title: "I've never asked one question." Understanding the barriers among orthopedic surgery residents to screening female patients for intimate partner violence.
abstract: BACKGROUND
  Intimate partner violence (IPV) is a global public health problem. Orthopedic surgery residents may identify IPV among injured patients treated in fracture clinics. Yet, these residents face a number of barriers to recognizing and discussing IPV with patients. We sought to explore orthopedic surgery residents' knowledge of IPV and their preparedness to screen patients for IPV in academic fracture clinic settings with a view to developing targeted IPV education and training.
  
  
  METHODS
  We conducted focus groups with junior and intermediate residents. Discussions explored residents' knowledge of and experiences with IPV screening and preparedness for screening and responding to IPV among orthopedic patients. Data were analyzed iteratively using an inductive approach.
  
  
  RESULTS
  Residents were aware of the issue of abuse generally, but had received no specific information or training on IPV in orthopedics. Residents did not see orthopedics faculty screen patients for IPV or advocate for screening. They did not view IPV screening or intervention as part of the orthopedic surgeon's role. Residents' clinical experiences emphasized time management and surgical intervention by effectively "getting through clinic" and "dealing with the surgical problem." Communication with patients about other health issues was minimal or nonexistent.
  
  
  CONCLUSIONS
  Orthopedic surgery residents are entering a career path where IPV is well documented. They encounter cultural and structural barriers preventing the incorporation of IPV screening into their clinical and educational experiences. Hospitals and academic programs must collaborate in efforts to build capacity for sustainable IPV screening programs among these trainees.
authors.affiliation: The Sunnybrook Research Institute, Toronto, Ont.
authors.forename: Lesley
authors.initials: L
authors.lastname: Gotlib Conn
authors.affiliation: The Department of Surgery, St. Michael's Hospital, Toronto, Ont.
authors.forename: Aynsely
authors.initials: A
authors.lastname: Young
authors.affiliation: The Department of Surgery, St. Michael's Hospital and the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont.
authors.forename: Ori D
authors.initials: OD
authors.lastname: Rotstein
authors.affiliation: The Division of Orthopaedic Surgery, St Michael's Hospital and the Department of Surgery, University of Toronto, Toronto, Ont.
authors.forename: Emil
authors.initials: E
authors.lastname: Schemitsch
mesh_terms: D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009985:Orthopedics / Q000193:education / Q000592:standards*; D010820:Physicians / Q000592:standards*; D013179:Spouse Abuse / Q000175:diagnosis*