Domestic violence: a national simulation-based educational program to improve physicians' knowledge, skills and detection rates.

BACKGROUND: Although physicians are in a unique position to identify and report domestic violence (DV), detection rates are poor. AIM: To develop a national DV experiential training program, based on standardized patients (SPs), to improve knowledge, skills and detection rates among physicians. METHODS: The program was initiated by the Israeli Ministry of Health and took place at the Israel Center of Medical Simulation (MSR). Three one-day workshops for physicians were developed, each focusing on intimate partner violence, elder abuse or child abuse. Outcome measures were perceived capabilities, reported case management, and perceived intervention barriers, as obtained by self-assessment questionnaires at baseline and within a follow-up period of six months. RESULTS: A total of 150 participants took part in 15 workshops. Perception of knowledge and skills, routine screening frequency and reported case management all demonstrated significant improvement. A clear trend to elevation in detection, evaluation and referral rates was found. Ranking of intervention barriers was compared with baseline values and lack of knowledge, lack of skills and psychological difficulties diminished significantly. CONCLUSIONS: An SP-based experiential DV training program for physicians improved perceived capabilities and overall management of DV cases and reduced intervention barriers in a follow-up period of six months.

The Israel Center for Medical Simulation: a paradigm for cultural change in medical education.

Simulation-based medical education (SBME) is a rapidly growing field, as is illustrated by the increased development of simulation centers worldwide. SBME is becoming a powerful force in addressing the need to increase patient safety through quality-care training. Recognizing the benefits of SBME, increasing numbers of bodies involved in medical and health care education and training are establishing simulation centers worldwide. The general model of most facilities focuses on a single simulation modality or a specific branch of medicine or health care, limiting their overall impact on patient safety and quality of care across the health care systems. MSR, the Israel Center for Medical Simulation, is a comprehensive, national, multimodality, multidisciplinary medical simulation center dedicated to enhancing hands-on medical education, performance assessment, patient safety, and quality of care by improving clinical and communication skills. The center uses an "error-driven" educational approach, which recognizes that errors provide an opportunity to create a unique beneficial learning experience. The authors present the Israeli experience as an alternative model, and describe the impact of the MSR model on the Israeli medical community during four years of activity. They also describe the opportunities this model has opened towards changing the culture of medical education and patient safety within Israel Although this model may require modification when implemented in other medical systems, it highlights important lessons regarding the power of SBME in triggering and bringing about cultural changes in traditional medical education.