Education for the mind and the heart? Changing residents' attitudes about addressing unhealthy alcohol use

ABSTRACT

Background: Screening and brief intervention counseling for unhealthy alcohol use are among the top 10 recommended clinical preventive services for US adults. Although federally funded training programs in alcohol screening, brief intervention, and referral to treatment (SBIRT) have focused on increasing physicians' professional readiness to address drinking with their patients, programs typically focus on knowledge and skill acquisition, with less attention to attitudinal change. The purpose of this study was to assess the impact of a multicomponent SBIRT training program on changes in internal medical residents' professional readiness for working with patients with unhealthy alcohol use. Methods: Between 2011 and 2013, first-year internal medicine residents (n = 80) at a large academic medical center participated in a 16-hour SBIRT training program, consisting of two 3-hour didactic sessions, online modules, and a half-day clinical experience, during the Ambulatory Care month of the residency training year. Residents completed a modified Alcohol and Problems Perceptions Questionnaire (AAPPQ) at the beginning and end of the residency year to assess changes in professional readiness to work with adults with unhealthy alcohol use across 6 domains: Role Adequacy, Role Legitimacy, Role Support, Motivation, Task-Specific Self-esteem, and Satisfaction. Wilcoxon signed-rank tests were used to evaluate changes in the 6 AAPPQ subscale scores over time. Results: Residents reported significant increases in Role Adequacy (alcohol-related knowledge/skills; pre: 34 and post: 39.5; P < .0001) and Role Support (professional support; pre: 16 and post: 18; P = .005) scores. No significant differences in the remaining AAPPQ subscales were detected. Conclusions: Residents in the SBIRT training program indicated improvements in knowledge, skills, and professional role support but not in motivation, task-specific self-esteem, or satisfaction for working with patients with unhealthy alcohol use. Explicit curricular attention to these domains may be required to facilitate SBIRT skills application and sustained practice change.

KEYWORDS:

• Attitude
• counseling
• education
• internship and residency
• professional role
• screening
• unhealthy alcohol use

Funding

The SMaRT project was originally funded through the Substance Abuse and Mental Health Service Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT) (Award No. 1TI020263-01; Principal Investigator: J. Pringle). The funding agency was not involved in the work reported in the manuscript or in the composition of the submission. At the time this work was completed, Michael Mitchell was supported by the US Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Addiction Treatment. Dr. Broyles was supported by a Career Development Award (CDA 10-014) from the Health Services Research and Development Service of the US Department of Veterans Affairs. The material is the result of work supported with resources and the use of facilities at the VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Acknowledgments

The authors would like to thank Mr. Michael Keyes, MCSD, for his assistance with data management and preparation. This work was previously presented as an oral presentation at the 38th annual national conference of the Association for Medical Education and Research in Substance Abuse, San Francisco, California, November 6, 2014. The citation for this conference abstract is: Mitchell M, Broyles LM, Pringle J, Kraemer K, Childers J, Buranosky R, Gordon AJ. SBIRT education for both the mind and the heart? Assessing changes in medical residents' attitudes to working with drinkers [abstract 24A]. In: Jenkins JA, Gordon AJ, eds. Building connections and bridging interdisciplinary leadership in addictions: 2014 AMERSA Annual Conference and a thank you to reviewers. Subst Abus. 2015;36:131–134. The authors declare that they have no conflicts of interest.

Author contributions

Mr. Mitchell conducted data analysis, participated in interpretation of the results, and authored the first draft of the manuscript. Drs. Broyles and Gordon participated in initial research conception and design, assisted with data analysis and interpretation of the results, and edited subsequent drafts of the manuscript. Drs. Pringle and Kraemer participated in the initial research conception and design. Drs. Kraemer, Buranosky, and Childers assisted with data collection. All authors participated in the revision of the manuscript and approved the final version prior to submission.