Genetics: Human Genome Tally: Is Recount in Order? Leadership: Summers to Succeed Rudenstein as President of Harvard Pathology: Cancer Cells' Immortality May Depend on Longevity Protein Medical Education: Taking the Pulse of Violence in America International Health: East–West Health Care Conference to Host 600 Chinese Doctors Caretaker Protein May Moonlight as Gatekeeper—and Vice Versa Pilot Study Suggests Ischemic Stroke Triggers Medicare Patients Give Higher Overall Marks to Nonprofit than For-profit Health Plans Report Gives Guidelines for Raising Teens Proceedings of the HMS Faculty Council Dean's Community Service Award Call for Nominations NOVA Airs Series on HMS-trained Doctors New Appointments to Full Professor In Memoriam: Donald Muirhead Allan Sandler Conference Shows Ways to Harness Discoveries HMS Alumni Bulletin a Finalist for National Magazine Award Honors and Advances Harvard Grad Student Caucus Probes Facets of Health Care Policy Front Page

MEDICAL EDUCATION Taking the Pulse of Violence in America New Course Trains Students to Diagnose and Treat Abuse Victims High school shooting sprees and other acts of teen violence may be making the news with alarming frequency. In fact, they are the least prevalent manifestation of an epidemic of violence that has been gripping America for decades, according to Massachusetts General Hospital's Stephanie Eisenstat. "When one of the school shootings occurs, it's obviously extremely painful and problematic. Luckily for the country, such acts of violence are still very rare," said Eisenstat, HMS assistant professor of medicine. Much more common are domestic abuse, child abuse, and other forms of violence involving firearms. Weight of Violence "There have been a couple of school shootings so far this year," Eisenstat said. "There are two million women battered each year. There are a million cases of child abuse annually, and a thousand deaths, most of them involving children under the age of 5," she said. Victims of abuse often show up in hospitals and physicians' offices. One out of three emergency room patients is the victim of domestic violence. Injuries and the adverse effects of violence are the number one cause of mortality in people younger than 34, and the number two cause of death for those between the ages of 35 and 44. Although doctors know how to treat the physical wounds incurred by such violence, they generally have not been trained to diagnose patients who are being abused or are at risk for abuse. Nor do they have the tools to help them break the cycle of violence. But that could be changing. This week, 35 HMS students will complete a 12-week elective course, Injury and Violence Prevention. Codirected by Eisenstat and Range Hutson, HMS assistant professor of emergency medicine at Brigham and Women's Hospital, the aim of the course is to provide medical students with tools for identifying and treating abuse and also with an understanding of the foundations of violence in this country. "Physicians need to understand that they can play a positive role and have a positive impact on the health outcomes of their patients," Eisenstat said. Domestic violence, battering behavior, child abuse, gang and school violence, sexual and date assault, hate crimes, elder abuse, international violence, and victimization of the disabled are some of the topics that have been presented over the past 12 weeks. The issue of unintentional injuries—such as those caused by playing with firearms or not wearing seatbelts—and how to prevent them have also been addressed in the weekly two-hour team-taught seminars. Organized Response Eisenstat has long been aware of the need for such a course. A decade ago as a physician at BWH, she saw many victims of domestic abuse but was concerned at the lack of tools provided to her and other physicians for screening and treating such cases. When she came to MGH seven years ago, she participated in a hospital-based initiative to formalize training in domestic violence. In 1995, she was asked by Daniel Federman, then dean for medical education at HMS, to chair an HMS-based task force on the broader issue of violence. The elective course as well as the development of violence as a theme in the curriculum are the outgrowths of that task force. Eisenstat believes that violence-prevention training for physicians involves three steps. First, physicians should know how to ask a patient about their history of abuse and do it effectively. "It's one thing to see four questions on a little card," she said. "It's another to engage a patient in a conversation so they feel trustful and comfortable opening up." Next, they should cultivate their knowledge of resources available to victims of abuse so that they can offer their patients options. Finally, they should be prepared to follow up on their patients, which is often the most difficult step of all. "Bringing a situation to the surface and deciding to leave a batterer can be the most dangerous time in a woman's life," she said. "So we need to maintain contact with patients without putting them into more danger." For more information on the course or violence prevention programs at the teaching hospitals, contact Stephanie Eisenstat at 724-6726 or e-mail saeisenstat@partners.org —Misia Landau