Assessing an Educational Intervention to Improve Physician Violence Screening Skills Anisha Abraham, MD, MPH*; Tina L. Cheng, MD, MPH*‡§; Joseph L. Wright, MD, MPH‡§; Irene Addlestone, MA*; Zhihuan Huang, MD, MPH‡; and Larrie Greenberg, MD*‡§ ABSTRACT. Objectives. Health professionals play an integral role in assessing the risk of violence in their patients. However, there have been few evaluations of violence prevention education programs for health care personnel. The objective of this study was to evaluate the effects of a violence-screening education program on pe- diatric residents’ and medical students’ comfort level and skills in the identification and management of violence risks. Setting. Adolescent clinic of a tertiary care pediatric hospital. Participants. Fifty-six second-year residents and third-year medical students assigned to a 4-week adoles- cent clinic rotation. Design. Randomized, controlled comparison study conducted over a 1-year period. Intervention. On alternate months, medical students and residents in the intervention group participated in a 3-hour workshop on violence prevention. The workshop included a didactic session with an overview of firearm, media, and sexual violence; a discussion of risk factors for adolescent violence; and training on the approach to the adolescent interview. Participants also discussed vi- olence risks in the community with a panel of teen health educators, engaged in one-on-one role play with the youth educators, and received feedback on their violence screening skills. The control group received the standard ambulatory clinic manual with articles on violence pre- vention. Evaluation Methods. All participants completed pre- rotation and postrotation questionnaires assessing their self-reported screening practices, as well as perceived importance and confidence in violence screening. Partic- ipants also interviewed and examined an adolescent standardized patient (SP) in the clinic. SPs completed evaluations on the content of the residents’ and students’ screening, their interpersonal skills, and their skill in the identification and management of the violence-related problem. Results. Over 12 months, 30 control and 26 interven- tion participants were recruited. There were no differ- ences in prerotation questionnaire scores for intervention and control groups in screening practices, perceived im- portance and confidence in violence screening. Postrota- tion intervention participants reported more screening compared with controls on violence in school/neighbor- hood and fighting history. There was also greater per- ceived importance in asking about access/use of weapons and violence in school/neighborhood. Intervention par- ticipants also had improved performance compared with controls on SP evaluations of screening for violence, identification and management of the violence-related scenario, and interpersonal skills. Conclusion. A violence prevention education pro- gram with teen health educators improved participants’ self-reported violence questioning, as well as increased perceived comfort and importance in violence screening. Participants in the program also improved their identifi- cation and management of a standardized violence-re- lated scenario presented in an adolescent clinic setting. Pediatrics 2001;107(5). URL: http://www.pediatrics.org/ cgi/content/full/107/5/e68; adolescent violence, physician education, violence risk screening. ABBREVIATIONS. AAP, American Academy of Pediatrics; SP, standardized patient; HEADS, Home, Education, Activities, Drugs/Alcohol, and Sexuality; FISTS, Fights, Injuries, Sexual Vi- olence, Threats, and Self-Defense Strategies; TASA, Teens Against the Spread of AIDS. V iolence involving youth is a major public health issue. Homicide is the leading cause of death among black youth ages 15 to 34 years and is the second leading cause of death for Ameri- can youth ages 15 to 19 years. 1–3 The US homicide rate for young adults 15 to 24 years old is quadruple the rate for the other 20 Western nations combined. 4 The underlying causes of violence are complex and diverse including: poverty; substance abuse; and ex- posure to household violence, media violence, and firearm access. Young people in high-risk environments need tar- geted violence prevention counseling. Health profes- sionals serving youth play an integral role in assess- ing the risk of violence in their patients, identifying resources, and providing support. Health profession- als have the opportunity to address violence through various means such as: teaching parents about de- creased exposure to violence at home and on televi- sion; assessing youth for violence exposure, alcohol/ drug use, and weapon carrying; and working directly with youth on conflict resolution and anger management. 5 Health professionals can also attempt to prevent violence risks by collaborating with schools and community organizations. According to the American Academy of Pediatrics From the *Department of General Pediatrics and Adolescent Medicine, Children’s National Medical Center; ‡Children’s Research Institute; §George Washington University School of Medicine and Public Health; and the Department of Emergency Medicine, Children’s National Medical Cen- ter, Washington, DC. Received for publication Apr 27, 2000; accepted Nov 17, 2000. Reprint requests to (A.A.) Department of Pediatrics, Womack Army Med- ical Hospital, Ft Bragg, NC 28307. E-mail: anisha.abraham@na.amedd. army.mil PEDIATRICS (ISSN 0031 4005). Copyright © 2001 by the American Acad- emy of Pediatrics. http://www.pediatrics.org/cgi/content/full/107/5/e68 PEDIATRICS Vol. 107 No. 5 May 2001 1 of 6 by guest on February 6, 2016 Downloaded from