Study objectives: Intimate partner violence is a significant public health problem affecting millions of women in the United States. Students and physicians working in an emergency department (ED) setting may be in a unique position to identify victims of intimate partner violence. The objective of this study is to determine the ability of fourth-year medical students to identify a victim of intimate partner violence using a simulated ED encounter.
Methods: In July and August of 2003, all 196 fourth-year medical students completed an Objective Structured Clinical Examination (OSCE) using standardized patients portraying a 46-year-old woman presenting to the ED with lower back pain simulating a case of intimate partner violence. Each student-standardized patient encounter was limited to 20 minutes. At the conclusion of each student-standardized patient encounter, the standardized patient documented whether the medical student inquired about the possibility of being in an abusive relationship, previous ED visits or injuries, whether the patient felt safe going home, about both the patient's and husband's use of alcohol and illicit drugs, whether the patient wanted to make a report to the police, whether the patient's children have ever been abused, whether the patient has ever been sexually abused, and whether there is a firearm in the home.
Results: All 196 fourth-year medical students completed the OSCE using a standardized patient to simulate an ED patient encounter of intimate partner violence. One hundred sixty-seven (85.2%) students inquired whether the standardized patient was a victim of intimate partner violence, and 178 (90.8%) asked about previous ED visits or injuries. In 132 (67.7%) encounters, the standardized patient was asked whether she felt safe returning home. The standardized patient was questioned about her alcohol and illicit drug use in 90 (45.9%) cases, and she was questioned about her spouse's use of alcohol and illicit drug use in 7 (3.6%) of the encounters. The standardized patient was asked in 13 (6.6%) cases whether she would like to make a report to the police. In 126 (64.3%) encounters, the standardized patient was asked whether her children were ever abused, and in 12 (6.1%) encounters, the standardized patient was asked whether she had ever been sexually abused by her partner. In 16 (8.2%) of cases, the standardized patient was asked whether there is a firearm in the home.
Conclusion: In most cases, medical students identified that the standardized patient was portraying a victim of intimate partner violence. It is, however, unclear whether this occurred by way of routine screening or as a result of deductive reasoning. Even after identification of intimate partner violence, few students inquired into the social history of the spouse, whether the patient has ever been sexually abused, whether she wanted to make a report to the police, or whether a firearm was present in the home.