Teaching Residents Screening, Brief Intervention, and Referral to Treatment (SBIRT) Skills for Alcohol Use: Using Chart-Stimulated Recall to Assess Curricular Impact

Abstract

Background: Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents’ use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). Methods: Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. Results: Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. Conclusions: More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

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

“…Of the 1,856 articles identified in the initial search (after duplicate were removed), 95 met our inclusion criteria, 42–136 the earliest of which was published in 2007. 48 Figure 1 shows the flowchart of the literature search and Supplemental Digital Appendix 3 at http://links.lww.com/ACADMED/B249 provides a summary of each of the included articles.…”

Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions

“…There are well-described physician-related barriers to performing SBIRT. Despite recommendations that substance use curricula be integrated into medical school and postgraduate training (Polydorou et al, 2008;Jackson et al, 2010;O'Connor et al, 2011), many residents and practicing physicians report a lack of knowledge and skills in screening and brief intervention for patients with at-risk use or frank SUDs and training is variable depending on physician specialty (Friedmann et al, 2000;Cunningham et al, 2010;Wamsley et al, 2016;Stone et al, 2017). Physicians may be reluctant to ask about alcohol/substance use out of concern that patients may be offended or unwilling to discuss these issues (Friedmann et al, 2000).…”

Evaluación de competencias clínicas en los contextos médicos curriculares actuales

“…Se ha demostrado que es una herramienta útil en mejorar las destrezas en los estudiantes de posgrado, por ejemplo, en radiología, en la calidad de los reportes en términos de validez, confiabilidad, reproducibilidad y aceptación [94]. Se ha empleado esta modalidad de evaluación en el aprendizaje pues identifica en los estudiantes áreas de fortaleza y debilidad, por lo cual es útil para emplear las estrategias aprendidas en la práctica [95,96]. Como en las otras modalidades de evaluación, la discusión basada en casos tiene elementos prácticos de costo, tiempo y necesidad de asesores experimentados, lo que puede dificultar su implementación [91].…”