Intimate partner abuse: developing a framework for change in medical education

Addressing domestic violence presents unique challenges for individual physicians and for the institutions that shape medical education and practice. In addition to the need to acquire new knowledge and skills, clinicians must confront the feelings and social beliefs that shape their responses to patients, develop new frameworks for understanding complex social issues, and generate collaborative models for working in partnership with community groups. Educators, in turn, must provide training experiences that foster the development of those understandings and skills, institutional structures that support their integration into routine practice, and faculty who model nonabusive behaviors in all aspects of training and medical care. Expanding traditional medical paradigms to address the multiple dimensions of abuse can lay the groundwork for such a process. In addition, students need to be encouraged to develop awareness of the larger social forces that affect all of our lives and health, and to recognize their potential roles as community members in ending domestic violence. This article offers suggestions for changes in the structure of medical education as part of generating a health care system contribution to ending abuse in this society. Creating a model for fostering nonabusive relationships at individual and institutional levels within the health care system can provide a paradigm for transforming the conditions under which abuse is tolerated.