title: Effect of domestic violence training: systematic review of randomized controlled trials.
abstract: OBJECTIVE
  To describe and evaluate the effectiveness of domestic violence education in improving physicians' knowledge, recognition, and management of abused women.
  
  
  METHODS
  The Cochrane Database of Systematic Reviews, MEDLINE, PubMed, PsycINFO, ERIC, and EMBASE were searched for articles published between January 1, 2000, and November 1, 2012. This search was supplemented by manual searches for relevant articles using a combined text-word and MeSH-heading search strategy.
  
  
  METHODS
  Randomized controlled trials were selected that used educational interventions among physicians and provided data on the effects of the interventions.
  
  
  RESULTS
  Nine randomized controlled trials were included that described different educational approaches with various outcome measures. Three studies examined the effects of educational interventions among postgraduate trainee physicians and found an increase in knowledge but no change in behaviour with regard to identifying victims of domestic violence. Six studies examined educational interventions for practising physicians. Three of these studies used multifaceted physician training that combined education with system support interventions to change physician behaviour, such as increasing general awareness of domestic violence with brochures and posters, providing aids to remind physicians how to identify victims, facilitating physician access to victim support services, and providing audits and feedback. Multifaceted educational interventions included interactive workshops, Web-based learning, and experiential training. Another study used focus-group discussions and training, and showed improved domestic violence reporting among physicians. The remaining 2 studies showed improved perceptions of practising physicians' self-efficacy using problem-based online learning.
  
  
  CONCLUSIONS
  It was difficult to determine the most effective educational strategy, as the educational interventions and the outcome measures varied among the selected studies. Brief interventions for postgraduate trainee physicians improved knowledge but did not seem to affect behaviour. Online education using a problem-based learning format improved practising physicians' perceptions, knowledge, and skills in managing domestic violence. Physician training combined with system support interventions seemed to benefit domestic violence victims and increase referrals to domestic violence support resources.
authors.affiliation: Staff family physician at Prince Sultan Military Hospital in Saudi Arabia.
authors.forename: Eman
authors.initials: E
authors.lastname: Zaher
authors.affiliation: Pediatric emergency physician at the Hospital for Sick Children in Toronto, Ont.
authors.forename: Kelly
authors.initials: K
authors.lastname: Keogh
authors.affiliation: Associate Professor in the Department of Paediatrics and the Dalla Lana School of Public Health at the University of Toronto and a staff physician in the Division of Emergency Medicine, Clinical Pharmacology, and Toxicology at the Hospital for Sick Children. savithiri.ratnapalan@sickkids.ca.
authors.forename: Savithiri
authors.initials: S
authors.lastname: Ratnapalan
mesh_terms: D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D007722:Health Knowledge, Attitudes, Practice; D016032:Randomized Controlled Trials as Topic; D013179:Spouse Abuse / Q000175:diagnosis*