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344 A RANDOMIZED CONTROL TRIAL USING INSINUATED STANDARDIZED PATIENTS TO ASSESS RESIDENTS' DOMESTIC VIOLENCE SKILLS: A PILOT STUDY
  1. S. A. Haist,
  2. J. F. Wilson,
  3. M. J. Lineberry,
  4. J. S. Gibson,
  5. C. H. Griffith
  1. Lexington, KY.

Abstract

Purpose To assess the domestic violence (DV) clinical skills of internal medicine residents participating in a DV workshop (WS) compared to residents not participating in the DV WS.

Methods 27 internal medicine residents were randomized to receive either a 2-2.5-hour DV WS or a 2-2.5 hour chronic pain (CP) WS. The two WSs were given simultaneously on four nights. Residents were paid $200. A pre-WS questionnaire included demographics, self-assessed prior DV and CP training, and perceived knowledge. The WSs were interactive with residents participating in 2 standardized-patient (SP) cases portraying different aspects of DV or CP and faculty-led discussion followed. Thirteen novel SPs never used at the study institution were trained to 2 cases (subtle DV, feeling tired and sad; obvious DV, shoulder injury with previous trauma). The 2 cases were randomized and insinuated into each resident's continuity clinic at either 1-3 months or > 3 months after the DV WS. The SPs completed a detailed checklist immediately after the encounter. Multiple regression techniques (GLM) were used to compare the results of DV SP checklist scores of DV WS residents vs. non-DV WS residents. Gender, prior DV training, perceived knowledge and WS participation were control variables.

Results 14 and 13 residents participated in the DV and CP WSs, respectively. 25 residents encountered the subtle DV case and 26 residents encountered the obvious DV case. Scores on the subtle DV checklist items were 50% for DV WS residents vs. 29% for non-DV WS residents (F = 4.0, p = .04), controlling for gender. The DV WS residents (subtle and obvious DV cases) scored 38% on the DV safety plan subscale vs. 19% for the non-DV WS residents (p = .10, effect size 0.62 SD). For the subtle and obvious DV cases, 79% of the most important DV WS specific item scores were higher for DV WS residents than for the non-DV WS residents (e.g. for “Asks if you have money hidden away” DV WS residents scored 49% and 18% higher for the subtle and obvious DV cases). Self-reported previous DV knowledge and being a woman positively influenced performance. Time between WS and the continuity clinic SP encounter did not affect the results.

Conclusion Residents participating in a DV workshop demonstrated better clinical skills than a control group as assessed by an insinuated SP portraying a subtle DV case in their continuity clinic. To our knowledge, this is the first report of insinuated SPs demonstrating improved DV clinical skills following an educational intervention.

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