Commentary on "intimate partner violence education for medical students: toward a comprehensive curriculum revision".

I n ‘‘Intimate Partner Violence Education for Medical Students: Toward a Comprehensive Curriculum Revision,’’ the authors describe a shortage of intimate partner violence (IPV) content in a medical school curriculum, measure personal IPV experience among medical students, and demonstrate that perceived or actual IPV knowledge may be related to IPV content exposure, but report that it does not appear to be significantly influenced by personal or family IPV experience, which was surprisingly prevalent (28.7%) in medical students. The importance of IPV is hard to refute. Twenty-five percent of all women and 14.5% of all men have experienced a lifetime episode, and rates of IPV can be even higher among women who are young, single, poorly educated, and victims of childhood abuse. A 2011 study showed that the leading cause of pregnancy-related mortality was not what one might consider the ‘‘traditional’’ obstetrical complications, such as hemorrhage, infection, or eclampsia. Rather, the number-one cause of maternal mortality was pregnancy-associated homicide, followed by pregnancy-associated suicide. Furthermore, 54.3% of pregnancy-associated suicides involved IPV that appeared to contribute to the suicide, and 45.3% of pregnancyassociated homicides were associated with IPV. Being a victim of IPV also increases the long-term risk of adverse health outcomes, including asthma, musculoskeletal disease, complications of pregnancy and childbirth, sexually transmitted diseases (including human immunodeficiency virus/acquired immune deficiency syndrome), substance abuse, anxiety, and depression. IPV also is associated with higher health care utilization rates, especially for mental health services. Sadly, children who are exposed to IPV are much more likely to be both victims and perpetrators of IPV as adults, thus helping to perpetuate a cycle of abuse and victimization. Despite the clear evidence demonstrating that IPV should be taken seriously, the issue is often ignored or marginalized. As the authors point out, there is almost never a formal IPV curriculum in medical school. The same is true for graduate medical education and continuing medical education, despite evidence (from studies such as this one) showing that formal IPV curricula can improve preparedness to address IPV survivors, as well as perceived and actual knowledge about IPV. Neglect of IPV is not limited to medical education. Despite many studies demonstrating the importance of IPV in healthcare outcomes and utilization, little research has focused on effective interventions for IPV. In fact, universal screening for IPV remains controversial because the available screening tools are unreliable and evidence is weak to support the idea that screening for IPV actually reduces violence or improves other outcomes. The lack of IPV research and education translates into neglect of IPVat the service-delivery level. Most clinical systems do not have adequate resources in place either to screen for IPV or to respond effectively when cases of IPV are identified. Most systems do not give providers adequate time, resources, or reimbursement to address this important issue. Unfortunately, in the setting of shrinking resources, IPV is likely to continue to be marginalized until advocates reach critical mass and demand a more systematic response to this issue. The authors are to be applauded for their efforts to shine light on the continued neglect of IPV in medical school curricula and to suggest some solutions. Let us all consider how we can better address the scourge of IPV in our own practices and communities.