Nineteen of 21 eligible interns and residents in the University Hospital General Internal Medicine Clinic agreed to participate. One resident declined because of concern over conflict with his patient appointments, and the other objected to the presence of an unannounced SP in his clinic. Of the 19 residents, 74% were men and 26% were women; 21% were interns, 32% were second-year residents, and 47% were third-year residents. When the study sample was compared to the entire medicine resident group with regard to gender, type of training, or year of training, a significantly higher proportion of primary care trainees existed in the study sample. The percentages of women and senior residents were not significantly different between the two groups.
In , approximately one half of the participating residents (52.6%) asked about alcohol use before the educational intervention compared to 94.6% who asked after the educational intervention (absolute change of 42%; 95% confidence interval [95% CI], 0.14 to 0.70; P < .01). Twenty-six percent assessed for alcohol use pre-intervention, and 73.6% assessed post-intervention; 26% advised pre-intervention, and 73.6% advised post-intervention (absolute change of 46.4%; 95% CI, 0.16 to 0.79; P < .01). In an attempt to control for maturation effects of residency training and education over the 6-month study period, the proportion of residents who advised tobacco cessation before and after the educational intervention was measured and compared to the proportion who advised about alcohol use (. The proportion of residents advising tobacco cessation pre-intervention did not change significantly 6 months later (68% vs 74%). In comparison, a significant change occurred in the proportion of residents advising patients about alcohol use pre- and post-intervention (26% vs 74%).
Alcohol screening rate, alcohol assessment rate, and alcohol intervention rate of residents (N = 19) before (pre-test) and after (post-test) a brief teaching intervention.
Alcohol and tobacco intervention rate of residents (N = 19) before (pre-test) and after (post-test) a brief teaching intervention.
Alcohol screening and intervention rates did not significantly vary when controlled for year of residency training and whether residents had primary care training. Knowledge and interviewing skills scores did not significantly change after the educational intervention. Resident response to the teaching intervention was assessed using a Lickert scale with scores of 1 (completely useless) to 7 (definitely useful). Average scores were 6 for instruction by the faculty, 5.5 for handouts provided, 5.3 for standardized patient feedback, and 6 for overall experience. Close to 60% of residents reported the teaching encounter as a better experience than regular instruction in the general internal medicine clinic. Written statements by the participating residents included the following: “The SP was quite credible, making the exercise seem real”; “This process really humanizes the problem of EtOH (alcohol) abuse and, overall, I think that this encounter is an excellent educational adjunct”; “…this will definitely change my practice habits”; “…good teaching case with immediate feedback and teaching by staff to drive important points home with verbal/written reinforcement”; “… good opportunity to explore my abilities to assess pts' (patients') EtOH related behavior (with) backup support from staff.”