MacLeod Jana B A, Hungerford Daniel W, Dunn Chris, Hartzler Bryan
Department of Surgery, Emory University, School of Medicine, Atlanta, GA 30303, USA.
J Am Coll Surg. 2008 Nov;207(5):639-45. doi: 10.1016/j.jamcollsurg.2008.06.327.
Because nearly half of injured patients admitted to trauma centers misuse alcohol, the American College of Surgeons has required that Level I trauma centers have a mechanism for providing brief bedside counseling interventions (BI) to patients with alcohol problems. We hypothesized that with minimal training, surgical interns could become proficient at performing BI.
First-year surgical interns were trained in an 8-hour BI workshop. A group of first-year medicine interns who were not trained in BI served as the comparison group. BI skills of both groups were assessed before and 5 weeks after this training using simulated interviews with standardized patient actors trained to depict a scenario of a challenging patient with an alcohol problem. Audiotapes of those interviews were rated by trained, blinded coders.
Before the training, both groups demonstrated similar BI skill levels. Compared with the control group, after training, the surgical interns showed marked improvements in BI skills, including more frequently giving patients feedback on their blood alcohol concentration results (p=0.000), providing guidelines for low-risk drinking (p=0.000), offering patients more than 1 change option (p=0.000), asking permission to discuss drinking (p=0.003), and offering patients hope and encouragement (p=0.003).
After training, surgery interns effectively demonstrated BI skills when challenged to do so in a standardized patient actor scenario. This model of intern screening and brief intervention training constitutes a viable alternative for trauma centers as they look for options to meet the American College of Surgeons' new requirement to provide BI for trauma patients with alcohol problems. Future research should further evaluate surgical interns' ability to routinely implement these skills in their daily clinical environments.
由于近一半入住创伤中心的受伤患者存在酒精滥用问题，美国外科医师学会要求一级创伤中心具备为有酒精问题的患者提供简短床边咨询干预（BI）的机制。我们假设，经过最少的培训，外科实习医生就能熟练进行BI。
一年级外科实习医生参加了一个8小时的BI工作坊培训。一组未接受BI培训的一年级内科实习医生作为对照组。在培训前和培训5周后，通过与经过标准化培训以模拟有酒精问题的具有挑战性患者场景的患者演员进行模拟访谈，评估两组的BI技能。这些访谈的录音由经过培训的盲法编码员进行评分。
培训前，两组的BI技能水平相似。与对照组相比，培训后，外科实习医生在BI技能方面有显著提高，包括更频繁地向患者反馈其血液酒精浓度结果（p = 0.000）、提供低风险饮酒指南（p = 0.000）、为患者提供不止一种改变选择（p = 0.000）、请求允许讨论饮酒问题（p = 0.003）以及给予患者希望和鼓励（p = 0.003）。
培训后，外科实习医生在标准化患者演员场景中接受挑战时能有效展示BI技能。这种实习医生筛选和简短干预培训模式是创伤中心的一种可行选择，因为它们正在寻找满足美国外科医师学会为有酒精问题的创伤患者提供BI这一新要求的方法。未来的研究应进一步评估外科实习医生在日常临床环境中常规应用这些技能的能力。
