A Web-Based Alcohol Screening and Brief Intervention Training Module Within Physician Assistant Programs in the Midwest to Increase Knowledge, Attitudes, and Confidence: Evaluation Study.

Leigh E Tenkku Lepper,Katherine Ervie,Lara Oakley,Genevieve Delrosario,Tracy Cleveland,Catherine Link,Debra J Sprague,Abdelmoneim Elfagir

doi:10.2196/11963

Abstract

BackgroundPreventing and reducing risky alcohol use and its side effects remains a public health priority. Discussing alcohol use with patients can be difficult; dedicated training for health care providers is needed to facilitate these conversations. A Web-based alcohol screening and brief intervention (SBI), comprising didactic and skills application training, was designed for physician assistant students.ObjectiveThis paper details experiences and outcomes in developing an alcohol SBI training curriculum and coordinating virtual encounters with standardized patients. We also explain challenges faced with developing an alcohol SBI training and a Web-based learning management site to fit the needs of 5 different physician assistant programs.MethodsTraining development comprised 3 phases—precourse, development, and implementation. The precourse phase included developing the initial training curriculum, building a website, and testing with a pilot group. The development phase refined the training curriculum based on user feedback and moved into a three-component module: didactic training module, guided interactive encounter with a simulated patient, and live encounter with a standardized patient. A learning management system website was also created. In the implementation phase, 5 physician assistant schools incorporated the Web-based training into curricula. Each school modified the implementation method to suit their organizational environment. Evaluation methods included pre- and postchange over time on trainee attitudes, knowledge, and skills (confidence) on talking to patients about alcohol use, trainee self-reported proficiency on the standardized patient encounter, standardized patient evaluation of the trainee proficiency during the alcohol use conversation, user evaluation of the type of technology mode for the standardized patient conversation, and overall trainee satisfaction with the Web-based training on alcohol SBI.ResultsFinal evaluation outcomes indicated a significant (P<.01) change over time in trainee knowledge and skills (confidence) in the conduct of the alcohol SBI with a standardized patient, regardless of the program implementation method. Trainees were generally satisfied with the Web-based training experience and rated the use of the videoconference medium as most useful when conducting the alcohol SBI conversation with the standardized patient. Training that included a primer on the importance of screening, individual participation in the Web-based didactic alcohol SBI modules, and virtual encounters with standardized patients through a university-based simulation center was the most widely accepted. Successful implementation included program investment and curriculum planning. Implementation barriers involved technical challenges with standardized patient encounters and simulation center logistics, and varying physician assistant school characteristics.ConclusionsDevelopment and implementation of Web-based educational modules to educate health care professionals on alcohol SBI is effective, easy to reproduce, and readily accessible. Identifying challenges affecting development, implementation, and utilization of learned techniques in practice, enhances facilitation of learning and training efficacy. As the value of technology-based learning becomes more apparent, reports detailing what has worked versus what has not may help guide the process.

Highlights

I will have patients that will need alcohol counseling, and this [alcohol screening and brief intervention (SBI) training] helped me to approach that subject in a better way with future patients. [Physician Assistant student 2016 pilot]Numerous studies have found that health care providers, especially physicians, lack the knowledge and confidence to inquire about patient alcohol use behavior
Trainees were generally satisfied with the Web-based training experience and rated the use of the videoconference medium as most useful when conducting the alcohol SBI conversation with the standardized patient
Training that included a primer on the importance of screening, individual participation in the Web-based didactic alcohol SBI modules, and virtual encounters with standardized patients through a university-based simulation center was the most widely accepted

Summary

Introduction

I will have patients that will need alcohol counseling, and this [alcohol SBI training] helped me to approach that subject in a better way with future patients. [Physician Assistant student 2016 pilot]Numerous studies have found that health care providers, especially physicians, lack the knowledge and confidence to inquire about patient alcohol use behavior. Brief intervention, and referral to treatment (SBIRT) is an evidence-based, public health approach utilized to screen patients and initiate a conversation on alcohol use, which may lead to a brief intervention. This method is recommended by the Institute of Medicine, the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA), and many other research, policy, and public health organizations to reduce alcohol exposure and alcohol use disorders with demonstrated effectiveness [5]. A Web-based alcohol screening and brief intervention (SBI), comprising didactic and skills application training, was designed for physician assistant students

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