Partner Violence: How it Relates to Medical Practice

Authors: Bruce Ambuel PhD & L. Kevin Hamberger, PhD
Medical College of Wisconsin

I. Synopsis
A. This 40 minute introductory lecture provides second-year medical students with an overview of partner violence with an emphasis upon issues most relevant to the physician. The content includes lecture that covers the definition of partner violence, a discussion of dynamics in violent relationships, barriers that victims face to seeking help and impact upon health. A videotape It's Not OK provides a first-person look at partner violence by interviewing battered women.

II. Objectives.
A. Participants will:
1. Have a working knowledge of the definition of partner violence.
2. Identify basic societal-level and relationship-level dynamics that affect the occurrence of partner violence.
3. Understand difficulties involved in identifying battered women in medical settings.
4. Understand the importance of conducting screening to detect battered women in medical settings.

III. Key definitions and concepts
A. Violence is the threatened or actual use of physical force or power against another person, against oneself, or against a group or community which either results in, or has a high likelihood of resulting in injury, death or deprivation. US Centers for Disease Control & Prevention
B. Partner violence encompasses acts carried out by an intimate partner or ex-partner (spouse, ex-spouse, partner or ex-partner) with the intention of causing physical pain, injury, intimidation, or fear, or for the purpose of exerting control or domination.
C. Acts of partner violence include: physical violence; sexual violence; harm to others; destruction of property & pets; deprivation & neglect; psychological abuse
D. Battering refers to a pattern of violence over time that includes physical assault, sexual assault, destruction of property and pets, and psychological abuse. Battering is generally used with the intention of causing physical pain, injury, intimidation, or fear, or for the purpose of exerting control or domination.
E. Sexual assault refers to the threat or actual use of physical force that either coerces another person to submit to sexual behavior or leads to the sexual excitement or release in the perpetrator or in another person (National Research Council, 1993, p. 109).
F. Elder abuse has been defined very broadly. Included are a wide variety of omissions and commissions of various behaviors (Barnett, Miller-Perrin, & Perrin, 1997, p. 259) characterized by the exercise of power and control over the elder person, and including physical abuse, psychological abuse, sexual assault, deprivation, financial or material exploitation, and violation of constitutional rights. Self-neglect also constitutes a prevalent form of elder abuse.

IV. Relationship to specialty/course/rotation.*
[How do the learning objectives of this module relate to the specialty and to the specific course or rotation within which this module is being taught.]
A. Knowledge: Partner violence is one of the most common causes of injury experienced by women. In addition, a past history of partner violence and/or current partner violence causes increased hospitalization and increased outpatient care for all types of health problems. Therefore an orientation to partner violence is essential in a course that covers human behavior and human health.
B. Clinical Skills: The lecture format of this course does not lend itself to teaching clinical skills, however the course lays the groundwork for clinical skills that are covered during the 3rd year ambulatory rotation.
C. Attitudes & Values: This lecture uses a video taped interview with survivors of partner violence to foster understanding of and empathy for the battered woman's experience. The lecture directly addresses some of the most challenging questions that student have-e.g. Why do women stay in an abusive relationship? Are men victims of domestic violence? What can a physician do to help a victims of partner violence?

V. Linkages to other MCW Curricula
A. Horizontal links to other courses in the second year: There is no other family violence module during M2 year.
B. Vertical links to prior courses and upcoming courses.
1. During the M1 year students discuss partner violence during a problem-based-learning case discussion in Psychiatry, and during an interviewing course. This lecture builds upon these experiences by providing a systematic overview of partner violence in health care, and specific recommendations for screening and intervention.
2. This lecture prepares students for the M3 ambulatory seminar on the physician's role in family violence treatment and intervention.

VI. References
A. For faculty:
Ambuel B, Hamberger LK, Lahti J. The Family Peace Project: A model for training health care professionals to identify, treat and prevent partner violence. In: Hamberger LK, et al. (ed). Violence Issues for Health Care Educators and Practitioners. Binghamton, NY, Haworth; 1997, pp. 55-83

American Medical Association (1992a). Violence against women: Relevance for medical practitioners. Journal of the American Medical Association, 267(23): 3184-3189.

Bergman B, Brismar B. A 5-year follow-up study of 117 battered women. AJPH. 1991; 81:1486-1488.

Feldhaus, KM, et al. (1997). Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA 277(17):-1361

McLeer SV, Anwar RAH, Herman S, Maquiling K. Education is no enough: A system failure in protecting battered women. Annals Emer Med, 1989;18:651-653.

Sugg NK, Inui T. Primary care physicians' response to domestic violence: Opening Pandora's box. JAMA. 1992; 267:3157-3160.

B. For students:
Ambuel, B., Hamberger, LK, Lahti, J. (1996). Partner violence: A systematic approach to identification and intervention in outpatient health care, Wisconsin Medical Journal, May 292-7.

American Medical Association (1992a). Violence against women: Relevance for medical practitioners. Journal of the American Medical Association, 267(23): 3184-3189.

Bergman B, Brismar B. A 5-year follow-up study of 117 battered women. AJPH. 1991; 81:1486-1488.

Feldhaus, KM, et al. (1997). Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA 277(17):-1361

Popular films that deal with family violence include:
Dolores Claiborne (1995). Running Time 131 minutes; Hackford, Taylor (Director).
Sleeping with the Enemy (1991). Running time: 99 minutes; Rubin, Joseph (Director).
The Color Purple (1985). Running time: 154 minutes; Spielberg, Steven (Director).
Prince of Tides (1991). Running time: 132 minutes; Streisand, Barbra (Director).

C. For patient education: No references

Describe written objectives and evaluation strategies.
What evaluation strategies are used in this curriculum module? Check all that apply:

Describe this course's written objectives related to family violence by checking the appropriate columns in the chart below:

VII. Teaching Tools
A. Faculty Guide: This is an introductory 45-minute lecture on partner violence that occurs during the second year at the Medical College of Wisconsin. The content of this lecture is also suitable for use as an introduction to partner violence for medical residents and practicing professionals. The lecture has 4 parts:
1. an overview of partner violence definitions and dynamics (10 minutes)
2. It's Not OK, a video tape that interviews women who have been victims of partner violence (I suggest using the first 20 minutes of this video which includes individual interviews with two women). (20 minutes)
3. An overview of incidence, prevalence, impact upon health, screening methods and intervention methods. (10 minutes)
4. Questions (5 minutes)

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