More training needed on screening for domestic violence and abuse
I read with great interest Kirk and Bezzant's (2020) article drawing attention to the numerous barriers that prevent health professionals from screening women for domestic violence and abuse (DVA). Insufficient training and education were the most frequent barriers, with health professionals describing a lack of confidence in having vitally important discussions about DVA with patients. As a final-year medical student at University College London, I feel strongly about the importance of building confidence in knowledge of DVA at the undergraduate level, including how to have sensitive and effective consultations with patients.
Research has found that nursing students receive inadequate training and education about DVA during their undergraduate studies (Alshammari et al, 2018). The unfortunate result of this is that they feel unprepared and unable to respond appropriately in practice where they suspect DVA. A recent study looking at DVA teaching within UK medical schools also found that students were receiving limited teaching, often in the form of a single small group session or lecture (Potter and Feder, 2018).
Given the global health burden and both the short- and long-term health impacts of suffering DVA, I believe that the subject is receiving insufficient attention in health professional undergraduate curricula. I believe that students require opportunities to practise their communication skills in this area, including the use of sensitive language and delicate questioning (involving the use of direct and indirect questions) and the use of evidence-based screening tools. These strategies aid disclosure and are valuable for holding effective consultations about DVA (Sohal et al, 2007).
Preparedness, self-confidence and comfort following a disclosure are factors that influence decisions about whether to routinely ask women about DVA (Gutmanis et al, 2007). These factors are all amenable to improvement through immersion in scenarios. There are certain key areas that could be targeted, namely increasing confidence in communication skills, recognition of the signs of DVA, and knowledge about support services and referral, all of which, when poorly understood, can pose preventable barriers to screening.
Through dedicated simulation and scenario-based teaching, students can overcome any reluctance to screen for DVA. Such sessions allow provision of individualised feedback. Students would become familiar with the signs of abuse and indications for screening and aware of those at greater risk, such as pregnant women and vulnerable children and adults.
Having more time devoted to DVA would allow students to learn about issues of consent, relevant UK law, performing a risk assessment and what to document. Students would be able to practise giving patients information regarding available support (whether for safety, health and wellbeing or legal support) and could consider the need for onward referral. This would remove the barrier to screening of not knowing what to do if DVA is disclosed.
It is important that health professionals appreciate that we all have a part to play in responding to DVA. Knowing what support is available and having practised these challenging interactions will, I believe, allow health professionals to respond compassionately in future practice and, hopefully, help patients who disclose DVA to feel more empowered.