Gay Partner Violence Assessment and Intervention

Authors:Stuart Weisberg, M.D. and Joseph B. Layde, M.D., J.D.
Medical College of Wisconsin

I. Sexual History Taking Videotaped Exercise

II. Synopsis
A. Audience: M-II students in the Human Sexuality Course
B. Mode of Education: Role-playing by medical students, one of whom portrays an emergency physician, one of whom plays a gay male victim of domestic violence, and one of whom plays a gay male perpetrator of domestic violence. A fourth student operates a video camera and videotapes the sexual history taking, which is then critiqued by small group students and a small group leader in the M-II Human Sexuality Course in Psychiatry.

III. Objectives
A. At the conclusion of this module, the learner will be able to:
B. Describe the presentation of domestic violence in an emergency medicine setting.
C. Competently obtain a sexual history from a victim of domestic violence.
D. Explain the psychosocial context of domestic violence in the gay population.

IV. Key Definitions and Concepts
A. Physicians must be alert to subtle signs of domestic violence in the emergency room setting.
B. Domestic violence can occur in the context of gay relationships.
C. Careful history taking of cases of domestic violence in the emergency room setting requires the physical separation of the victim and perpetrator in the emergency room.

V. Relationship to Human Sexuality Course
A. This module contributes to a student's mastery of the knowledge base related to partner violence in individual relationships and to an under-standing of the diversity of homosexual relationships.
B. Sexual history taking is observed in this module in a videotaped exercise.
C. The physician's professional role in dealing with human sexuality is furthered by the student's opportunity to role-play an emergency physician interviewing a victim of domestic violence.

VI. Linkages to other MCW curriculum
A. Horizontal links to other M-II courses: Link to partner violence in the Human Psychopathology portion of M-II Psychiatry.
B. Vertical links:
1. M-I Foundations of Human Behavior
2. M-III Psychiatry
3. M-IV Emergency Medicine

VII. References
A. For faculty:
Understanding Sexuality, 3rd Edition, St. Louis, Mosby Year Book, 1993, Haas and Haas: "Communication", pgs. 352-368; "Homosexual Relationships", pgs. 401-430; "Sexual Coercion and Violence", pgs. 558-578.

Synopsis of Psychiatry, 8th Edition, Baltimore, Lippincott, Williams & Williams, 1998, Kaplan and Sadock: "Human Sexuality", pgs. 676-719.

B. For students:
Understanding Sexuality, 3rd Edition, St. Louis, Mosby Year Book, 1993, Haas and Haas: "Communication", pgs. 352-368; "Homosexual Relationships", pgs. 401-430; "Sexual Coercion and Violence", pgs. 558-578.

Synopsis of Psychiatry, 8th Edition, Baltimore, Lippincott, Williams & Williams, 1998, Kaplan and Sadock: "Human Sexuality", pgs. 676-719.

C. For patient education:
Understanding Sexuality, 3rd Edition, St. Louis, Mosby Year Book, 1993, Haas and Haas: "Communication", pgs. 352-368; "Homosexual Relationships", pgs. 401-430; "Sexual Coercion and Violence", pgs. 558-578.

Synopsis of Psychiatry, 8th Edition, Baltimore, Lippincott, Williams & Williams, 1998, Kaplan and Sadock: "Human Sexuality", pgs. 676-719.

VIII. Evaluation Strategies
A. Videotape review
B. Student self-assessment of skill
C. Written objectives related to family violence

IX. Appendix
A. Case #4 - Case scenario for role play - Taylor and Jacob
B. Group leader instructions for the M-II Human Sexuality Course videotaping exercise
C. Goals and objectives of videotaped exercise
D. M-II Human Sexuality Student Evaluation, focusing on the videotaped exercise

X. Goals and Objectives
A. Teach the facts of sexuality necessary for practicing physicians.
B. The overall goal of this course is to help students address the issues surrounding human sexuality with their patients and their patient's relationships. Critical aspects of a person's health care are frequently not addressed when they involve human sexuality, because of the belief that this is a "very private and personal area of behavior."
C. Teach the skill of sexual history taking and allow students to see themselves on videotape taking a sexual history.

This module will identify and provide basic skills on how to address sexual issues, which are frequently seen in a clinical setting including:
· Sexual development
· Sexual orientation
· Reproductive health issues (abortion, contraception, and sexually transmitted diseases)
· Sexual history taking
· Sexual violence
· Management of sexuality with respect to chronic illness
· Sexual dysfunction and sex therapies

We are in no way trying to persuade you to accept aspects of human sexuality which you disapprove of or with which you do not agree. However, we hope this course will help you explore your feelings regarding human sexuality and inspire you to explore the emotions you are likely to experience as you work with patients and their relations.

Upon completion of this module, the student will:

• Have an understanding of the complexity of human sexuality from a medical point of view.
  
• Identify the importance of discussing human sexuality with patients.
  
• Understand the variety of sexual practices and orientations without being judgmental.
  
• Identify ways to become comfortable discussing sexuality with a patient.
  
• Recognize specific medical disease processes and their impact on sexuality.
  
• Have received feedback on sexual history taking skills from the group leader and other students who critique the videotaped exercise.

This module presents material in various forms. Formal presentations can accomplish this to some extent, but the most effective means is generally thought to be small group discussions.

At no time will you be expected to "bare your soul." If you are asked a question that makes you uncomfortable or embarrassed, say so. "I'd rather not answer that" is always an acceptable response. Respect the privacy of others and insist that they respect yours. We expect you to participate in-group discussion, but only at your own level of comfort. What happens in your group should be seen as a shared responsibility by all members. Confidentiality is to be respected by all in the group. Try to speak from your own experiences rather than as a representative of a group or culture. In this way, discussion is more likely to focus on values, attitudes and experiences rather than facts, opinions, and social standards.

Back to Table of Contents