Academic journal article Journal of Alcohol & Drug Education

Designing Standardized Patient Assessments to Measure SBIRT Skills for Residents: A Literature Review and Case Study

Academic journal article Journal of Alcohol & Drug Education

Designing Standardized Patient Assessments to Measure SBIRT Skills for Residents: A Literature Review and Case Study

Article excerpt


Objectives: Resident physicians report insufficient experience caring for patients with substance use disorders (SUDs). Resident training in Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been recommended. We describe the development of a standardized patient (SP) assessment to measure SBIRT skills, resident perceptions of the exercise, and confidence in SBIRT skills.

Methods: Fifteen Internal Medicine residents participated in the pre-curriculum SP assessment and 12 participated in the post-curriculum assessment.

Results: Residents reported that SP encounters were similar to patients seen, and resident satisfaction was high. Residents felt confident screening for alcohol abuse, but less confident developing SUD treatment plans.

Conclusion: An SP assessment can evaluate SBIRT skills and is well received. Residents may need additional practice to improve confidence in making SUD treatment plans.

Key words: SBIRT, graduate medical education, standardized patients, substance use disorders


While substance use disorders (SUDs) and other forms of problematic substance use (e.g., illicit drug use, misuse of prescription drugs, and hazardous drinking) pose critical public health problems, many patients do not seek treatment and remain unidentified even while receiving medical care (Madras et al., 2009). Awareness of this gap led to the development of techniques to promote clinical attention in general medical settings to substance use. In recent years, empirical research and policy leaders in the SUD treatment field have encouraged the use of Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a public health approach to improving patient care. SBIRT is a "comprehensive and integrated approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders and those at risk" (Babor et al., 2007, p. 8). The U.S. Preventive Services Task Force has established the efficacy of screening and counseling for alcohol use disorders and recommends universal, annual screening for all adults (United States Preventive Services Task Force, 2004). SBIRT yields short-term improvements in rates of drug use and hazardous drinking, although researchers have not yet demonstrated long-term effects in controlled trials (Babor et al., 2007).

In spite of the evidence for SBIRT efficacy, physicians-in-training (resident physicians) may be reluctant to adopt SBIRT due to insufficient training in screening and treatment procedures (Stimmel, Cohen, Colliver, & Swarz, 2002). To address these barriers, core SUD competencies have been proposed for all primary care resident physicians (Jackson, Alford, Dube, & Saitz, 2010; Office of National Drug Control Policy, 2004), and a number of institutions have increased substance use training for medical students and/or residents (Chossis et al., 2007; Parish, Ramaswamy, Stein, Kachur, & Arnsten, 2006; Kokotailo, Langhough, Neary, Matson, & Flemming, 1995; Wilk & Jensen, 2002). Instruction in SBIRT has been suggested as a standard feature of residency training programs (O'Connor, Nyquist, & McLellan, 2011). However, challenges remain regarding how to best evaluate the efficacy of SBIRT curricula and the competency of trainees in SBIRT skills.

There are several potential options to consider when assessing residents' competency in conducting SBIRT (Jackson et al., 2010; O'Connor et al., 2011). One possibility is direct observation, using tools such as the "mini-clinical evaluation exercise" (mini-CEX) in which an attending physician observes a resident for a period of 10-20 minutes and provides feedback on history taking, physical examination and patient interaction skills (Norcini, Blank, Duffy, & Fortna, 2003). However, direct observation is patient-dependent and for any given clinical encounter, the opportunity to evaluate SBIRT skills may be limited. …

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