{"id":118467,"date":"2025-10-13T02:49:07","date_gmt":"2025-10-13T02:49:07","guid":{"rendered":"https:\/\/www.europesays.com\/ie\/118467\/"},"modified":"2025-10-13T02:49:07","modified_gmt":"2025-10-13T02:49:07","slug":"addressing-domestic-violence-by-obstetric-and-gynecological-resident-doctors-pre-post-intervention-study-bmc-medical-education","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/ie\/118467\/","title":{"rendered":"Addressing domestic violence by obstetric and gynecological resident doctors: pre-post intervention study | BMC Medical Education"},"content":{"rendered":"

Our results show that providing care to women who are victims of violence causes suffering to residents in obstetrics and gynecology. We also observed that the barriers imposed by a biomedical care model, centered on a curative approach and with little focus on prevention and health promotion actions, make interventions for DV a challenge for resident obstetrician-gynecologists. Participants considered DV as a relevant topic, but it is commonly perceived as outside their professional activities, as interventions are more associated with social and economic issues [15<\/a>, 27<\/a>].<\/p>\n

In general, it is observed that the interviewees expect an immediate resolution of the demands that women bring to the consultation. However, it is observed that the resolution of violent situations is not immediate, generating anguish and suffering. Similar to our findings, several studies have pointed out that the topic of DV arouses different feelings and intense emotions in professionals, but these have been factors that have made them aware of this problem and, consequently, mobilized their practice [27<\/a>, 28<\/a>].<\/p>\n

In this study, another factor associated with low adherence to the approach to violence was the lack of preparation of professionals to approach the topic. However, preparation must be understood both in terms of technical skills and personal psychological resources to deal with the feelings that emerge in the relationships between doctors and health service users when dealing with a complex topic and, on many occasions, invisible.<\/p>\n

The importance of training health professionals to address GBV\/DV in health services has been discussed in several studies [7<\/a>, 15<\/a>, 18<\/a>, 27<\/a>]. Some services have already carried out educational interventions aimed at increasing DV detection rates. However, the results of the interventions were divergent between the studies. In some settings, there was no increase in cases identified, while in others, a greater number of women said they had already suffered some type of aggression. However, there was no evidence of the effectiveness of subsequent actions that were intended to reduce the DV [19<\/a>].<\/p>\n

Participants show concerns about the lack of training to support DV victims and the management of this issue. They perceive that DV is not a spontaneous concern raised during ANC consultations. In this sense, the users\u2019 own view of complaints that are attended to in this environment may also influence the perception of low exposure of the problem within the scope of the ANC consultation. However, a study conducted in an English health service showed that the majority of women felt comfortable when asked about DV and considered such questioning appropriate [29<\/a>]. The DV is usually perceived as a domestic and private matter, which becomes a limitation to understanding it as an issue associated with medical care [15<\/a>, 20<\/a>, 29<\/a>, 30<\/a>].<\/p>\n

Structural barriers, such as limited time, lack of privacy, training gaps, and insufficient management support, policies, and resources, could potentially limit the healthcare professionals\u2019 practices regarding this issue [31<\/a>]. Healthcare systems must ensure some conditions to guarantee DV response from healthcare providers, including the coordination of internal and external referrals, health workforce training, financing, health infrastructure, and information systems [13<\/a>]. Furthermore, addressing domestic or intimate partner violence is taboo in the vast majority of societies that have a sexist and patriarchal construction.<\/p>\n

The Woman\u2019s Hospital has undertaken various strategic actions over the past few years to address domestic violence against women. These initiatives may have enhanced the residents\u2019 prior knowledge and increase their awareness of domestic violence issues. Within the institution, medical residents have participated in formal activities such as case-based learning discussions, residency classes, and formal meetings within the Obstetrics Department. Additionally, activities outside the hospital setting, such as pursuing specialized training driven by personal interest in this topic, may further contribute to the residents\u2019 understanding and knowledge.<\/p>\n

The lack of significant differences between pre-and post-intervention findings shows the need to implement systematic strategies to improve the knowledge, attitudes, and practices of obstetrics and gynecology residents to address domestic violence in antenatal care services. The use of one-time intervention is a valuable resource and will contribute to sensitizing healthcare professionals to psychosocial issues, which are rarely addressed during medical training. Studies incorporate educational videos into domestic violence education programs for medical residents, combining evidence-based didactic teaching methods with seminars (including video and case-based discussion), literature reviews, and role play [32<\/a>, 33<\/a>]. To achieve more significant and long-term improvements, a longitudinal domestic violence curriculum is recommended [34<\/a>].<\/p>\n

Evidence suggest that combining multiple interventions would be more effective than a single intervention to improve professional practice [35<\/a>]. Similarly, our findings suggest that to promote behavior changes among healthcare professionals would require comprehensive and long-term interventions.<\/p>\n

The participants\u2019 use of terms such as \u201chelp\u201d or \u201cadvise\u201d shows that this topic is acquiring a personal approach, sometimes denoting a lack of delimitation regarding the limits of their professional roles. Studies have shown that sometimes, when a professional intends to intervene in these cases, their conduct may be motivated by personal attitudes rather than technical-scientific guidance [15<\/a>]. Likewise, some management issues and organization of work dynamics in health services can affect professionals\u2019 conduct in adhering to routine screening, such as establishing a bond between the professional and the pregnant woman. This bond is affected by the variation in the number of professionals who carry out screening, the limited time of consultations, and sometimes the lack of privacy.<\/p>\n

Likewise, the idea of avoiding \u201craising a problem for nothing\u201d may induce professionals not to ask about exposure to situations of violence, especially when realizing that the institutional structure and support network may be insufficient to accommodate the different needs that women in situations of violence may present.<\/p>\n

The lack of training to address DV is one of the aspects that limits the resident\u2019s practice in healthcare services [36<\/a>]. Although this is a barrier frequently highlighted in the literature, few studies indicate interventions aimed to improve obstetrics\/gynecology residents\u2019 competencies to address this issue [34<\/a>]. In this sense, a study aimed to assess educational strategies for obstetrics\/gynecology residents shows that few consistently perform or feel comfortable screening [34<\/a>]. Addressing these gaps in DV education and training is critically important, given the low levels of DV screening rates that remain in this setting, contrasting with the high prevalence of DV among antenatal care attendees.<\/p>\n

Although we recognize the need for health-system level changes to increase screening and deliver quality care for DV survivors, further research is needed to evaluate how training healthcare professionals impacts their clinical practice and contributes to increased screening rates.<\/p>\n

The study carried out had limitations regarding the sample. The sample size, being small and belonging to a single service, can limit the extrapolation of results. Additionally, the use of questionnaires with closed questions can produce fragile results. Furthermore, a validity test for the questionnaire was not conducted. Another limitation of our study is the potential desirability bias in the participants\u2019 responses. However, some strategies were adopted to minimize this issue, such as self-administration of the questionnaire, the inclusion of mixed-methods techniques such as questionnaire and semi-structured interview, and ensuring the participants\u2019 confidentiality during all the study phases.<\/p>\n

Additionally, a potential barrier to integrating this knowledge into the residents\u2019 practice may stem from certain characteristics of the intervention, such as limited face-to-face interaction or the absence of survivors\u2019 testimonies, which can play a critical role in sensitizing healthcare professionals to this issue and its impacts on women\u2019s lives. However, incorporating such testimonies into healthcare training poses challenges and requires careful consideration of ethical standards to avoid re-victimization and psychological discomfort for both professionals and domestic violence survivors.<\/p>\n

As positive points, the qualitative part of the study also gave the interviewees a voice, with freedom to express their feelings and difficulties in approaching this issue. Another strength of this study is that this intervention can be applied to other services. Furthermore, the approach to the topic already brings reflection to each resident doctor involved in the research, which could expand the debate on the topic and bring new forms of intervention.<\/p>\n

In addition to issues associated with the training of health professionals, developing skills to multidisciplinary teamwork and creating a favorable work environment are elements that can contribute to integrating the DV approach into the obstetrician-gynecologists\u2019 practices. The model of care for women in situations of violence needs to transcend the reductionist and individualistic model that still prevails [17<\/a>, 27<\/a>]. Likewise, creating spaces for professionals to listen can help ensure that the suffering that accompanies the approach to sensitive topics that mobilize intense feelings is recognized, welcomed and worked through.<\/p>\n

One of the critical points revealed by our study is the need for systematic training of medical residents to address DV in ANC. In this sense, our findings reinforce that health workforce development is a core component of the health-care response necessary to address VAW [13<\/a>]. We highlight that training is not the only element that should be ensured to guarantee an adequate response to confront DV in this setting. A comprehensive systems approach is necessary, taking into account other key building blocks, such as service delivery, health information, infrastructure and access to essential medicines, financing, and leadership and governance [13<\/a>].<\/p>\n

Further steps should include long-term actions, such as the introduction of champions as a key component of the interventions. Some evidence shows the role of champions in mentoring and supporting healthcare professionals to improve their DV approach in this setting [37<\/a>].<\/p>\n

Our results also highlight the urgency of improving health professionals\u2019 knowledge about the social assistance network in the region where they work and the mechanisms for articulating health services with these networks. This is an essential issue to ensure that intersectoral work facilitates the approach to situations of violence to which women who attend prenatal services may be exposed.<\/p>\n","protected":false},"excerpt":{"rendered":"Our results show that providing care to women who are victims of violence causes suffering to residents in…\n","protected":false},"author":2,"featured_media":118468,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[78],"tags":[18,55388,12097,135,475,19,17,5461,72400,24103],"class_list":{"0":"post-118467","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-eire","9":"tag-gender-based-violence","10":"tag-gender-equality","11":"tag-health","12":"tag-health-care","13":"tag-ie","14":"tag-ireland","15":"tag-medical-education","16":"tag-obgyn-residence","17":"tag-theory-of-medicine-bioethics"},"share_on_mastodon":{"url":"","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/118467","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=118467"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/118467\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/118468"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=118467"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=118467"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=118467"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}