Teaching internal medicine resident physicians about Alcoholics Anonymous: a pilot study of an educational intervention.

Greater physician confidence in treating alcoholism is associated with a higher frequency of referring alcoholic patients for treatment, but many physicians have limited experience with Alcoholics Anonymous. We implemented a brief, didactic and experiential educational intervention about AA and evaluated its effect on knowledge and attitudes, using a before-after repeated measures study design. Thirty-six first-year internal medicine resident physicians received an educational intervention, which consisted of a 45-minute lecture about AA, a visit to an AA meeting, and a 30-minute debriefing session the next day. Residents' knowledge and attitudes were assessed by a brief written anonymous survey before and after the educational intervention. Residents reported increases in self-perceived knowledge about AA and had more favorable attitudes towards AA after the intervention. Our pilot study shows that a brief, didactic and experiential course can improve physician knowledge and attitudes about AA, and holds promise for improving physician interface with this commonly used intervention.     

Development of a Pharmacy Residency Research Certificate Program

Background: Similar to teaching certificate programs, which have been incorporated in many pharmacy residencies to improve teaching skills, resident research certificate programs could provide residents with more exposure to biostatistics and research design. However, few research certificate programs have been described. Objective: To assess the impact of a research certificate program on residents’ attitude toward, confidence in, and knowledge of research. Methods: A resident research certificate program was created for the 2018-2019 residency class at our institution, which included 33 pharmacy residents (15 postgraduate year-1 [PGY1] and 18 PGY2 residents). The program consisted of 7 sessions aimed at providing residents with research training. To earn a certificate, participants were required to attend 6 or more sessions and achieve a score greater than or equal to 70% on a postassessment. An optional questionnaire assessing attitude, confidence, and knowledge was also administered at baseline and following the certificate program. Results: Of the 33 residents participating in the research certificate program, 21 (9 PGY1 and 12 PGY2) residents completed both the baseline and follow-up questionnaire and were included in the analysis. All items assessing attitude and 3 of 6 items assessing confidence improved significantly following the certificate program when compared to baseline (P < .05 for all). Median knowledge scores were no different on the baseline versus follow-up questionnaire (P = .54). Conclusions: After completing a research certificate program, resident knowledge scores did not differ from baseline, but attitudes toward research and confidence appeared to improve. Research certificate programs could be an avenue for providing pharmacy residents with increased exposure to and comfort with biostatistics and research design.     

A Buprenorphine Education and Training Program for Primary Care Residents: Implementation and Evaluation

ABSTRACT. Background: Although substance use disorders are highly prevalent, resident preparation to care for patients with these disorders is frequently insufficient. With increasing rates of opioid abuse and dependence, and the availability of medication-assisted treatment, one strategy to improve resident skills is to incorporate buprenorphine treatment into training settings. Methods: In this study, esidency faculty delivered the BupEd education and training program to 71 primary care residents. BupEd included (1) a didactic session on buprenorphine, (2) an interactive motivational interviewing session, (3) monthly case conferences, and (4) supervised clinical experience providing buprenorphine treatment. To evaluate BupEd, the authors assessed (1) residents’ provision of buprenorphine treatment during residency, (2) residents’ provision of buprenorphine treatment after residency, and (3) treatment retention among patients treated by resident versus attending physicians. Results: Of 71 residents, most served as a covering or primary provider to at least 1 buprenorphine-treated patient (84.5 and 66.2%, respectively). Of 40 graduates, 27.5% obtained a buprenorphine waiver and 17.5% prescribed buprenorphine. Treatment retention was similar between patients cared for by resident PCPs versus attending PCPs (90-day retention: 63.6% [n = 35] vs. 67.9% [n = 152]; P = .55). Conclusion: These results show that BupEd is feasible, provides residents with supervised clinical experience in treating opioid-dependent patients, and can serve as a model to prepare primary care physicians to care for patients with opioid dependence.     

South Texas Residency Screening,Brief Intervention,and Referral to Treatment (SBIRT) Training: 12-Month Outcomes

Background: Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and cost-effective skill set when implemented in primary care settings regarding hazardous alcohol use. This study assesses the impact of medical resident SBIRT training across 3 specialties and identifies predictors of change in trainee behavior, attitudes, and knowledge over 12 months. Methods: This program's substance use SBIRT training was developed and tailored to fit diverse curricular objectives and settings across an array of medical residency programs in South Texas. The 329 residents training in pediatrics, family medicine, and internal medicine during 2009–2012 constituted the trainee group reported in this analysis. Surveys assessing SBIRT-related knowledge, current practice, confidence, role responsibility, attitudes, beliefs, and readiness to change were completed by 234 (71%) trainees at 3 time points: pre-training, then 30 days and 12 months post-initial training. Results: SBIRT-related knowledge, confidence, and practice increased from pre-training to 12-month follow-up. Residents who reported the least amount of pre-training clinical and/or prior academic exposure to substance use reported the greatest SBIRT practice increases. When controlling for demographic and prior exposure variables, the largest contributor to variance in SBIRT practice was attributed to residents' confidence in their SBIRT skills. Conclusions: SBIRT training that employs diverse educational methodologies as part of customizing the training to residency specialties can similarly enhance SBIRT-related knowledge, confidence, and practice. Trainee report of limited prior clinical or academic exposure to substance use and/or low confidence regarding SBIRT skills and their professional role responsibilities related to substance use predicted trainee success and sustained SBIRT strategy application. When customizing SBIRT training, curriculum developers should consider leveraging and capacity building related to those factors predicting continued use of SBIRT practices.     

Internal Medicine Residents’ Training in Substance Use Disorders: A Survey of the Quality of Instruction and Residents’ Self-Perceived Preparedness to Diagnose and Treat Addiction

ABSTRACT

Background: Resident physicians are the direct care providers for many patients with addiction. This study assesses residents’ self-perceived preparedness to diagnose and treat addiction, measures residents’ perceptions of the quality of addictions instruction, and evaluates basic knowledge of addictions. Methods: A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May 2012. Results: Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a substance use disorder (SUD). Twenty-five percent of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across postgraduate year (PGY) level. Fifty-five percent rated the overall instruction in addictions as poor or fair. Seventy-two percent of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all 6 knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. Nine percent of residents responded that someone had expressed concern about the respondent's substance use. Conclusions: Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUDs. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.     

Teaching physicians to address unhealthy alcohol use: a randomized controlled trial assessing the effect of a Web-based module on medical student performance

Background

The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use.

Methods

First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received.

Results

Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise–Assist knowledge for Web students (14% vs. −3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences.

Conclusion

Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area.     

Scottish pharmacists’ views and attitudes towards continuing professional development

Objectives To summarise Scottish pharmacists’ views and attitudes towards Continuing Professional Development (CPD). Setting Random sample of RPSGB registered Scottish pharmacists. Method A postal questionnaire of pharmacists’ CPD activity, views and attitudes was developed, piloted and sent to 2420 pharmacists. Questions were collated to produce total scores and to rate pharmacists’ motivation and attitudes to CPD separately. The number of CPD hours reported by sector and gender were compared (‘t’ test) and differences identified between hospital, community and primary care in relation to mean motivational attitudinal scores (Mann-Whitney test). Results Five hundred and forty three pharmacists completed the questionnaire (22.4% response rate). In this study 9.8% of the pharmacists reported spending no time on CPD. Comparisons of hours showed primary care pharmacists and hospital pharmacists reported similar times spent on CPD and significantly more time than community pharmacists (68 h and 66 h vs 45 h; P < 0.05). No statistically significant differences between genders were revealed. Internal reliability on motivation and attitude scores ranged from 0.74–0.83 (Cronbach’s alpha). Although scores were similar across sectors of practice in terms of motivation and attitudinal questions, statistical differences were consistent; showing higher scores for separate motivation and attitude among pharmacists in primary care than in hospital or community practice sectors (Mann Whitney test; P < 0.001). Community pharmacists had a statistically significantly lower attitude score than pharmacists in hospital or primary care sectors (Mann Whitney test; P < 0.001). Conclusion There is a section of pharmacists still not participating in CPD. Primary care pharmacists reported most motivation and scored highest in attitude score. Community pharmacists appear to be the sector requiring most support to increase not only their motivation to CPD but also their confidence and ability in participation.     

Factors influencing the acceptance of referrals for clinical pharmacist managed disease states in primary care

ObjectiveClinical pharmacists use population health methods to generate chronic disease management referrals for patients with uncontrolled chronic conditions. The purpose of this study was to compare primary care providers’ (PCPs) referral responses for 4 pharmacist-managed indications and to identify provider and patient characteristics that are predictive of PCP response.DesignRetrospective cohort study.SettingThis study occurred in an academic internal medicine clinic.ParticipantsClinical pharmacy referrals generated through a population health approach between 2012 and 2016 for hypertension, chronic pain, depression, and benzodiazepine management were included.Main outcome measuresProportion of referrals accepted, left pending, or rejected and influencing provider and patient characteristics.ResultsOf 1769 referrals generated, PCPs accepted 869 (49%), left pending 300 (17%), and rejected 600 (34%). Compared with referrals for hypertension, benzodiazepine management, and depression, chronic pain referrals had the lowest likelihood of rejection (odds ratio [OR] 0.31; 95% CI 0.19–0.49). Depression referrals had an equal likelihood of being accepted or rejected (OR 1.04; 95% CI 0.66–1.64). Provider characteristics were not significantly associated with referral response, but residents were more likely to accept referrals. Patient characteristics associated with lower referral rejection included black race (OR 0.39; 95% CI 0.18–0.87), higher systolic blood pressure (OR 0.98; 95% CI 0.97–0.99), and missed visits (OR 0.24; 95% CI 0.07–0.81).ConclusionThe majority of referrals for clinical pharmacists in primary care settings were responded to, varying mostly between acceptance and rejection. There was variability in referral acceptance across indications, and some patient characteristics were associated with increased referral acceptance.     

Assessing and responding to hazardous and risky alcohol and other drug use: The practice,knowledge and attitudes of staff working in mental health services

Introduction: Comorbidity of mental illness and alcohol and other drugs (AOD) raises workforce challenges in terms of appropriate knowledge, skills and attitudes required for delivering best care.

Aim: (1) To assess the knowledge, skills and attitudes of mental health staff in relation to AOD use and (2) to inform development of training to provide effective screening and interventions for people with both mental health and AOD problems (co-morbidity).

Method: Quantitative survey of knowledge, skills and attitudes regarding AOD issues completed by multidisciplinary mental health staff (n?=?104/218) working across acute and community settings.

Results: A 47.7% response rate was achieved. Generally staff held positive attitudes and motivation towards working with people with comorbidity, but there was an absence of formal training, experience or knowledge. Most staff believed they could deal with AOD issues; however, confidence was higher with assessment over AOD-related interventions (brief interventions, motivational approaches and goal setting) and only 24% of staff correctly identified standard drinks. Most staff recognized that AOD assessment and intervention is part of their role and access to training would facilitate their ability to improve service to mental health consumers.

Conclusion: Integrated care for people with comorbidity requires mental health service providers to address identified gaps in clinician's knowledge, skills and attitudes with training in relation to AOD. To ensure effective training uptake and implementation, workforce leaders need to target identified barriers with initiatives such as support, mentoring and appropriate tools in relation to AOD.     

What Do Adolescents Exposed to Alcoholic Anonymous Think About 12-Step Groups?

Abstract

Objectives: Referral to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) is a common continuing care recommendation. Evidence suggests some youth benefit, yet, despite referrals, youth participation is low. Little is known about adolescents' experiences of AA/NA. Greater knowledge would inform and help tailor aftercare recommendations.

Method: Two clinical samples of youth (N = 74 and N = 377) were asked about their perceptions of, and experiences with, AA/NA with responses categorized by content into domains assessed for face validity and reliability.

Results: The aspects of AA/NA youth liked best were general group dynamic processes related to universality, support, and instillation of hope. The most common reason for discontinuing was boredom/lack of fit.

Conclusions: General group-therapeutic, and not 12-step-specific, factors are most valued by youth during early stages of recovery and/or degree of AA/NA exposure. Many youth discontinue due to a perceived lack of fit, suggesting a mismatch between some youth and aspects of AA/NA.     

Factors affecting the views and attitudes of Scottish pharmacists to continuing professional development

Objectives To explore factors associated with Scottish pharmacists' views and attitudes to continuing professional development (CPD). Methods A retrospective principal component analysis of 552 (22.8%) questionnaires returned from a sample of 2420 Scottish pharmacists randomly selected from the 4300 pharmacists registered with the Royal Pharmaceutical Society of Great Britain and with a Scottish address. Key findings Principal component analysis of questionnaire items (n = 19) revealed four factors associated with Scottish pharmacists' views and attitudes to CPD: having positive support in the workplace, having access to resources and meeting learning needs, having confidence in the CPD process and motivation to participate in the CPD process. Community pharmacists were identified as the subgroup of pharmacists that needed most support for CPD regarding all four factors, while pharmacists working in primary care felt that they had most support in the workplace in comparison to other sectors (P < 0.05) and better access to resources and meeting learning needs when compared to community (P < 0.001) and hospital (P = 0.008) colleagues. Pharmacists working in primary care also felt more motivated to participate in the CPD process than those in the community (P < 0.001), and hospital pharmacists reported having more confidence in the CPD process compared to community pharmacists (P < 0.05). Conclusion Using principal component analysis has identified four factors associated with Scottish pharmacists' views and attitudes to CPD. This may provide an approach to facilitate comparison of CPD views and attitudes with intra and inter professional groupings. Further study may allow identification of good practice and solutions to common CPD issues.     

Perceptions of the incorporation of health literacy in pharmacy training programs

ObjectivesTo assess pharmacy residents’ perceptions regarding the incorporation of health literacy in pharmacy school and pharmacy residency training and to assess confidence while interacting with patients of limited health literacy.DesignProspective cross-sectional study.SettingUnited States from March to May 2012.ParticipantsPostgraduate year (PGY)1 and -2 pharmacy residents and pharmacy residency program directors.InterventionOnline survey.Main outcome measurePGY1 and -2 resident perceptions of health literacy incorporation into pharmacy school and residency training.Results939 surveys were completed. Residents agreed that their pharmacy school training encouraged the development of health literacy skills (P < 0.001) and made efforts to improve health literacy awareness (P < 0.001) significantly more than their PGY1 programs. In addition, they felt significantly more confident in their ability to communicate with patients with limited health literacy after their pharmacy school training compared with during or following PGY1 residency training (P < 0.001); however, no difference was found regarding confidence in identifying patients of limited health literacy.ConclusionPGY1 residency programs lag behind the efforts of schools of pharmacy to incorporate the health literacy training essential to encountering patients of limited health literacy. Future studies should assess whether these perceptions reflect true health literacy awareness and management among pharmacy residents.