Professional Education in Child Abuse and Neglect

Abstract

Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe. Pediatrics 2008;122:S13-S17 A MONG OUR MANY responsibilities, physicians are sentinels for child maltreatment. Federal and state laws mandate us to report suspected cases of abuse and neglect for investigation, and our ethical mandate is to use our skills to promote the health, safety, and well-being of our patients. Yet, despite our best intentions, the data suggest that many physicians are unable to fulfill the mandate to protect children from abuse and neglect. 1,2 Physician inability to identify abused children and resistance to reporting suspected abuse is explained by many considerations, as noted in the Child Abuse Recognition Experience Study (CARES). 1,2 One of the more important contributors to physicians' discomfort with the management of child and family violence is their lack of education and training about the problem. In all specialties in medicine, clinical competence is based in both knowledge and experience. If the aim of medical education is to improve practice, rather than simply knowledge, appropriate education must ensure that physicians are capable of identifying child abuse, addressing the concern with families, reporting suspicions to the proper authorities, assisting investigators with interpretation of medical information, managing medical consequences of both physical and psychological trauma, advocating for their patients, and working with families affected by child maltreatment. It is a lot to learn, and the evidence published to date suggests that we have not done our job sufficiently. 1,2 MEDICAL STUDENT EDUCATION Accreditation of US medical schools is obtained through the Liaison Committee on Medical Education (LCME). Accreditation by the LCME is required for medical schools to receive federal grants for education, and the majority of state licensing boards require US medical schools to be accredited by the LCME. The LCME publishes accreditation standards that address the structure of medical education for all students. Clinical education is required for all organ systems and must include ambulatory experience. In the most recent revision of the accreditation standards, the LCME states, "The curriculum must prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse." 3 Although the standards for medical education explicitly include a requirement for education in social issues such as child abuse, the responsibility for curriculum development rests with medical school faculty and is not specifically dictated by accrediti...

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