Training programs target domestic violence awareness. (First-Person Contact with Victims).

WASHINGTON -- There's no better way to improve recognition of the clinical signs of domestic violence than first-person contact with victims.

That's the premise of two programs in the Washington, D.C., area that teach young physicians how to identify and assist patients who are the victims of partner abuse. Residents and fourth-year medical students who sign up for the programs use the legal system and the emergency room as initial points of contact in providing medical care and counseling for battered patients.

The lifetime prevalence of intimate partner abuse has been reported to range from 30% to 40%, yet the problem often goes unrecognized in primary care settings, said Dr. Kim Bullock of Georgetown University, Washington, who initiated both programs.

Dr. Bullock is convinced that early training is the best way to raise physician awareness of domestic violence. Once physicians start up, a practice, she observed, "they're seeing 20-30 patients a day, and they won't have time to take a course that immerses them in all this."

Residents and students who enroll in either of the training programs as an elective spend 8-10 hours per day on domestic violence work for at least a month.

Those who sign up for the George Washington/Providence Hospital Domestic Violence Advocacy Program work with battered patients in the emergency room. After triage nurses flag patients as possible domestic violence victims, participants in the program evaluate the patients and offer advice and counseling. If either a temporary restraining order or other legal measure is needed, a law student trained in legal advocacy takes over to provide advice.

The ER program has been around for 3 years. Last year, the program attracted 12 students, most of whom are heading into family practice, Dr. Bullock said.