inferences can be made. The committee has attempted to distill those concerns pertinent to the education and training of health care professionals.1
Forces intrinsic to settings of health professional training may shape curricula. Such factors include: (1) curricular time and educational priorities and (2) institutional culture and norms. Curricular time refers to the specific course(s), hours, or other time allotted to training on family violence. How the time is used is dictated in part by the recognition of educational needs and determinations of the extent to which those needs will be met, involving setting priorities for the limited time available. Institutional culture and norms refers to the professional values and beliefs within the training environment.
The following discussion relies on the data available, the experience of committee members, and reports of others in health professional education elicited during a public forum the committee held on this topic, as well as other communications. The majority of the available literature focuses on physician and nurse education.
Family violence, although of ancient origins, is newly recognized as a substantial concern for the public health and health care systems. For many in health care, it is perceived more easily as a social or legal problem. In fact, historically, society in general and some health professions in particular have considered family violence to be primarily a social or legal problem and have been slow to recognize its significant health component. As recently as 15 years ago then-Surgeon General C. Everett Koop convened the first workshop linking violence and public health. In Dr. Koop’s words:
Identifying violence as a public health issue is a relatively new idea. Traditionally, when confronted by the circumstances of violence, the health professionals have deferred to the criminal justice system. . . . [Now] the professionals of medicine, nursing, and the health related social services must come forward and recognize violence as their issue. (1991:v)
The committee refers the reader to a number of references that do discuss barriers to practice (e.g., Chamberlain and Perham-Hester, 2000; NRC and IOM, 1998; Parsons et al., 1995). The Parsons et al. study, for example, does indicate that a lack of education is commonly identified as a barrier to screening practices and suggests the importance of training. However, this study relied on a questionnaire in which a sample of obstetrician-gynecologists were asked to rank a series of potential barriers to screening. It suggests that training is an important factor in screening practices but does not establish a cause-and-effect relationship between education (or lack thereof) and practice.