A statewide screening, brief intervention, and referral to treatment (SBIRT) curriculum for medical residents: Differential implementation strategies in heterogeneous medical residency programs

The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research

PURPOSE

To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula.

METHOD

The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability.

RESULTS

Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula.

CONCLUSIONS

SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.

Integrated Education Reduces Negative Attitudes Toward Persons with Substance Use Disorders: A Pilot Study

Educational practices to reduce negative attitudes toward persons with substance use disorders (SUD) are urgently needed for undergraduate nursing students, but few studies have examined their long term effectiveness. In this pilot, consenting students completed the Drug and Drug Problems Perception Questionnaire (DDPPQ) anonymously online, before and 1 year after integrated curricular content about SUD. Pretest scores were significantly higher than posttest, indicating higher negative attitudes toward persons with SUD before the integrated content. Time main effect was statistically significant. To our knowledge, this is the first report examining long-term effects of an educational intervention with reinforcement in multiple courses over time upon the attitudes of undergraduate nursing students toward persons with SUD.

A prospective cohort study evaluating enhanced addiction medicine curriculum graduate medical education on bias, clinical readiness and future practice

Background Studies demonstrate gaps in graduate medical education (GME) in treatment of opioid-use disorders (OUD). There is lack of consensus on best practices to address gaps between clinical readiness and community need despite action to improve education. Through enhanced OUD curriculum, we evaluated the impact in bias, clinical readiness, and intent for future practice OUD compared to usual training in a multi-specialty community-based GME Institution between 2018 and 2020. Objective Evaluate impact of enhanced OUD training during residency to usual training in GME.   Methods Residents and faculty members were voluntarily surveyed at baseline and after 2 years in years 2018 and 2020. Interventions included SAHMSA buprenorphine-waiver training, treatment of OUD with medication-assisted treatment (MAT) in the primary care office, and two required addiction medicine rotations. The survey included questions related to bias, self- perceived clinical readiness, faculty teaching self- perceived readiness, and intent for future practice. Results Participation in the survey was 29%, 45%, and 48% for the baseline, control group and intervention group, respectively. The enhanced training group demonstrated statistically significant improvements in four out of seven bias questions, six out of eight clinical-readiness questions and intention to utilize MAT in future practice. Additional findings include a decrease in intent to prescribe MAT from the baseline group to the control group over the two-year period.   Conclusions Data from this single-institution survey demonstrate that intentional enhanced OUD education can impact resident physician bias, self-perceived clinical readiness, and intent to treat patients with OUD in future practice.

A Video- and Case-Based Curriculum on the Management of Alcohol Use Disorder for Internal Medicine Residents

INTRODUCTION

Alcohol use disorder (AUD) is commonly undertreated. Physicians cite discomfort with AUD medication as a barrier to treatment. While several curricula teach and assess screening and brief interventions, few teach and assess learner knowledge of treatment options.

METHODS

We created a video- and case-based curriculum for internal medicine residents delivered by 16 internal medicine faculty in three 30-minute sessions at four clinic sites. Learner knowledge, attitudes, and confidence were assessed before and after the curriculum. We used qualitative methods to evaluate learner reflections. We also assessed faculty satisfaction with the curriculum.

RESULTS

Of 153 residents receiving the curriculum, 35 (23%) completed both pre- and postsurveys. Median percent correct on knowledge questions improved from 67% pre- to 80% postcurriculum (p < .001). Confidence increased for all three items assessing it, with a notable increase in confidence with pharmacotherapy (2.9 pre- vs. 4.5 postcurriculum on a 7-point Likert scale with high scores indicating greater confidence, p < .001). Positive attitudes toward people with AUD increased from 3.4 pre- to 3.9 postcurriculum (p < .001) on a 7-point Likert scale. Learners continued to express concerns about prescribing logistics, the role of primary care, and management of ongoing use. Thirteen of 16 faculty (83%) completed the postcurricular survey; all said they would be happy to facilitate again.

DISCUSSION

Implementation of this curriculum for the management of AUD improved resident knowledge, attitudes, and confidence in AUD treatment. The curriculum was acceptable to faculty and is ideal for programs looking to expand teaching about AUD.

Outcomes of an interprofessional SBIRT training program: Knowledge attainment and perceived competence for practice

BACKGROUND

One way to address substance misuse is to train health professional students in Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention strategy. This study evaluated a semester-long, 50-hour elective SBIRT training that blended online coursework with interprofessional experiences. Medicine, nursing, pharmacy, and social work students completed an interprofessional standardized patient experience and completed a minimum of two interprofessional SBIRT experiences at community agencies. Methods: We analyzed longitudinal data from 197 students using structural equation modeling to examine gains in knowledge and perceived competence, as well as to test if background variables predicted 30-day application of SBIRT knowledge and skills, 30-day satisfaction' 12-month frequencies of care for performing SBIRT; and number of SBIRT clients/patients served directly. Results: Overall, student SBIRT knowledge and perceived competence both increased by more than a standard deviation during the course. Students who experienced larger gains in perceived competence rated the course significantly higher in terms of relevance and usefulness and, in turn, served significantly more SBIRT clients/patients during the following year. We did not find evidence that intra-individual growth in knowledge impacted the degree to which students ultimately applied SBIRT components. Finally, students who had more previous training and experience related to substance abuse ultimately reported greater application of SBIRT knowledge and skills. Interprofessional differences included: At baseline, medicine students had significantly lower substance abuse education knowledge as compared to the other disciplines. Pharmacy and social work students were more likely to have had previous experience with motivational interviewing. Baseline perceived competence in applying SBIRT was higher in social work and nursing. Upon completion, pharmacy and medicine students had lower satisfaction with the course. Conclusions: These findings suggest that SBIRT courses can increase knowledge and perceived competence; moreover, student background characteristics, work settings, and experiences may have important effects on learning SBIRT.

Structure and longitudinal invariance of the Short Alcohol and Alcohol Problems Perception Questionnaire

Many studies have employed the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) to measure professionals' attitudes toward working with people experiencing alcohol problems. However, research has not confirmed the internal structure of the SAAPPQ, leaving open the possibility that scale scores are not valid empirical proxies for underlying attitudes. It is also unclear if measurement invariance holds over time or across groups. This is an important gap in light of evidence that (a) experiences can change the structure of scales and (b) structures of some popular scales differ dramatically between groups. Thus, measurement bias may confound comparisons of composite SAAPPQ scores between measurement occasions or groups. To address these gaps in the literature, we conducted a longitudinal examination of the psychometrics of the SAAPPQ using data from 241 human services professionals-in-training. We found a four-factor structure, rather than the previously reported five factors. Configural, metric, and a strong degree of scalar invariance held longitudinally. Few factor intercorrelations were significant at time one and they strengthened over time, suggesting that the SAAPPQ should not be aggregated at higher-order levels (i.e., global scores should not be used). Findings suggest four SAAPPQ subscale scores may be used as valid proxies for attitudes toward alcohol users; however, additional confirmatory studies are needed to ensure that measurement bias does not compromise inferences based on SAAPPQ scores.

Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update

PURPOSE OF REVIEW

Alcohol is a leading risk factor for ill health and premature death. Regardless of poor levels of implementation achieved after more than 30 years of research and policy advice, alcohol screening and brief advice (SBA) remains one of the best policy options. This study updates the evidence by considering recent publications on SBA for heavy drinking and alcohol use disorder in primary healthcare at a timely moment, because researchers are, at present, debating future direction of research and policy in this field.

RECENT FINDINGS

Systematic literature search between 1 January 2016 and 31 December 2017 was conducted for new research on alcohol SBA in primary healthcare. In all, 63 articles were included.

SUMMARY

Primary healthcare-based SBA programmes are effective in reducing alcohol consumption among heavier drinkers. There is low implementation of these programmes in real practice. Academia is rethinking and debating future directions.

An opioid overdose curriculum for medical residents: Impact on naloxone prescribing, knowledge, and attitudes

BACKGROUND

Despite escalating opioid overdose death rates, addiction medicine is underrepresented in residency curricula. Providing naloxone to at-risk patients, relatives, and first responders reduces overdose deaths, but rates of naloxone prescribing remain low. The goal of this study is to examine the impact of a brief curricular intervention for internal medicine residents on naloxone prescribing rates, knowledge, and attitudes.

METHODS

Internal medicine residents (N = 160) at an urban, tertiary care medical center received two 1-hour didactic sessions addressing overdose prevention, including intranasal naloxone. The number of naloxone prescriptions generated by residents was compared to faculty, who received no similar intervention, in the 3-month periods before and after the curriculum. Resident knowledge and attitudes, as assessed by pre- and post-intervention surveys, were compared.

RESULTS

The resident naloxone prescribing rate increased from 420 to 1270 per 100,000 inpatient discharges (P = .01) and from 0 to 370 per 100,000 ambulatory visits (P < .001) post-intervention. Similar increases were not observed among inpatient faculty, whose prescribing rate decreased from 1150 to 880 per 100,000 discharges (P = .08), or among outpatient faculty, whose rate increased from 30 to 180 per 100,000 ambulatory visits (P < .001) but was lower than the post-intervention resident rate (P = .01). Residents demonstrated high baseline knowledge about naloxone, but just 13% agreed that they were adequately trained to prescribe pre-intervention. Post-intervention, residents were more likely to agree that they were adequately trained to prescribe (Likert mean 2.5 vs. 3.9, P < .001), to agree that treating addiction is rewarding (Likert mean 2.9 vs. 3.3, P = .03), and to attain a perfect score on the knowledge composite (57% vs. 33%, P = .05).

CONCLUSIONS

A brief curricular intervention improved resident knowledge and attitudes regarding intranasal naloxone for opioid overdose reversal and significantly increased prescribing rates.