Abstracts
Abstract
Background: Family physicians are uniquely able to provide comprehensive and longitudinal care to those experiencing sexual assault and domestic violence (SADV). To date, we know little about how Canadian family medicine (FM) residents learn about SADV. This study explored SADV teaching in residency from the perspectives of FM residents.
Methods: This qualitative study took place in the Western University FM residency program. We conducted semi-structured interviews with first- and second-year FM residents (n=8). We analyzed data using thematic analysis.
Results: We identified three inter-related themes: (1) Inconsistent training for SADV, (2) Attitudes towards SADV and (3) Learner hesitancy. Quality and quantity of SADV learning opportunities were inconsistent across learners, fuelling feelings of incompetence and lack of confidence around providing SADV care. This led to hesitant behaviours by learners when encountering SADV clinically.
Conclusions: Understanding FM residents’ experiences and ideas regarding SADV education is critical in order to graduate physicians equipped to care for this vulnerable population. This research highlights the relationship among learners’ and teachers’ experiences, attitudes and behaviours; targeting this behavioural cycle may improve SADV learning.
Résumé
Contexte : Les médecins de famille sont particulièrement bien placés pour fournir des soins complets et longitudinaux aux personnes victimes d’agression sexuelle et de violence familiale (ASVF). À ce jour, nous savons peu de choses sur la façon dont les résidents en médecine familiale (MF) au Canada se familiarisent avec l’ASVF. Cette étude explore la formation sur le sujet dans le cadre de la résidence en MF, du point de vue des résidents eux-mêmes.
Méthodes : Cette étude qualitative s’est déroulée dans le cadre du programme de résidence en FM de l’Université Western. Nous avons mené des entretiens semi-structurés avec des résidents en première et deuxième année de médecine familiale (n=8). Les données ont fait l’objet d’une analyse thématique.
Résultats : Nous avons relevé trois thèmes interdépendants : (1) Formation inégale en matière d’ASVF, (2) Attitudes envers l’ASVF et (3) Hésitation de la part des apprenants. La qualité et la quantité des occasions d’apprentissage sur le sujet de l’ASVF n’étaient pas uniformes parmi les apprenants, alimentant des sentiments d’incompétence et un manque de confiance dans la prestation de soins liés à l’ASVF. En conséquence, les apprenants sont hésitants lorsqu’ils rencontrent des situations liées à l’ASVF en clinique.
Conclusions : Il est essentiel de comprendre les expériences et les idées des résidents en MF concernant la formation sur le sujet de l’ASVF afin de former des médecins qui seront outillés pour s’occuper d’une population vulnérable. Nos travaux mettent en évidence la relation entre les expériences, les attitudes et les comportements des apprenants et des enseignants. On peut améliorer l’apprentissage en matière d’ASVF en ciblant ce cycle comportemental.
Download the article in PDF to read it.
Download
Appendices
Bibliography
- World Health Organization. Understanding and addressing violence against women: intimate partner violence. World Health Organization; 2012. Available from: https://www.who.int/reproductivehealth/publications/violence/rhr12_36/en/.
- Dicola D, Spaar E. Intimate partner violence. Am Fam Physician. 2016;94(8):646-51. Available from: https://www.aafp.org/afp/2016/1015/p646.html.
- Zaher E, Keogh K, Ratnapalan S. Effect of domestic violence training: systematic review of randomized controlled trials. Can Fam Physician. 2014;60(7):618-24. Available from: https://www.cfp.ca/content/60/7/618.long.
- Cronholm PF, Fogarty CT, Ambuel B, Harrison SL. Intimate partner violence. Am fam physician. 2011 May;83(10):1165-72.
- 5. Sims C, Sabra D, Bergey MR, Grill E, Sarani B, Pascual J, Kim P, Datner E. Detecting intimate partner violence: more than trauma team education is needed. J Am Coll Surg. 2011;212(5):867-72. https://doi.org/10.1016/j.jamcollsurg.2011.01.003.
- Evans MA, Feder GS. Help‐seeking amongst women survivors of domestic violence: A qualitative study of pathways towards formal and informal support. Health Expect. 2016;19(1):62-73. https://doi.org/10.1111/hex.12330.
- García-Moreno C, Hegarty K, d'Oliveira AF, Koziol-McLain J, Colombini M, Feder G. The health-systems response to violence against women. Lancet. 2015;385(9977):1567-79. https://doi.org/10.1016/S0140-6736(14)61837-7.
- Riedl D, Exenberger S, Daniels JK, Böttcher B, Beck T, Dejaco D, Lampe A. Domestic violence victims in a hospital setting: prevalence, health impact and patients’ preferences–results from a cross-sectional study. Eur J Psychotraumatol. 2019;10(1):1654063. https://doi.org/10.1080/20008198.2019.1654063.
- Vranda MN, Kumar CN, Muralidhar D, Janardhana N, Sivakumar PT. Barriers to disclosure of intimate partner violence among female patients availing services at tertiary care psychiatric hospitals: a qualitative study. J Neurosci Rural Pract. 2018;9(03):326-30. https://doi.org/10.1111/hsc.13282
- Zelazny SM, Chang JC, Burke JG, Hawk M, Miller E. Adolescent and young adult women’s recommendations for establishing comfort with family planning providers’ communication about and assessment for intimate partner violence. J Commun Healthc. 2019;12(1):32-43. https://doi.org/10.1080/17538068.2018.1560073
- Allen T, Brailovsky C, Rainsberry P, et al. Defining competency-based evaluation objectives in family medicine: dimensions of competence and priority topics for assessment. Can Fam Physician. 2011;57(9):e331-40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173441/.
- Barrett M, McKay A, Dickson C, et al. Sexual health curriculum and training in Canadian medical schools: a study of family medicine, obstetrics and gynaecology and undergraduate medicine programs in 2011 with comparisons to 1996. Can J Hum Sex. 2012;21(2):63-73. Available from: https://www.researchgate.net/publication/283402756_Sexual_health_curriculum_and_training_in_Canadian_medical_schools_A_study_of_family_medicine_obstetrics_and_gynaecology_and_undergraduate_medicine_programs_in_2011_with_comparisons_to_1996.
- Creswell JW. Qualitative inquiry and research design: choosing among five approaches. USA: Sage; 2012.
- Braun V, Clarke V. Thematic analysis: A practical guide. London: SAGE Publications; 2022.
- Varpio L, Ajjawi R, Monrouxe LV, O'Brien BC, Rees CE. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation and member checking. Med Educ. 2017;51(1):40-50. https://doi.org/10.1111/medu.13124
- Alvarez C, Fedock G, Grace KT, Campbell J. Provider screening and counseling for intimate partner violence: a systematic review of practices and influencing factors. Trauma Violence Abuse. 2017;18(5):479-95. https://doi.org/10.1177/1077801204271959
- Gutmanis I, Beynon C, Tutty L, Wathen CN, MacMillan HL. Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health. 2007;7(1):1-1. https://doi.org/10.1186/1471-2458-7-12
- Minsky-Kelly D, Hamberger LK, Pape DA, Wolff M. We’ve had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting. J Interpers Violence. 2005;20(10):1288-309. https://doi.org/10.1177%2F0886260505278861.
- Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):1-2. https://doi.org/10.1186/1748-5908-6-42.