A survey of resident attitudes and behaviors regarding youth violence prevention in the acute care setting.

Abstract

Surgery, emergency medicine (EM), and pediatric resident physicians play an integral role in treating youth violence patients. We assessed these residents' behaviors, attitudes, and perceived barriers to youth violence prevention (YVP) in the acute care setting. A cross-sectional survey of EM, surgery, and pediatric residents at one large medical institution was conducted using a theory-based self-administered paper questionnaire. Data were analyzed using descriptive statistics and Fisher's exact tests to examine differences between resident specialties. Of 73 residents, 55 completed the questionnaire, composed of 23 EM (42%), 18 pediatrics (33%), and 14 surgery (25%) residents, with a response rate of 75%. Fifteen percent (n = 8) of the respondents received YVP training during residency. The majority (n = 49, 91%.) of the respondents reported consistently collecting a history of events leading to violent injury. A smaller percentage of residents reported consistent assessment of retaliation risk (n = 11, 20%), referral to social work (n = 37, 69%), and screening for substance abuse (n = 37, 69%) and mental health (n = 35, 65%). Surgery residents were more likely than pediatric and EM residents to refer to social work (100% vs. 72% and 45%, p < 0.01) and screen for substance abuse (93% vs. 78% and 45%, p = 0.01). While the majority of residents agreed that youth violence is preventable (n = 50, 91%) and physicians should play a role in prevention (n = 47, 85%), there was less agreement that YVP should be a resident task (n = 38, 69%). Less than half of residents (n = 26, 47%) felt competent discussing safety risks and plans. Residents cited lack of time and training as the top two barriers for conducting risk assessments and referring to support services. While EM, surgery, and pediatric residents agree that YVP is essential and should involve physicians, many do not perceive this as part of their responsibilities, and they do not feel competent in this role.