Online intervention tool for physician trainees may improve care of patients with substance use disorders

The study used a novel internet-based learning module designed to improve the communication skills of primary care physicians during screenings and brief counseling sessions with patients with substance use disorders. The study was co-led by Paul N. Lanken, MD, associate dean for Professionalism and Humanism and professor of Medicine and Medical Ethics and Health Policy at Penn, and Barbara A. Schindler, MD, vice dean emerita, Educational and Academic Affairs, and professor of Psychiatry at Drexel.

"The study findings with residents are promising because we saw that a relatively brief intervention yielded big changes in their attitudes and communication skills," said Lanken. "Based on these results, we would expect improved medical care of patients with substance use disorders, but further studies are needed to look at practice-based and patient-centered outcomes in connection with this type of educational intervention."

Substance use disorders have led to an epidemic of morbidity and mortality, and more than an estimated 100,000 deaths and $400 billion in health and social costs per year in the United States have been directly attributed to the use of drugs and alcohol, according to the study. While health care providers are adequately prepared to diagnose and treat the medical consequences of substance use disorders, they are far less likely to screen for and treat the disorders themselves. However, this study asserts that primary care physicians can play a key role in both prevention and intervention.

Previous studies of educational interventions have shown improvement in screening and counseling patients with substance use disorders, however, these approaches haven't been widely adopted, likely due to time constraints of current curricula. The authors suggest that internet-based learning has the potential to reach large numbers of learners with both fewer logistical barriers than other educational formats and comparable or superior effectiveness and efficiency.

The two-part intervention in this study consisted of a self-directed, media-rich online learning module, followed by a small group, faculty-led debriefing. The study group consisted of 129 internal and family medicine residents and 370 medical students at two medical schools (Penn and Drexel) during the 2011-2012 school year. Through a cluster randomized controlled trial design, comparing the intervention group with a control group, the study found that residents showed increased confidence in their ability to screen and identify a substance use disorder, a more positive attitude towards their abilities and improved communication skills. However, among the medical students, there were no significant differences between the intervention and control groups, both of which improved over baseline.

"The difference in findings among students and residents is important to note," said Schindler. "The results emphasize that educators need to take into account a trainee's stage of professional development and competence when considering how and when to introduce new educational material."