Three twenty-minute standardized patient encounters that are designed for internal medicine or family medicine residents to assess SBIRT skills and to determine individual areas for improvement. Standardized patient cases include the following:
- 35 year-old man with risky alcohol use and paroxysmal atrial fibrillation, contemplative stage.
- 39 year-old woman with low back pain and opiate misuse, precontemplative stage.
- 63 year-old woman with depression and alcohol use disorder, preparation stage.
Each case is written to represent a twenty-minute clinic visit and focuses on substance use history taking, assessment and development of a clear treatment plan. There are no physical exams included in these cases, but if desired the cases could be modified to assess relevant physical examination skills. After each SP case, residents have a ten-minute exercise to assess specific knowledge and skills including: encounter documentation, assessment of stages of change, approach to older patients with substance use, approach to non-English speaking patients with substance use and developing pain contracts with patients.
This publication contains standardized patient training materials and post-case exercises for 3 cases. In addition, there are scoring rubrics for the post-case exercises and for the overall cases. Finally, there is a guide to debriefing the exercise with the residents and a resident evaluation of the exercise.
Screening, Brief Intervention and Referral to Treatment (SBIRT) has been promoted as model for improving healthcare delivery for patients with alcohol and substance use disorders. Brief interventions in primary care settings have been shown to reduce risky/harmful alcohol use (Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence by the US Preventive Services Task Force. Ann Intern Med 2004;140:557-568.) and have been found to be one of the highest ranking preventive services in terms of cost-effectiveness (Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse: ranking its health impact and cost effectiveness. Am J Prev Med 2008;34:143–152). Many have called for increased curricular content in medical schools and residency training on alcohol and substance use disorders. Effective tools need to be developed to assess the impact of these curricula and to assess resident competence in these skills. We developed three standardized patient cases and three post-case exercises to assess SBIRT skills in internal medicine residents. We have included the post-case exercises in these materials, but other may want to modify the post-case exercises based on their own curricular objectives.
Fifteen primary care internal medicine residents participated in the SP exercise (7 PGY2 and 8 PGY3). On average, residents received 79% of history points (SD=16) and 70% of information-sharing points (SD=12) for all three cases. Their average patient-physician interaction score was .69 (SD=0.06, 0=unacceptable, 1=outstanding). Averaging across all three cases, the residents received an overall satisfaction rating of 0.63 which ranked them slightly above “good”.
Residents reported that the standardized patient scenarios were representative of the patients they might see in clinic [mean = 3.67, SD = .98, (1 = strongly disagree, 5 = strongly agree)]. Most felt the learning experience was valuable (mean = 3.67, SD = 1.23) and would recommend the exercise to a fellow resident (mean = 3.60, SD = 1.24).
Residents reported highest levels of confidence in screening patients for alcohol (mean=3.73, 1=strongly disagree, 5=strongly agree) and drugs (mean=3.67), but felt less confident making a treatment plan for patients with substance use disorders (mean=3.13). During the semi-structured debrief session residents most commonly requested direct performance feedback and assistance in identifying ways to improve necessary skills.
- To assess primary care resident SBIRT skills.
- To screen for alcohol and substance use.
- To screen for mental illness.
- To take a substance use history.
- To provide accurate assessment of substance use disorders.
- To provide brief intervention to address substance use.
- To provide appropriate referral for patients with substance use disorders.
- To provide effective communication with patients regarding substance abuse.
None to report.
None to report.
Using Standardized Patients to Evaluate Resident Skills in Screening and Brief Interventions for Substance Abuse in the Primary Care Setting. Poster presented at: WGEA/WGSA Regional Conference; April 2011; Palo Alto, CA.
Using Standardized Patients to Evaluate Resident Skills in Screening and Brief Interventions for Substance Abuse in the Primary Care Setting. Poster presented at: SGIM National Meeting; May 2011; Phoenix, AZ.
This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.