Strategic footholds for medical education about domestic violence.

The author describes in detail the successful education initiatives on domestic violence, especially violence against adult women, that have been implemented for family medicine residents at the St. Paul-Ramsey Medical Center in St. Paul, Minnesota, and for medical students at each of the three Minnesota medical schools. For example, in 1990 the residency program adopted a community-oriented primary care approach to teaching and clinical activities, including the area of domestic violence. This approach stresses partnerships with community organizations that deal with domestic abuse. Also developed was a curriculum to help residents deal with their apprehension about domestic violence and acquire the knowledge, attitudes, and skills they need to confront this problem effectively. At the three medical schools, teaching about domestic violence takes place in preclinical courses, during clinical rotations (where students work with abuse victims), and through extracurricular activities. The author describes some important types of resistance to having instruction about domestic violence in the medical curriculum. To move forward, faculty must overcome their discomfort with the topic yet acknowledge that teaching about it is difficult and requires personal stamina and empathy with colleagues. Faculty must also agree to collaborate with those who have sensitivity and expertise in the area, and must make a long-term commitment to prepare physicians to recognize problems of domestic violence and work effectively with its victims and perpetrators.