Fort Worth Medical Students Experience How Domestic Violence Victims Navigate Healthcare System

FORT WORTH – For medical students, stepping into a patient’s shoes can be an eye-opening experience.

Medical students at Anne Burnett Marion School of Medicine at Texas Christian University were able to experience firsthand what it would be like to be a domestic violence or abuse patient navigating through the U.S. healthcare system.

“By having situations like this where I can see some of the warning signs and things that happen, I could maybe identify those a little quicker in the hospital setting,” said Brandon Mallory, MS-4 at Burnett School of Medicine, who one day hopes to practice emergency medicine.

About one third (27%) of women aged 15-49 years-old worldwide have reported experiencing some form of physical and/or sexual violence by their intimate partner, according to data published by the World Health Organization (WHO) in October 2021.

However, in recent years domestic violence has not been viewed as a healthcare problem in the United States as much as it should be, according to Ken Hopper, M.D., associate professor and physician development coach at Burnett School of Medicine at TCU.

“And it has enormous costs both emotionally for the individual that’s being abused, for the abuser and our society,” Dr. Hopper said.

During Phase 3 of their medical education at the Burnett School of Medicine, medical students go through a 16-week Preparation For Practice (P4P) course. P4P puts an emphasis on 10 themes the medical school has designated as critical to a well-rounded physician practicing 21st-century medicine.

The P4P curriculum prepares students for multidimensional aspects of the medical profession. It includes topics such as business of medicine, medical ethics, healthcare policy and advocacy, patient safety, informatics, population health, team-based care and the role of the physician as educator.

For the domestic violence and partner violence session, 60 students were split into groups of two with one student playing the role of the patient and the other as the ‘shadow,’ who silently observes and follows the case. The medical school’s Simulation & Technology classrooms were transformed to represent different places someone experiencing domestic violence would go to get help.

There was a community center, church, support groups, relatives and friends, court, child protective services, workplaces, doctor’s office, homeless shelter, their home with the abuser and a funeral home.

Case Study: 60-year-old woman experiencing domestic violence

Mallory and his partner studied the hypothetical case of a 60-year-old Jewish woman and her husband who have two adult children.

Their relationship started off well when they were in their 30s, but over time, her husband would get angry and become abusive if she didn’t cook for him, clean the house or if she was away from home for what he deemed to be too long. As time passed, he forbid her to work and as they got older, the abuse escalated. The 60-year-old woman finally had enough and sought out help from her Rabbi.

“Her children didn’t want her to leave their dad and even her Rabbi urged her to continue to work on her marriage,” Mallory said.

The 60-year-old woman reached out to a support group that had gun violence survivors. After a few sessions, she felt her domestic abuse at home was not as serious as other types of violence.

“She went back (to her husband) multiple times until it got to a point where he got really aggressive and she called the police and got an order of protection,” Mallory said.

The 60-year-old woman got a new job and tried to restart her life without her husband. However, that road became difficult because her skillset was outdated for many of the jobs available where she lived.

The session helped Mallory understand how his own biases toward domestic violence might need to be recognized before treating future patients suffering from abuse.

“When you think about domestic abuse you tend to think it’s a typically young couple,” Mallory said. “In my head, if someone is abusing you, you wouldn’t stay with them for 30 years. To see that they had this whole life together, it made me realize I need to check my own biases because even if a person is coming in older to check for signs of domestic abuse or to ask how their home life is.”

Giving medical students that perspective is the ultimate goal of the session, Dr. Hopper added.

“They get to experience the difficulties of getting things done when you’re in one of these types of situations,” Dr. Hopper said. “Because you’re wondering who’s going to be your advocate when you start saying someone is doing something like this to you. And to look at the cost and failures that can occur.”

Case Study: 24-year-old woman moves from Ukraine to America after falling in love

Another hypothetical case study involved a 24-year-old Ukrainian woman who answered an ad to be a pen pal with an American man.

The case was followed by Mei Mei Edwards and Charna Kinard, both MS-4s at Burnett School of Medicine.

“She quickly falls in love with him and despite not knowing the English language she decided to move to America and live with him,” Edwards said.

Their relationship went well in the beginning. The couple even got married, but a few years into their marriage the relationship began to sour. The man became jealous of almost any man who looked at the woman, but he directed that anger toward her. His anger spilled over into physical abuse and even rape at one point.

“Not knowing the language in America, she didn’t have any support,” Edwards said. “She tried going to a variety of support groups. She tried going to a shelter but honestly the language barrier became too much.”

The 24-year-old woman sought out interpreters, but still ran into problems communicating with others in America.

“They either dismissed her or gave her poor interpretations of what the doctors might have been saying,” Edwards said. “She could only turn back to her husband and hoped he would get better.”

The relationship never got better. Eventually a domestic dispute between the couple turned deadly. The 24-year-old woman was killed by her husband due to jealously in the case study.

Edwards and Kinard walked into the dimly lit classroom resembling a funeral home. They both sat in front of the woman’s coffin and contemplated what could have been done differently to prevent her death.

“It was very eye-opening because even as a medical student in clinic I can be of assistance or provide a different prospective for my preceptor to ensure our patient’s safety,” Kinard said.

Each room and flash card in the case study revealed the options available to the abuse victim. Before following each new step in her path, the students were given another flash card explaining the thought process into the decisions the woman made.

“You realize that it’s not as simple as the skits that we’ve seen growing up or modules we have to do from one institution to another,” Kinard said. “It’s a lot more involved and often times it’s a lot more hopeless. Sometimes, even when you try your best, the system is not helpful.”

The timing of when this session occurs in Phase 3 is after the medical students have completed their Transition to Longitudinal Integrated Clerkship (TLIC) and have been immersed in hospitals in a variety of settings.

Once they return for this once-a-week session, they’ve seen real-life cases similar to the case studies, Dr. Hopper added.

“I think there will be an appreciation of the hidden cases that we’ve been looking at today,” he said.