforce with clinical patient interviews - health history questions Guided clinical experiences

It is time that Education and Health Care Providers be Part of the Solution not Part of the Problem!