Intimate Partner Violence: Proposed Curricular Change for Dental Schools

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 bePart of the Solution not Part of
the Problem!