A Statewide Screening,Brief Intervention,and Referral to Treatment (SBIRT) Curriculum for Medical Residents: Differential Implementation Strategies in Heterogeneous Medical Residency Programs
Restricted accessResearch articleFirst published online April, 2017
A Statewide Screening,Brief Intervention,and Referral to Treatment (SBIRT) Curriculum for Medical Residents: Differential Implementation Strategies in Heterogeneous Medical Residency Programs
Background: Many screening, brief intervention, and referral to treatment (SBIRT) training curricula have been implemented within graduate medical residency training programs, with varying degrees of success. The authors examined the implementation of a uniform, but adaptable, statewide SBIRT curriculum in 7 diverse residency training programs and whether it could improve resident knowledge, skills, and attitudes regarding SBIRT and unhealthy alcohol and other drug (AOD) use. Methods: The authors assessed the implementation of the Pennsylvania SBIRT Medical and Residency Training (SMaRT) curriculum at 7 residency sites training a variety of disciplines. Faculty could use a variety of training modalities, including (1) Web-based self-directed modules; (2) didactic lectures; (3) small-group sessions; and/or (4) skill-transfer interactions with standardized or real patients in preceptor-led encounters. Acquisition of knowledge, skills, and attitudes regarding SBIRT and unhealthy AOD use–associated patient care were assessed via a pre- and post-survey instrument with 4 domains: Resident Knowledge, Resident Competence, Resident Skills and Attitudes (Alcohol), and Resident Skills and Attitudes (Drug). Responses to the pre- and post-surveys (N = 365) were compared and analyzed with t tests and Wilcoxon signed-rank tests. Results: The diverse modalities allowed each of the residency programs to adapt and implement the SMaRT curriculum based on their needs and environments. Residents’ knowledge, skills, and attitudes regarding SBIRT and working with unhealthy AOD use, as assessed by survey, generally improved after completing the SMaRT curriculum, despite the variety of models used. Specifically, Resident Knowledge and Resident Competence domains significantly improved (P < .000). Residents improved the least for survey items within the Resident Skills and Attitudes (Alcohol) domain. Conclusions: Adaptable curricula, such as SMaRT, may be a viable step towards developing a nationwide curriculum.
BaborTF, McReeBG, KassebaumPA, GrimaldiPL, AhmedK, BrayJ. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28:7–30.
2.
GentilelloLM, EbelBE, WickizerTM, SalkeverDS, RivaraFP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005;241:541–550.
3.
AlbertS, BrasonFW2nd, SanfordCK, DasguptaN, GrahamJ, LovetteB. Project Lazarus: community-based overdose prevention in rural North Carolina. Pain Med. 2011;12(Suppl 2):S77–S85.
4.
MadrasBK, ComptonWM, AvulaD, StegbauerT, SteinJB, ClarkHW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99:280–295.
5.
National Institute on Drug Abuse (NIDA) National Advisory Council on Drug Abuse. Minutes of the 101st Meeting of the National Advisory Council on Drug Abuse, February 3–4, 2009, Bethesda, MD. http://archives.drugabuse.gov/about/organization/nacda/minutes101st.html. Accessed March 9, 2015. Published 2009
6.
Substance Abuse and Mental Health Services Administration Center for Integrated Health Solutions. SBIRT: Screening, Brief Intervention, and Referral to Treatment Opportunities for Implementation and Points for Consideration. http://www.integration.samhsa.gov/SBIRT_Issue_Brief.pdf. Accessed March 9, 2015.
7.
WhitlockEP, PolenMR, GreenCA, OrleansT, KleinJ, United States Preventive Services Task Force. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med.2004;140:557–568.
SaitzR. Addressing Unhealthy Alcohol Use in Primary Care. New York, NY: Springer; 2013.
11.
BoggsJ, RahmAK, MartinC, . PS1-18: feasibility of implementing screening brief intervention and referral to treatment (SBIRT) within multiple health settings. Clin Med Res. 2013;11:167–167.
12.
GordonAJ, AlfordDP. Screening, brief intervention, and referral to treatment (SBIRT) curricular innovations: addressing a training gap. Subst Abus. 2012;33:227–230.
Rahm AK, Boggs JM, Martin C, Price DW, Beck A Backer TE, Dearing, JW. Facilitators and barriers to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care in integrated health care settings. Subs Abus. 2015;36(3): 281–288.
15.
StonerSA, MikkoAT, CarpenterKM. Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs. J Subst Abuse Treat. 2014;47:362–370.
16.
AgleyJ, McIntireR, DeSalleM, TiddD, WolfJ, GassmanR. Connecting patients to services: screening, brief intervention and referral to treatment in primary health care. Drugs Educ Prev Policy. 2014;21:370–379.
17.
BurnsHK, PuskarK, FlahertyMT, . Addiction training for undergraduate nurses using screening, brief intervention, and referral to treatment. Nurse Educ Pract. 2012;2:167–177.
18.
O'ConnorPG, NyquistJG, McLellanAT. Integrating addiction medicine into graduate medical education in primary care: the time has come. Ann Int Med. 2011;154:56–59.
19.
WelshC, EarleyK, DelahantyJ, . Residents’ knowledge of standard drink equivalents: implications for screening and brief intervention for at-risk alcohol use. Am J Addict. 2014;23:194–196.
20.
TannerTB, WilhelmSE, RossieKM, MetcalfMP. Web-based SBIRT skills training for health professional students and primary care providers. Subst Abus. 2012;33:316–320.
21.
NeufeldKJ, AlvanzoA, KingVL, . A collaborative approach to teaching medical students how to screen, intervene, and treat substance use disorders. Subst Abus. 2012;33:286–291.
22.
RyanSA, MartelS, PantalonM, . Screening, brief intervention, and referral to treatment (SBIRT) for alcohol and other drug use among adolescents: evaluation of a pediatric residency curriculum. Subst Abus. 2012;33:251–260.
23.
ClemenceA. J., BalkoskiV. I., LeeM., PostonJ., SchaeferB. M., MaisonneuveI. M., … & HamiltonC. J.Residents’ experience of screening, brief intervention, and referral to treatment (SBIRT) as a clinical tool following practical application: A mixed-methods study. Subs Abus. 2016;37(2):306–314.
24.
WamsleyMA, SteigerS, JulianKA, GleasonN, O'SullivanPS, GuyM, SatterfieldJM.Teaching residents SBIRT skills for alcohol use: using chart-stimulated recall to assess curricular impact. Subst Abus. 2016;37(3):419–126.
25.
ClemenceAJ, BalkoskiVI, SchaeferBM, LeeM, BromleyN, MaisonneuveIM, … PieterseP.Multispecialty SBIRT training in an academic medical center: resident training experience across specialties. Subst Abus. 2015(just-accepted):00–00.
26.
GiudiceEL, LewinLO, WelshC, . Online versus in-person screening, brief intervention, and referral to treatment training in pediatrics residents. J Grad Med Educ. 2015;7:53–58.
27.
ScottDM, McLaurin-JonesT, BrownFD, . Institutional incorporation of screening, brief intervention, and referral to treatment (SBIRT) in residency training: achieving a sustainable curriculum. Subst Abus. 2012;33:308–311.
28.
SatterfieldJM, O'SullivanP, SatreDD, . Using standardized patients to evaluate screening, brief intervention, and referral to treatment (SBIRT) knowledge and skill acquisition for internal medicine residents. Subst Abus. 2012;33:303–307.
29.
CoxM, IrbyDM, CookeM, IrbyDM, SullivanW, LudmererKM. American medical education 100 years after the Flexner report. N Engl J Med. 2006;355:1339–1344.
30.
IsaacsonJH, FlemingM, KrausM, KahnR, MundtM. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000;61:912–915.
31.
ChildersJW, BroylesLM, HanusaBH, . Teaching the teachers: faculty preparedness and evaluation of a retreat in screening, brief intervention, and referral to treatment. Subst Abus. 2012;33:272–277.
32.
BernsteinE, BernsteinJ, FeldmanJ, . An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Subst Abus. 2007;28:79–92.
33.
TannerTB, WilhelmSE, RossieKM, MetcalfMP. Web-based SBIRT skills training for health professional students and primary care providers. Subst Abus. 2012;33:316–320.
34.
StantonMR, AthertonWL, TorielloPJ, HodgsonJL. Implementation of a “learner-driven” curriculum: an screening, brief intervention, and referral to treatment (SBIRT) interdisciplinary primary care model. Subst Abus. 2012;33:312–315.
35.
SealeJP, ShellenbergerS, ClarkDC. Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum. BMC Med Educ. 2010;10:33.
36.
TetraultJM, GreenML, MartinoS, . Developing and implementing a multispecialty graduate medical education curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT). Subst Abus. 2012;33:168–181.
37.
RyanSA, MartelS, PantalonM, . Screening, brief intervention, and referral to treatment (SBIRT) for alcohol and other drug use among adolescents: evaluation of a pediatric residency curriculum. Subst Abus. 2012;33:251–260.
38.
BrayJH, KowalchukA, WatersV, AllenE, LaufmanL, ShillingEH. Baylor Pediatric SBIRT Medical Residency Training Program: model description and evaluation. Subst Abus. 2014;35:442–449.
39.
SchramP, HarrisSK, Van HookS, . Implementing adolescent screening, brief intervention, and referral to treatment (SBIRT) education in a pediatric residency curriculum. Subst Abus. 2015;36:332–338.
40.
WhittleAE, BuckelewSM, SatterfieldJM, LumPJ, O'SullivanP. Addressing adolescent substance use: teaching screening, brief intervention, and referral to treatment (SBIRT) and motivational interviewing (MI) to residents. Subst Abus. 2015;36:325–331.
41.
PringleJL, MelczakM, JohnjulioW, CampopianoM, GordonAJ, CostlowM. Pennsylvania SBIRT Medical and Residency Training: developing, implementing, and evaluating an evidenced-based program. Subst Abus. 2012;33:292–297.
42.
PuskarK, GothamHJ, TerhorstL, . Effects of screening, brief intervention, and referral to treatment (SBIRT) education and training on nursing students’ attitudes toward working with patients who use alcohol and drugs. Subst Abus. 2013;34:122–128.
43.
D'OnofrioG, PantalonMV, DegutisLC, . Brief intervention for hazardous and harmful drinkers in the emergency department. Ann Emerg Med. 2008;51:742–750 e742.
44.
PolydorouS, GundersonEW and LevinFR. Training physicians to treat substance use disorders. Curr Psychiatry Rep. 2008;10:399–404.
45.
MartinoS, HaeselerF, BelitskyR, PantalonM, FortinAH. Teaching brief motivational interviewing to year three medical students. BMCMed Educ. 2007;41:160–167.
46.
PringleJL, SealeJP, ShellenbergerS, . Development and Evaluation of Two Instruments for Assessing SBIRT Competency. Subst Abus. 2017;38(1):43–47.
47.
AndersonP, ClementS. The AAPPQ revisited: the measurement of general practitioners’ attitudes to alcohol problems. Addiction. 1987;82(7):753–759.
48.
WatsonH, MaclarenW, KerrS. Staff attitudes towards working with drug users: development of the Drug Problems Perceptions Questionnaire. Addiction. 2007;102:206–215.
49.
GlasgowRE, VogtTM, BolesSM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–1327.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
