utilizing web-based patient simulations to advance ...€¦ · • colleen cordes, phd, clinical...
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Utilizing Web-Based Patient Simulations to Advance Clinical Skill Mastery
• Adrienne Lindsey, DBH, Principal Manager, Interprofessional Curriculum & Training Center for Applied Behavioral Health Policy, Arizona State University
• CR Macchi, PhD, LMFT, Clinical Associate Professor and Associate Chair of Internship Programs, Doctor of Behavioral Health, Arizona State University
• Colleen Cordes, PhD, Clinical Professor and Director, Doctor of Behavioral Health, Arizona State University
Session # track letter and number
CFHA 19th Annual ConferenceOctober 19-21, 2017 • Houston, Texas
Faculty DisclosureThe presenters of this session have NOT had any relevant
financial relationships during the past 12 months.
Agreed
Conference Resources
Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2017
Slides and handouts are also available on the mobile app.
Learning Objectives
At the conclusion of this session, the participant will be able to:
• Define the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model and describe its implications for integrated behavioral healthcare.
• Describe two forms of web-based SBIRT-related learning and practice.
• Explain the potential impact of avatar-based patient simulations on clinician SBIRT proficiency.
Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted
at the end of this presentation.
Meeting the Triple Aim• Improved Patient
Experience
• Improved Population Health
• Reducing Per Capita Cost of Health Care
• Can we utilize web-based patient simulations to enhance providers’ brief intervention skills to improve patient satisfaction?
• Can we utilize web-based learning opportunities to increase universal screening for alcohol, to improve health of at-risk patient populations (e.g. adolescents, chronic pain patients, pregnant women, etc.)?
• Can web-based training products be utilized to reduce cost of workforce development, due to reduced time out of clinic?
Meeting the Triple Aim• Alcohol misuse costs approximately $235
billion per year
• Up to 25% of the general population engages in risky drinking◦ Need universal screening to identify
those engaging in maladaptive drinking behaviors
• Motivational interviewing has been found to enhance the patient-provider relationship◦ MI should be the cornerstone of brief
alcohol interventions
(National Survey on Drug Use & Health, 2015; US Dept. Health and Human Services, 2014; CDC, 2015; Miller & Rollnick, 2013)
• Improved Patient Experience
• Improved Population Health
• Reducing Per Capita Cost of Health Care
Screening, Brief Intervention, and Referral to Treatment
Key Terms
S (screening): brief tool used to identify those at risk for substance use disorders or those engaging in risky drinking
BI (brief intervention): brief interaction that serves to educate the patient and motivate them to move in the direction of healthier behaviors
RT (referral for treatment): referral to an offsite specialty substance abuse treatment provider for individuals requiring more extensive treatment than the current setting can offer
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SBIRT Process
Screening Universal
Low RiskNo Intervention
Moderate Risk
Brief Intervention
Mod-High RiskBrief Treatment
Severe Risk
Referral
Effects of Skill-Development Training
Impact of Patient Simulations• A review of 20 nursing studies indicated simulation-enhanced learning
produces moderate to large effect sizes, when compared with traditional teaching methods (Shin, Park & Kim, 2015)
• Meta-analysis of 92 studies comparing simulation learning to traditional forms of learning (e.g. lectures, written papers) found simulations are associated with higher cost, but demonstrate stronger outcomes with knowledge and clinical skills (Cook et al., 2012)
• A review of 289 studies with nearly 20,000 participants indicate simulation features such as: repetition, real-time feedback, engaging multiple learning styles, and variation in difficulty of tasks have the greatest impact on student learning (Cook et al., 2013)
• Limited literature available on SBIRT-specific simulations◦ one study of 65 medical providers (nurses & PCPs) demonstrated a
significant improvement in knowledge, self-efficacy and brief intervention skills post-simulation (Tanner, Wilhelm, Rosie, & Metcalf, 2012)
What type of MI trainings are effective?140 clinicians randomly assigned to:
• Book only (waiting list)
• Two-day workshop only
• Workshop + feedback on practice samples
• Workshop + six telephonic coaching sessions
• Workshop + feedback + coaching
13
(Miller, Yahne, Moyers, Martinez, & Pirritano, 2004)
What type of MI trainings are effective?
14(Miller, Yahne, Moyers, Martinez, & Pirritano, 2004)
Implications
• Learners’ MI skill development is enhanced with opportunities to:◦ Reflect upon knowledge and use of skills
◦ Receipt of targeted guidance for refining specific skills
◦ Demonstrate and refine skills within an environment that mirrors actual practice situations
• Learners’ performance improves to a greater extent with an increasing combination of training approaches
Web Technologies for SBIRT Learning
Pilot Study Findings
Research Questions
• Does a web-based avatar patient simulation enhance learning outcomes for online learners?
• What impact does an online patient simulation have on identified SBIRT skillsets (e.g., proper administration of a screening tool, motivation enhancement)?
• Does stronger performance on an online patient simulation result in greater mastery of SBIRT skills, as demonstrated by an SBIRT demonstration in a recorded role play?
Pilot Study Overview• trainees participated in an eight-week university SBIRT course• students were randomized to one of two study groups (n=60):
◦ group 1: training as usual (didactic online instruction)
◦ group 2: patient simulation-enhanced training
• impact of simulation training on three course assignments was assessed: ◦ knowledge assessment/exam
◦ written case study with instructor feedback
◦ video-recorded role play
Findings
• no significant group differences◦ group assignment (training as usual or avatar
simulation-enhanced training) did not significantly impact or predict course assignment performance
• increased avatar simulation scores were significantly correlated with performance improvements in:◦ screening administration techniques ◦ motivational interviewing techniques
Findings (cont’d)Table 1. Comparing Clinical Skill Demonstration Between Simulation-Enhanced Training and Training as Usual
Group Variable N Mean
Std.
Deviatio
n
Simulation-
Enhanced Training
role play motivational interviewing 30 4.37 1.03
role play referral 30 3.90 1.86
role play screening 30 4.73 0.94
Didactic Training
(training as usual)
role play motivational interviewing 30 4.33 0.88
role play referral 30 4.20 1.56
role play screening 30 4.97 0.18
Findings (cont’d)
Table 2. Group Differences Between Simulation-Enhanced Training and Training as Usual
SBIRT Skillsets Np-
valueSignificant
screening (role play) 60 0.293 No
motivational interviewing (role play) 60 0.838 No
warm handoff (role play) 60 0.572 No
screening (case study) 60 0.142 No
brief intervention (case study) 60 0.559 No
Findings (cont’d)
simulation main
score
simulation bonus
score
simulation total
scorecorrelatio
np-value correlation p-value correlation p-value
screening
administratio
n
0.70715 <0.0001* -0.13166 0.488 0.62342 0.0002*
motivational
interviewing0.7205 <0.0001* -0.1709 0.3666 0.62172 0.0002*
referral and
warm
handoff
0.28219 0.1308 0.18606 0.3249 0.33622 0.0693
Table 3. Correlational Data Comparing Recorded Role Play and Simulation Scores for Experimental (Simulation) Group (n=30)
Limitations• Participants likely had varying levels of baseline MI
proficiency
• Low sample size; study ongoing
• Video-recorded role play assignment may not accurately simulate actual patient interactions
• Could not control for other forms of learning occurring during course (e.g., in other courses, in the workplace)
• Didactic training (comparison condition) had no scoring mechanism
• Simulation did not include focus on referrals/warm handoffs
Implications• Avatar-based training may provide an effective approach to skill
development to effectively bridge the gap between instruction and practice
• Screening techniques may be more generalizable, and therefore, more trainable than patient-specific interaction skills (i.e., referrals, warm handoffs)
• Further studies are needed to compare the effects of didactic versus avatar-based learning to determine the most effective applications for each type of skill
ReferencesBuck, J.A. (2011). The looming expansion and transformation of public substance abuse treatment
under the Affordable Care Act. Health Affairs, 30(8), 1402-1410.Center for Behavioral Health Statistics and Quality (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
Cook, et al. (2013). Comparative effectiveness of instructional design features in simulation-based education: Systematic review and meta-analysis. Medical Teacher, 35, 844-855.
Higgins-Biddle et al. (2014). Screening and brief interventions for unhealthy alcohol use: A step-by-step guide for primary care practices. Atlanta, GA: Centers for Disease Control.
Miller, W.R., Yahne, C.E., Moyers, T.B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050-1062.
Miller, W.R. & Rollnick, S. (2013). Helping people change (3rd ed.). Guilford Press: New York, NY.
McCance-Katz, E. F. & Satterfield, J. (2012). SBIRT: A key to integrate prevention and treatment of substance abuse in primary care. The American Journal on Addictions, 21, 176-177.
Shin, S., Park, J.H., & Kim, J.H. (2015). Effectiveness of patient simulation in nursing education: Meta-analysis. Nurse Education Today, 35, 176-182.
Tanner, T.B., Wilhelm, S.E., Rosie, K.M., & Metcalf, M.P. (2012). Web-based SBIRT skills training for health professional students and primary care providers. Substance Abuse, 33(3), 316-320.
QuestionsC.R. Macchi
602.496.1355
Colleen Clemency Cordes
602.496.1356
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