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Research

Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest–posttest study

The EDUCATE Investigators
December 18, 2018 6 (4) E628-E636; DOI: https://doi.org/10.9778/cmajo.20180150
Departments of Surgery (Sprague, Petrisor, Bhandari, Faidi, McKay, Schneider), Health Research Methods, Evidence, and Impact (Sprague, Scott, Heels-Ansdell, Bhandari, Agarwal, Cook, Thabane, Worster), Family Medicine (Agarwal), Medicine (Cook, Worster) and Midwifery (Reitsma) and School of Rehabilitation Science (Dal Bello-Haas, MacIntyre, Solomon), McMaster University, Hamilton, Ont.; St. Joseph’s Healthcare (Adili), Hamilton, Ont.; Department of Surgery (Prism Schneider, Buckley, Harrison, Kennedy), University of Calgary, Calgary, Alta.; Department of Surgery (Furey, Cyr, Baker), Memorial University of Newfoundland, St. John’s, Nfld.; St. Michael’s Hospital (Hall, Nauth, Vicente), Toronto, Ont.; Women’s Centre for Social Justice (MacGregor), Toronto, Ont.; London Health Sciences Centre (MacNevin, Schemitsch), London, Ont.; Domestic Assault Review Team (Resendes Gilbert), Waterloo, Ont.; The CORE Institute (Sietsema), Phoenix, Ariz.; Department of Orthopaedics (Slobogean), University of Maryland School of Medicine, Baltimore, Md.; Department of Medicine (Swaminathan), University of Toronto, Toronto, Ont.; Canadian Orthopaedic Association (Thomson, Wittman), Montréal, Que.; Sexual Assault/Domestic Violence Care Centre (Tikasz), Hamilton Health Sciences (Collerman), McMaster University Medical Centre, Hamilton, Ont.
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    Figure 1:

    Study participant flowchart.

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    Table 1:

    EDUCATE program content

    ComponentContentPurposeTimeSetting
    1A video presentation about the importance of orthopedic surgeons and other HCPs becoming involved in IPV identification and assistance. The video also introduced the IPV education program. The video is available through https://www.youtube.com/watch?v=Z7NLxpslVro
    • Obtain buy-in from the orthopedic community and convince them of the importance of investing time and resources in the IPV education program

    • Inform trainees about what they could expect to receive from the IPV education program

    3 minViewed individually at participants’ convenience or as part of the in-person training session, depending on the champion’s preference
    2Three interactive online modules that are part of the series entitled “Responding to Domestic Violence in Clinical Settings” available through dveducation.ca.22 The modules focus on conveying background knowledge (e.g., definitions, prevalence, dynamics of abusive relationships, barriers to leaving an abusive relationship), as well as clinical skills pertaining to IPV identification and assistance. This training was designed to help trainees achieve competency in identifying and providing assistance to women who have experienced IPV.
    • Provide trainees with core IPV knowledge such as definitions, prevalence, effects of IPV, supportive and nonjudgmental communication

    • Demonstrate appropriate ways of asking women about IPV experiences

    • Provide interactive opportunities for trainees to select from a variety of statements asking women about IPV and to receive feedback on the appropriateness of these statements

    • Demonstrate appropriate ways of providing support and assistance to women experiencing IPV

    • Provide interactive opportunities for trainees to select from a variety of statements providing support and assistance to women experiencing IPV and to receive feedback on the appropriateness of these statements

    Approx. 1 hViewed individually at participant’s convenience or as part of the in-person training session, depending on the champion’s preference
    3The local IPV champion(s) delivered an in-person PowerPoint presentation that included a lecture explaining how to ask women about IPV in the fracture clinic and provide assistance to women experiencing IPV. This presentation included 2 videos demonstrating IPV identification and assistance within a health care setting, as well as 4 case-based scenarios. Champions were provided with mock cases but were encouraged to discuss real-life cases from their practice, if possible. Trainees were given a chance to role play and discuss how they would respond to these cases in their practice. The presentation concluded with a discussion of local IPV policies, protocols and procedures and community resources. Trainees were then provided with an opportunity to ask questions and have a group discussion about the training content.
    • To consolidate learning from the video and online training and provide trainees with an opportunity to ask questions about any previous aspects of training that were not clear

    • To provide training about how to identify, and provide assistance for, IPV

    • To provide trainees with an opportunity to practise asking about, and providing assistance with, IPV

    • To ensure trainees are knowledgeable about key local resources

    • To consolidate learning through interactive discussion and opportunities to ask questions

    Approx. 1 hIn-person group training session led by champion
    OngoingLocal IPV champions received bimonthly training updates from the Methods Centre (McMaster University). Local IPV champions were responsible for distributing these updates to trainees (e.g., through presentations at rounds, training meetings, and email).
    • Note: HCP = health care provider, IPV = intimate partner violence.

    • View popup
    Table 2:

    Participant characteristics

    CharacteristicNo. (%)
    Age, yr,* mean ± SD35.7 ± 10.2
    Sex
     Male96/140 (68.6)
     Female44/140 (31.4)
    Race/ethnicity
     White107/140 (76.4)
     South Asian16/140 (11.4)
     East Asian11/140 (7.9)
     Middle Eastern3/140 (2.1)
     Black (African/Caribbean)1/140 (0.7)
     Other2/140 (1.4)
    Profession
     Orthopedic surgery resident62/140 (44.3)
     Orthopedic surgeon28/140 (20.0)
     Orthopedic technician11/140 (7.9)
     Nurse10/140 (7.1)
     Research personnel9/140 (6.4)
     Orthopedic surgery fellow6/140 (4.3)
     Physiotherapist5/140 (3.6)
     Physician/surgical assistant5/140 (3.6)
     Medical student2/140 (1.4)
     Occupational therapist1/140 (0.7)
     Booking clerk1/140 (0.7)
    Amount of previous IPV training, h
     067/139 (48.2)
     1–565/139 (46.8)
     6–157/139 (5.0)
    Type of previous IPV training
     Attended a lecture/talk64/72 (88.9)
     Watched a video25/72 (34.7)
     Completed online training9/72 (12.5)
     Attended skills-based training workshop7/72 (9.7)
     Other3/72 (4.2)
    Setting of previous IPV training
     Medical or professional school33/72 (23.6)
     Residency/placement/internship20/72 (14.3)
     Workplace18/72 (12.9)
     Professional education12/72 (8.6)
     Self-learning3/72
     Volunteer position2/72
     Research1/72
    • Note: IPV = intimate partner violence, SD = standard deviation.

    • ↵* n = 139.

    • View popup
    Table 3:

    Change in scores on Physician Readiness to Manage IPV Survey subscales between baseline and immediately after training and between baseline and 3 months after training

    Subscale*Score, mean ± SDRegression analysis, mean difference (95% CI)
    n = 136
    Score, mean ± SDRegression analysis, mean difference (95% CI)
    n = 121
    BaselineImmediately after trainingBaseline3 months after training
    Actual knowledge26.71 ± 4.8830.06 ± 3.953.35 (2.77 to 3.94)26.60 ± 4.79)29.04 ± 3.892.44 (1.79 to 3.09)
    Perceived preparation2.69 ± 1.104.74 ± 1.142.06 (1.88 to 2.23)2.63 ± 1.064.59 ± 1.121.96 (1.79 to 2.13)
    Perceived knowledge2.76 ± 1.104.89 ± 1.012.14 (1.98 to 2.30)2.71 ± 1.084.77 ± 1.052.05 (1.88 to 2.23)
    Practice issues5.53 ± 5.969.62 ± 5.914.08 (3.35 to 4.82)5.73 ± 6.2711.83 ± 7.746.10 (4.98 to 7.23)
    Opinion subscales
    Preparation3.70 ± 1.174.75 ± 0.941.04 (0.89 to 1.20)3.68 ± 1.204.74 ± 0.971.06 (0.89 to 1.22)
    Legal requirements3.44 ± 1.555.10 ± 1.171.66 (1.47 to 1.85)3.41 ± 1.514.91 ± 1.121.50 (1.30 to 1.70)
    Workplace issues3.04 ± 0.904.12 ± 0.821.08 (0.96 to 1.20)3.00 ± 0.924.11 ± 0.881.11 (0.97 to 1.26)
    Self-efficacy3.56 ± 0.454.12 ± 0.490.56 (0.49 to 0.63)3.56 ± 0.454.09 ± 0.570.54 (0.45 to 0.63)
    Alcohol/drugs4.24 ± 0.554.44 ± 0.580.20 (0.10 to 0.30)4.26 ± 0.564.28 ± 0.46003 (−0.05 to 0.11)
    Victim understanding4.94 ± 0.695.08 ± 0.770.15 (0.04 to 0.25)4.95 ± 0.704.95 ± 0.780.002 (−0.11 to 0.11)
    • Note: CI = confidence interval, SD = standard deviation.

    • ↵* Ranges and estimated minimally important clinical differences (MCIDs)† for subscales (range, MCID): actual knowledge (0 to 38, 2.42); perceived preparation to manage IPV (1 to 7, 0.55); perceived knowledge of important IPV issues (1 to 7, 0.55); practice issues (0 to 58, 3.06); preparation (1 to 7, 0.59); legal requirements (1 to 7, 0.77); workplace issues (1 to 7, 0.45); self-efficacy (1 to 7, 0.22); alcohol/drugs (1 to 7, 0.28); and victim understanding (1 to 7, 0.35).

    • † MCIDs were estimated as half the subscales’ standard deviations.20

    • View popup
    Table 4:

    Change in scores on Physician Readiness to Manage IPV Survey subscales between baseline and immediately after training and between baseline and 3 months after training

    SubscaleScore, mean ± SDPaired t-test analysis, mean difference (95% CI)
    n = 136
    Score, mean ± SDPaired t-test analysis, mean difference (95% CI)
    n = 121
    BaselineImmediately after trainingBaseline3 months after training
    Actual knowledge26.71 ± 4.8830.06 ± 3.953.35 (2.57 to 4.13)26.60 ± 4.79)29.04 ± 3.892.44 (1.54 to 3.33)
    Perceived preparation2.69 ± 1.104.74 ± 1.142.06 (1.85 to 2.27)2.63 ± 1.064.59 ± 1.121.96 (1.75 to 2.17)
    Perceived knowledge2.76 ± 1.104.89 ± 1.012.14 (1.93 to 2.35)2.71 ± 1.084.77 ± 1.052.05 (1.84 to 2.27)
    Practice issues5.53 ± 5.969.62 ± 5.914.08 (3.29 to 4.88)5.73 ± 6.2711.83 ± 7.746.10 (4.91 to 7.30)
    Opinion subscales
    Preparation3.70 ± 1.174.75 ± 0.941.04 (0.82 to 1.27)3.68 ± 1.204.74 ± 0.971.06 (0.81 to 1.30)
    Legal requirements3.44 ± 1.555.10 ± 1.171.66 (1.38 to 1.94)3.41 ± 1.514.91 ± 1.121.50 (1.21 to 1.80)
    Workplace issues3.04 ± 0.904.12 ± 0.821.08 (0.94 to 1.23)3.00 ± 0.924.11 ± 0.881.11 (0.93 to 1.30)
    Self-efficacy3.56 ± 0.454.12 ± 0.490.56 (0.48 to 0.64)3.56 ± 0.454.09 ± 0.570.54 (0.43 to 0.64)
    Alcohol/drugs4.24 ± 0.554.44 ± 0.580.20 (0.08 to 0.32)4.26 ± 0.564.28 ± 0.460.03 (−0.09 to 0.15)
    Victim understanding4.94 ± 0.695.08 ± 0.770.15 (0.03 to 0.26)4.95 ± 0.704.95 ± 0.780.002 (−0.13 to 0.13)
    • Note: CI = confidence interval, SD = standard deviation.

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Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest–posttest study
The EDUCATE Investigators
Oct 2018, 6 (4) E628-E636; DOI: 10.9778/cmajo.20180150

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Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest–posttest study
The EDUCATE Investigators
Oct 2018, 6 (4) E628-E636; DOI: 10.9778/cmajo.20180150
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