Public Release: 

Online intervention tool for physician trainees may improve care of substance users

New study points to solution for early identification and treatment of substance use disorders

University of Pennsylvania School of Medicine

Online learning interventions and small group debriefings can improve medical residents' attitudes and communication skills toward patients with substance use disorders, and may result in improved care for these patients, according to a new study from the Perelman School of Medicine at the University of Pennsylvania and Drexel University College of Medicine published online in Academic Medicine.

The study used a novel internet-based learning module designed to improve the communication skills of primary care physicians during screenings and brief counseling sessions with patients with substance use disorders. The study was co-led by Paul N. Lanken, MD, associate dean for Professionalism and Humanism and professor of Medicine and Medical Ethics and Health Policy at Penn, and Barbara A. Schindler, MD, vice dean emerita, Educational and Academic Affairs, and professor of Psychiatry at Drexel.

"The study findings with residents are promising because we saw that a relatively brief intervention yielded big changes in their attitudes and communication skills," said Lanken. "Based on these results, we would expect improved medical care of patients with substance use disorders, but further studies are needed to look at practice-based and patient-centered outcomes in connection with this type of educational intervention."

Substance use disorders have led to an epidemic of morbidity and mortality, and more than an estimated 100,000 deaths and $400 billion in health and social costs per year in the United States have been directly attributed to the use of drugs and alcohol, according to the study. While health care providers are adequately prepared to diagnose and treat the medical consequences of substance use disorders, they are far less likely to screen for and treat the disorders themselves. However, this study asserts that primary care physicians can play a key role in both prevention and intervention.

Previous studies of educational interventions have shown improvement in screening and counseling patients with substance use disorders, however, these approaches haven't been widely adopted, likely due to time constraints of current curricula. The authors suggest that internet-based learning has the potential to reach large numbers of learners with both fewer logistical barriers than other educational formats and comparable or superior effectiveness and efficiency.

The two-part intervention in this study consisted of a self-directed, media-rich online learning module, followed by a small group, faculty-led debriefing. The study group consisted of 129 internal and family medicine residents and 370 medical students at two medical schools (Penn and Drexel) during the 2011-2012 school year. Through a cluster randomized controlled trial design, comparing the intervention group with a control group, the study found that residents showed increased confidence in their ability to screen and identify a substance use disorder, a more positive attitude towards their abilities and improved communication skills. However, among the medical students, there were no significant differences between the intervention and control groups, both of which improved over baseline.

"The difference in findings among students and residents is important to note," said Schindler. "The results emphasize that educators need to take into account a trainee's stage of professional development and competence when considering how and when to introduce new educational material."


The study's other authors included Penn's Richard Landis, PhD, and Jennifer Lapin, PhD, and Drexel's Dennis H. Novack, MD, and Christof Daetwyler, MD. The study was funded by the National Institutes of Health's National Institute on Drug Abuse (HHSN271200900021C).

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.

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