1. 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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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)

15. 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

16. 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

17. 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

18. 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

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