Dental Students and Intimate Partner

Violence: Measuring Knowledge and

Experience to Institute Curricular Change
Pamela D. Connor, Ph.D.; Simonne S. Nouer, M.D., Ph.D.; SeTrail N. Mackey,
M.C.J., M.P.A.; Megan S. Banet, M.A.; Nathan G. Tipton, M.A.
Abstract: Our study documents the shortage of intimate partner violence (IPV) content exposure within one dental school cur-
riculum, with an eye toward utilizing this information to revise an existing comprehensive family violence curriculum that will be
fully integrated into required university coursework to improve competence and help overcome knowledge gaps. IPV is defined
by the Centers for Disease Control and Prevention as physical and sexual violence, threats of physical and sexual violence, or
psychological/emotional abuse including coercive tactics that adults or adolescents use against current or former intimate part-
ners. We report on the results of a four-part (background, IPV knowledge, opinions, and personal experience), sixty-seven-item
validated survey instrument used to measure knowledge, attitudes, beliefs, and self-reported behaviors among dental students pre-
paring to become health care professionals working in the field. Survey responses from the nearly 80 percent of fourth-year dental
students who completed the survey were examined within the context of students actual IPV knowledge, as well as opinions and
attitudes that could directly or indirectly influence patients. Our findings indicate that a sizeable number of students received no
IPV training prior to or during dental school, leading to perceptions that they lack knowledge about IPV and are not well prepared
to address IPV with patients. A notable percentage of students (20 percent) also reported personal experience with IPV.
Dr. Connor is Professor, Department of Preventive Medicine, University of Tennessee Health Science Center; Dr. Nouer is As-
sistant Professor, Department of Preventive Medicine, University of Tennessee Health Science Center; Ms. Mackey is Research
Manager, Department of Preventive Medicine, University of Tennessee Health Science Center; Ms. Banet is Study Coordinator,
Department of Preventive Medicine, University of Tennessee Health Science Center; and Mr. Tipton is Coordinator, Department
of Preventive Medicine, University of Tennessee Health Science Center. Direct correspondence and requests for reprints to Dr.
Pamela D. Connor, Department of Preventive Medicine, University of Tennessee Health Science Center, 600 Jefferson Avenue,
3rd Floor, Memphis, TN 38105; 901-448-3300 phone; 901-448-3770 fax; dconnor@uthsc.edu.
Keywords: knowledge, attitudes, practice, intimate partner violence, IPV, domestic violence, dental students, dental curriculum,
dental education
Submitted for publication 9/2/10; accepted 1/19/11

I
ntimate partner violence (IPV) is a persistent,
prevalent public health care issue that has mul-
tiple catastrophic effects on individuals, families,
and the larger community.1,2 The Centers for Dis-
ease Control and Prevention (CDC) defines IPV as
physical and sexual violence, threats of physical and
sexual violence, or psychological/emotional abuse
including coercive tactics that adults or adolescents
use against current or former intimate partners.3
While research has shown that some men suffer
from abuseprimarily by their male partnersthe
majority of partner violence occurs between men and
their female partners. According to findings from
the National Violence Against Women Survey, it is
estimated that approximately 1.3 million women and
835,000 men are physically assaulted by an intimate
partner annually in the United States.4
Dental professionals, including dentists, den-
tal hygienists, and dental assistants, are uniquely
qualified to address the problem of IPV as it occurs
in their patients lives, given that routine dental
examinations involve close inspection of patients
heads and necksareas where signs of physical
battering and abuse are readily visible.5-11 Typical
injuries associated with IPV that may be detected
by a dental professional include intraoral bruises
from slaps or hits; soft and hard palate bruises and
abrasions; fractured teeth, nose, mandible, and/or
maxilla; abscessed teeth; torn frenum; hair loss from
pulling or other trauma and lacerations to the head;
and attempted strangulation marks on the neck.9,10
However, research has also shown that, even when
head and neck injuries are evident, dentists may be
less likely than other health care providers to screen
for IPV,5,12 offer minimal intervention when working
with IPV victims as patients,12,13 or address IPV with
their patients.5
According to numerous studies, lack of training
has been cited by dental professionals as a primary
reason for shortcomings in screening, intervention,

1010 Journal of Dental Education Volume 75, Number 8

or broaching the subject of IPV (other reasons given
included, but were not limited to, lack of cultural
competence or insufficient access to resources).14-18
This perceived lack of training persists in spite of
policies and resolutions passed by the American Den-
tal Education Association (ADEA) and the American
Dental Association (ADA) that have encouraged (and
continue to encourage) dental educators to include
topics related to child abuse/neglect and domes-
tic/intimate partner violence as part of curricular
preparation for students who are becoming dental
professionals.4,19,20
Since 1990 most dental and dental hygiene cur-
ricula have included information on child abuse and
neglect, due in large part to state statutes mandating
that dentists and other health professionals report
suspected child abuse cases; however, curricular
content related to other types of domestic violence
particularly IPVis present in less than half of dental
school curricula.4,13,21 As a result, providers may ob-
serve injuries but either do not diagnose IPV as the
cause oras is often the casedo not feel confident
in their ability to screen and manage IPV victims.1,4
The purpose of this study was to document the
shortage of IPV content exposure within one dental
school curriculum, then to utilize this information
to revise an existing comprehensive family violence
curriculum that will be fully integrated into required
university coursework to improve competence and
help overcome knowledge gaps. We report on the
results of an IPV self-assessment tool22 originally
designed as a comprehensive and reliable method
of ascertaining physician preparedness to manage
IPV patients. In its final form, this tool (the Physi-
cian Readiness to Manage Intimate Partner Violence
Survey, or PREMIS) measured the extent of educa-
tion, knowledge, and attitudes about IPV among
physicians by way of a fifteen-minute survey. The
PREMIS demonstrated good internal consistency
and reliability for ten final developed scales that
were closely correlated with theoretical constructs
and predictive of self-reported behaviors.
The PREMIS was modified and validated by
this studys authors23 in order to assess these measures
among health professions students (medical, dental,
nursing, and social work). Results from our survey
also document the prevalence of students lifetime
personal IPV experience, which allowed us to explore
the conflicting role this exposure has in both identify-
ing IPV in patients and intervening in a manner both
appropriate and safe for student and patient.
August 2011 Journal of Dental Education
We report here on responses from dental
students who participated in this study. Our find-
ings constitute the first phase of an overarching and
comprehensive curriculum revision effort for the
representative health care professions at our institu-
tion. As part of this effort, we will use our data to
ascertain students curricular needs; revise an exist-
ing IPV prevention and intervention curriculum and
deploy it in accordance with these identified needs;
incorporate this curriculumeither wholly or in
partinto future course catalogs as an established
part of students required coursework; and longitu-
dinally track student IPV knowledge gain.
Review of the Literature
Research by Love et al.,6 Chiodo et al.,18 and
Littel has established that education on IPV needs to
24
be standardized and incorporated into dental school
and continuing education curricula, thereby mak-
ing intervention with victims a normal and standard
part of dental professionals responsible practice.5
Indeed, IPV education has been intended to help
dental students not only be aware of IPV prevalence,
but also that they are being informed about physical
and behavioral indicators of IPV, thus making them
an invaluable part of the victims identification team
in the health care arena.4 However, changes with
regard to improved or increased IPV content in the
overall dental curriculum have progressed slowly, in
spite of ambitious comprehensive curriculum reviews
conducted by the majority of U.S. and Canadian
dental schools.25
For example, a study of dental hygiene students
surveyed by Gutmann and Solomon16 found that
although most dental and dental hygiene curricula
include the specific topics of child abuse and neglect,
other manifestations of domestic violence (e.g., elder
abuse, teen dating abuse, or IPV) are addressed far
less frequently. Their findings revealed that while
child abuse was taught in seven-tenths of programs,
elder abuse was taught in just over half, and IPV was
taught in less than half of dental hygiene programs.
Stewart et al.,21 moreover, reported in 2002 that, of
forty-two U.S. and Canadian dental schools with
predoctoral programs, 100 percent included child
abuse in their curricula, while 87 percent included
elder abuse. The authors, however, did not survey
these institutions regarding IPV education. As well,
Gironda et al.26 surveyed 291 predoctoral dental
students in 200608 to gather a comprehensive sam-
1011
 pling of student perceptions of and education about
elder abuse. Gironda et al.s study aims are similar
to those of our study although their focus was on
elder abuse rather than IPV. Those authors concluded
that most students did not feel adequately trained to
report a case of elder abuse, suggesting that dental
students need education on psychosocial aspects of
older adulthood as well as training in detecting and
reporting elder abuse.
Gibson-Howell et al.5 investigated U.S. and
Canadian dental school curricula in 1996 and again in
2007 to assess if and how specific domestic violence
topics were being included in the curriculum. While
these authors concluded that inclusion of domestic
violence curricular topicswhich included health
care professional responsibility, physical and be-
havioral indicators, referral and reporting protocols,
and prevalencehad increased over the eleven years
of their two surveys, they also noted that survey re-
spondents believed less strongly in 2007 than in 1996
that domestic violence is an increasing health care
issue and that, correspondingly, domestic violence
prevalence and societal impact were not perceived as
widespread. Even more disturbing are findings from
a study conducted by Nelms et al.27 that oral health
care workers continue to be less likely than any other
health care provider to address domestic violence
within their role as health care professionals, due in
large part to barriers including lack of education and
limited time or resources.
Research has consistently found that dental
students and professionals who receive any educa-
tion about IPV are more likely to screen for IPV and
provide appropriate intervention.11,15,28-30 In fact, two
IPV/family violence initiatives have been replicated
and deployed in numerous health care settings. RA-
DAR, a provider-focused initiative that promotes
assessment and prevention of IPV, involves a five-
step approach: Routinely ask about current and past
violence; Ask direct questions; Document findings;
Assess safety; and Review options and referrals.31
Research has not indicated, however, if RADAR is
taught as part of college or university medical school
curricula.
Another promising IPV/family violence ini-
tiative is the PANDA (Prevent Abuse and Neglect
through Dental Awareness) program. According
to Mouden,32 PANDA began as a model program
in Missouri in 1992 to help close the gap in dental
knowledge about stopping child abuse and neglect.
However, while PANDAs overarching focus on child
abuse is certainly important both in terms of reinforc-
1012
ing the dental professions role as mandated report-
ers and promulgating knowledge that could lead to
possible intervention and prevention, it nevertheless
minimizes the education dental professionals might
receive on the myriad potential challenges associated
with IPV.33 Furthermore, although Mouden notes that
predoctoral and postdoctoral education in the clinical
and legal aspects of child abuse and neglect remains
insufficient to close this awareness gap, the audi-
ence to which PANDA is overwhelmingly directed
is established dental professionals rather than dental
students.32
Thus, in spite of these promising dental aware-
ness programs, there remains a dearth of compre-
hensive IPV curricular content in dental schools. For
example, a six-month phone survey of students in
health professional studies at 212 Canadian institu-
tions of higher learning conducted by Wathen et al.34
found that fewer than half (46 percent) of predoctoral
dental programs and no postdoctoral dental programs
offered course content on IPV. Danley et al.11 have
attempted to fill this curricular void through the
AVDR approach. AVDRwhich involves Asking
patients about abuse; providing Validating mes-
sages acknowledging that battering is wrong while
confirming the patients worth; Documenting signs,
symptoms, and disclosures of abuse; and Referring
victims to domestic violence specialists in the com-
munitywas successfully tested in brief tutorial
form on dental students in 2002. Students in this
study showed significant improvements in attitudes
and beliefs about domestic violence screening and
intervention. Danley et al. caution, however, that re-
search is still needed to determine whether education
leads to actual changes in screening, intervention,
and other behaviors. As well, these authors did not
measure actual student behavior, nor did they collect
data related to students personal IPV experience.
Methods of This Study
For our study, we initiated the Intimate Partner
Violence Survey for Future Healthcare Providers
project to measure student knowledge of and at-
titudes about IPV, as well as the extent, content, and
sufficiency of IPV training received by students prior
to and during their graduate studies. Between 2007
and 2008, a total of 318 students in four populations
(dentistry, medicine, nursing, and social work gradu-
ate programs) at our institution were recruited by
their deans to participate in this study. Both the deans
Journal of Dental Education Volume 75, Number 8
and the departmental/college faculties approved of
the survey and the study prior to inviting student
participation, which was voluntary. Deans arranged
for the study organizers to meet directly with students
as they attended various student functions, during
which time the survey was administered. Institutional
Review Board approval was granted for this survey.
In addition to measurements of student knowledge
and attitudes, the survey included an IPV experience
variable to determine how students personal biogra-
phies influenced their vocational choice, as well as to
postulate the extent to which this experience affected
how students screened, assessed, and intervened with
victims of IPV.
Given the need for consistency in dental school
IPV education and training, this study concentrates
specifically on responses generated from and reported
by this population. Of the original 318 students,
seventy-seven were from the field of dentistry, out
of which sixty-one completed the survey, yielding a
79.2 percent response rate. This response rate, while
good, was the lowest of the four disciplines surveyed,
with nursing students having the highest response rate
(100 percent), followed by medical students (93.6
percent) and students in social work (87.5 percent).
All dental students surveyed were in their final year
of study and had completed their clinical rounds.
Our study utilized a modified version of the
Physician Readiness to Manage Intimate Partner Vio-
lence Survey (PREMIS)22 that we adapted for student
populations.23 Our adaptation measured knowledge,
attitudes, beliefs, and self-reported behaviors through
a four-part (background, IPV knowledge, opinions,
and personal experience), sixty-seven-item survey.
The survey was modified so that the language
focused on students in the health care arena rather
than the practicing physicians for whom the origi-
nal survey was designed. The PREMIS respondent
profile was also adapted to reflect the disciplines
represented by the students in our study population.
Two questions related to personal and family IPV
experience were added: 1) Have you ever experi-
enced physical violence, sexual abuse, intimidation,
economic deprivation, or threats of violence in an
intimate partner relationship? and 2) Have you ever
witnessed physical violence, sexual abuse, or psy-
chological abuse directed toward a family member?
These questions were used to document personal
student experience with IPV rather than being used
as part of a long-range assessment and were de-
signed to be dichotomous yes/no for purposes of
gathering evidence on personal experience. Lifetime
August 2011 Journal of Dental Education
experience was considered yes if students answered
affirmatively to any of these questions. Responses to
these questions could then be examined within the
context of students actual IPV knowledge as well as
opinions and attitudes that could directly or indirectly
influence patients.
The adapted instrument demonstrated high
reliability within some IPV constructs, and six of the
eight opinion scales described in the original PREMIS
were identified (Legal Requirements, Preparation,
Self-Efficacy, Alcohol/Drugs, Victim Autonomy,
and Victim Understanding).22 Three scales from the
original PREMIS (Legal Requirements, Preparation,
and Self-Efficacy) presented a Cronbachs .70,
demonstrating acceptable reliability, and a new scale
(IPV Screening) was also identified that showed good
reliability (=.74; see Table 1).
Data on IPV training for dental students prior to
and during dental school were individually tabulated
for each category, and the results presented individu-
ally in order to facilitate comparison with regard to
total hours of training received. Responses to ques-
tions about personal experience with some kind of
physical violence, sexual abuse, intimidation, or
threats of violence in an intimate partner relationship
and/or witnessed physical violence, sexual abuse,
or psychological abuse directed toward a family
member were combined to create a lifetime IPV
experience variable, with positive (yes) answers
to either or both questions indicating students ex-
posure to IPV sometime during their lifetime. Three
summary scales were also created rather than being
derived from factor analysis. These were Perceived
Preparation (twelve items asking respondents how
well prepared they were to work with IPV victims);
Perceived Knowledge (sixteen items asking how
much respondents felt they knew about IPV); and
Actual Knowledge (which used seven multiple-
choice questions and eleven true/false questions with
a total possible score of 38). For preparedness and
perceived knowledge, the average was estimated by
respondent; then, the overall average was calculated
for the sample. For actual knowledge, the sum of
correct scores for each respondent was calculated;
then, the sum of correct responses for the sample
was averaged. Internal consistency for both the Per-
ceived Preparation and Perceived Knowledge scales
was high, with a Cronbachs alpha equal to 0.97.22
There were no appropriate tests to evaluate internal
consistency on the Actual Knowledge scale.
Independent t-tests compared the summary
scales of students with IPV training prior to dental
1013
 Table 1. Survey of health care students regarding intimate partner violence (IPV): opinion scales
Scales Alpha Total Items Sample Item

1. Legal requirements 0.914 3 I am aware of legal requirements in this state regarding reporting of
suspected cases of elder abuse.
2. Preparation 0.886 4 I dont have the necessary skills to discuss abuse with an IPV victim
who is from a different cultural/ethnic background
3. IPV screening 0.740 2 I would ask all new patients about abuse in their relationships.
4. Self-efficacy 0.797 7 I can recognize victims of IPV by the way they behave.

Scales with low reliability

5. Alcohol/drugs 0.478 2 Alcohol abuse is a leading cause of IPV.

6. Victim autonomy 0.363 3 If a patient refuses to discuss the abuse, staff can only treat the patients
injuries.
7. Victim understanding 0.460 4 I understand why IPV victims do not always comply with staff
recommendations.

school to those without training; students with IPV
training during dental school were compared to those
without training; and students reporting personal
experience with IPV were compared to those with no
personal IPV experience. Pairwise deletion was used
to exclude students with missing data. Significance
was reached with an alpha less than .05. Sample sizes
in analyses varied due to missing data. Scale scores
were stratified only by gender, and there were no
demographic differences between male and female
dental students. Furthermore, given limitations due to
our small sample size and age group, it is unlikely that
categorizing by age group would add any significant
information to the analysis (see Table 2).
Results
The majority of these dental students (62.3
percent) were male, with a mean age of twenty-seven
years. Nearly three-fourths (70.0 percent) reported
receiving no IPV training prior to dental school, and
a quarter (25.0 percent) who were trained prior to
dental school received between one and five hours
of training. Some IPV training was defined as one
or more hours of received training. During dental
school, these students documented much higher
rates of IPV training, with 57.0 percent receiving
between one and five hours of training, while 5.0
percent had between six and fifteen hours of train-
ing and 2.0 percent received more than fifteen hours
of training. Over one-third (36.0 percent) of these
students reported having no IPV training in dental
school. A fifth (20.0 percent) acknowledged having
some experience with IPV in their lifetime, whether
through personal victimization or witnessing abuse
or violence directed at a family member (see Table 3).
The dental students in this study reported that
they received IPV training in their general graduate
coursework, as well as through their specialized focus
areas of oral and maxillofacial surgery, pediatrics,
and prosthodontics. While these students received
different doses of IPV training depending on their
chosen academic concentration, our study grouped
them together as a single graduate group in order
to measure the extent of their core IPV knowledge.
Knowledge, Attitudes, and
Perceptions
These dental students generally did not per-
ceive themselves as either well prepared to address
IPV with patients or knowledgeable about IPV. For
instance, when they responded about whether they
intended to address IPV with their patients, over
three-fourths (78.3 percent) said they would be
unlikely to ask all new patients about abuse in their
relationships, and the remaining fifth (21.7 percent)
indicated they were uncertain. In addition, a low
percentage of these students (16.7 percent) said they
would feel comfortable discussing IPV with patients.
Nearly a third (31.6 percent) reported that they were
aware of state reporting requirements regarding IPV.
Perceived effectiveness of previous IPV train-
ing was measured through the Perceived Preparation
scale. Participants scores and responses ranged from
1 (not prepared) to 7 (quite well prepared). The dental
students reported a Perceived Preparation score of

1014 Journal of Dental Education Volume 75, Number 8

3.6 (SD=1.0), lower than the overall mean across
disciplines of 3.8 (SD=1.5). Students were also sur-
veyed on a Perceived Knowledge scale, on which
scores ranged from 1 (nothing) to 7 (very much).
The dental students reported an average Perceived
Knowledge score of 3.5 (SD=0.8), lower than the
overall mean score across disciplines of 3.8 (SD=1.4).
On the third measure (Actual Knowledge), the dental
students reported a mean Actual Knowledge score of
22.2 (SD=5.1), lower than the overall mean Actual
Knowledge score of 24.2 (SD=5.4).
Table 2. Dental student scores in this study stratified
by gender, by mean and standard deviation
Male Female
Perceived preparation
Mean (SD) 3.6 (1.0) 3.6 (0.9)
Perceived knowledge
Mean (SD) 3.5 (1.0) 3.5 (0.8)
Actual knowledge
Mean sum of scores (SD) 22.0 (5.4) 22.2 (5.1)

Effects of Training
Table 3. Dental students in study: demographics and
The dental students with IPV training prior background characteristics
to dental school had significantly higher rates
Number (Percentage)
(M=24.61; SD=3.91) of Actual Knowledge than
those who had had no IPV training prior to dental Course
school (M=21.00; SD=5.38), t(61)=2.57, p=.013. Dentistry 61 (21.3%)
The dental students who had received IPV training Age (Mean/SD) 27.4 (2.74)
during dental school also had significantly higher Range 25 to 40
Actual Knowledge rates (M=23.32; SD=4.83) than
Gender
those dental students who had received no IPV Male 38 (62.3%)
training during dental school (M=20.00; SD=5.31), Female 23 (37.7%)
t(61)=2.50, p=.015. Differences between the dental
Hours of IPV training in dental school
students reporting IPV training both prior to and None 22 (36.0%)
during dental school and those who reported no IPV 15 hours 35 (57.0%)
training prior to or during dental school were higher 615 hours 3 (5.0%)
but not significant in terms of Perceived Preparation More than 15 hours 1 (2.0%)
and Perceived Knowledge (see Table 4). Hours of IPV training prior to dental school
We were also able to verify knowledge gaps None 43 (70.0%)
by identifying questions with the lowest percentage 15 hours 15 (25.0%)
of correct answers among the thirty-eight questions 615 hours 3 (5.0%)
used to assess Actual Knowledge. Eleven questions More than 15 hours 0 (0)
were identified in which less than 50 percent of the Personal IPV experiencea
dental students gave a correct answer, out of which Self 6 (10.0%)
three questions (Victims of IPV are able to make Family 8 (13.3%)
appropriate choices about how to handle their situ- Any personal experience 12 (20.0%)
ation; Even if a child is not in immediate danger, Note: All values are total and percentages, unless otherwise
stated.
health care providers in all states are mandated to SD=standard deviation
report an instance of a child witnessing IPV to Child a
Missing data=1
Protective Services; and What is the strongest
single risk factor for becoming a victim of intimate
partner violence?) had correct answer rates of less
than 25 percent (see Table 5). Effect of Personal Experience
It should be noted with regard to differences with IPV
in summary scale rates that, at our institution, IPV
A tenth (10 percent, N=6) of all dental students
is recommended but not mandated for inclusion in
surveyed (N=61; missing data N=1) reported being
all programs. As a result, each college and depart-
the victim of some form of IPV, including physi-
ment implements IPV instruction in different ways
cal violence, sexual abuse, intimidation, economic
and with substantial variation in method, content,
deprivation, or threats of violence in an intimate
and success.

August 2011 Journal of Dental Education 1015

 Table 4. Students IPV training prior to and during dental school
Prior Training Mean Std. Deviation p value

Perceived Preparation Some 3.96 1.03 t=1.94, p=.057

None 3.43 .927
Perceived Knowledge Some 3.84 .975 t=1.68, p=.099
None 3.42 .860
Actual Knowledge Some 24.61 3.91 t=2.57, p=.013
None 21.00 5.38
School Training Mean Std. Deviation p value

Perceived Preparation Some 3.60 1.03 t=.123, p=.903

None 3.57 .906
Perceived Knowledge Some 3.57 .965 t=.353, p=.725
None 3.49 .823
Actual Knowledge Some 23.32 4.83 t=2.50, p=.015
None 20.00 5.31

Table 5. Students responses to Actual Knowledge questions: number and percentages of correct answers
Number Percentage

What is the strongest single risk factor for becoming a victim of intimate partner violence? 3 4.9%
Which of the following are warning signs that a patient may have been abused by his/her partner?
Chronic unexplained pain 22 36.1%
Substance abuse 16 26.2%
Have you ever been afraid of your partner? 21 34.4%
Has your partner ever hit or hurt you? 26 42.6%
Alcohol consumption is the greatest single predictor of the likelihood of IPV.a 23 38.3%
Being supportive of a patients choice to remain in a violent relationship would condone the abuse.a 23 38.3%
Victims of IPV are able to make appropriate choices about how to handle their situation.a 10 16.7%
Health care providers should not pressure patients to acknowledge that they are living in an abusive 25 41.7%
relationship.a
Victims of IPV are at greater risk of injury when they leave the relationship.a 17 28.3%
Even if the child is not in immediate danger, health care providers in all states are mandated to report 8 13.3%
an instance of a child witnessing IPV to Child Protective Services.b
a
1 missing information
b
2 missing information

partner relationship. A slightly higher percentage

(13.3 percent, N=8) said that they had witnessed one Discussion
or more of these manifestations of physical violence,
As results from our study show, although ex-
sexual abuse, or psychological abuse directed toward
posure to and experience with IPV (whether through
a family member. When personal or family violence
family members who were victims of IPV or from
was considered as a whole, therefore, one-fifth (20.0
having personally experienced IPV) can be useful
percent, N=12) of all dental students in the study re-
and applicable as students encounter and interact
ported experiencing some type of domestic violence
with victims of IPV as part of their career trajectory,
including IPV.
it may not necessarily increase perceived or actual
knowledge about IPV. Nevertheless, having had those

1016 Journal of Dental Education Volume 75, Number 8

life experiences may make an individual feel more
capable of addressing IPV with patients. Future
research, therefore, should continue to monitor the
prevalence of IPV among this and other populations
of students in the health professions and explore its
ramifications in terms of client care and educational
and training efficacy, its association with other mo-
tivational factors that lead to choosing dentistry as
a vocation, and its influence on students personal
relationships.
Our study also found that a sizeable number
(ranging from half to nearly two-thirds) of our dental
students who were preparing to enter the profession
as practicing dentists are still receiving no education
about the highly prevalent health problem of IPV.
Although the trend in higher education continues
to support providing students with more and better
training in IPV,4 our findings reflect research which
affirms that there remains a pronounced deficit in
IPV education across disciplines and particularly in
the field of dentistry.16 This shortfall, in turn, results
in dental health care professionals entering the work-
place unprepared to care for victims, perpetrators,
and witnesses of IPV who are increasingly showing
up in large numbers in health care facilities.
The results of our study also showed some posi-
tive effects. The dental students in our study indicated
that their training either prior to or during dental
school was effective in increasing their confidence in
and perceptions of preparedness to address IPV with
patients. This confidence could, in turn, potentially in-
crease the likelihood of dentists asking patients about
violence in their personal relationships. Conversely,
the lower IPV knowledge scores reported by these
dental students is of some concern and indicates that
training provided to dental students is not effective
in increasing actual knowledge about IPV.
Our study has several limitations, the small
sample size of dental students surveyed being
prominent among them. Because our sample was
taken from a single institution, our results may not be
representative of and thus generalizable to students
in other dental schools. Our sample is, however,
representative of our local population. We did not
follow up with students to assess the extent to which
the IPV knowledge they received in dental school has
been deployed in their clinical practices. We also did
not gather qualitative personal IPV experience data,
which would have been instrumental in facilitating
a more directed, focused, and truly student-centered
curriculum revision. We acknowledge these short-
August 2011 Journal of Dental Education
comings and recognize that, as Hsieh et al.15 have
noted, the literature lacks substantive approaches and
models of IPV interventions thus far. Nevertheless,
our study provides important and necessary underpin-
nings for future education that will help increase the
likelihood that dentists will screen for, and intervene
appropriately with, patients affected by IPV.
Conclusion
We are presently charting future directions for
our findings. In addition to producing larger studies
that will not only include qualitative personal IPV
experience data but also ascertain generalizability
of findings to larger student populations, we plan to
begin evaluating health care systems in which stu-
dents will be working to ascertain what, if any, infra-
structure changes are needed to support institutional
policy, protocols, public advocacy, and foundational
research (e.g., data collection) leading to improved
IPV screening, identification, management and qual-
ity of care for this vulnerable population.
At the institutional level, we also plan to incor-
porate student survey responses as part of a revision
of the family violence curriculum entitled Healing
Homes. Healing Homes was initially developed in
2007 by researchers at our institution in cooperation
with local African American church leaders and was
pilot tested in a faith-based population based on
elevated rates of family violence within this com-
munity, as well as requests from clergy who observed
the problem of family violence in their congregations
but were unsure how to confront the problem. Heal-
ing Homes was initially designed to teach religious
leaders how to recognize family violence, make ap-
propriate referrals for crisis and non-urgent services,
and be aware of and provide resources within the
community that are helpful, safe, and appropriate
to pastoral intervention. The curriculums modular
format is easily adaptable to multiple audiences
including primary care providers and other diverse
populations and cultures.
Healing Homes utilizes a 5R (Recognizing,
Responding, Referring to Resources, and being
cognizant of mandated Reporting requirements)
approach to assess for and respond to presentations
of family violence across populations. These 5Rs
comprise the crux of the curriculum, but we intend
to focus on, modify, and enhance modules on Rec-
ognition and mandatory Reporting requirements in
1017
 order to specifically address dental students survey
responses to attitudinal and knowledge areas such
as personal comfort in discussing IPV with patients,
intent to address IPV with patients, and mandatory
reporting requirements. Educating dental students on
these 5Rs is crucial to increasing knowledge of IPV,
thereby allowing these students to become attuned,
empathetic, and proactively responsive to patients
who are IPV victims.
Moreover, we envision Healing Homes as a
required course that will be fully integrated into the
university curriculum, rather than as a supplement
to the already existing (albeit limited) IPV content
dental students currently receive at our institution.
As data from our study have indicated, this type of
comprehensive content is not only critical to over-
coming systemic knowledge gaps about IPV, but our
curriculum will also respond to the persistent calls
of previous researchers and academic administrators
to provide more and better IPV education for dental
students as they become professionals working in
the field.
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