Lanken Paul N, Novack Dennis H, Daetwyler Christof, Gallop Robert, Landis J Richard, Lapin Jennifer, Subramaniam Geetha A, Schindler Barbara A
Dr. Lanken is associate dean for professionalism and humanism and professor of medicine and medical ethics and health policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Novack is associate dean for medical education and professor of medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. Dr. Daetwyler is associate professor of family medicine and community and preventive medicine and developer of online resources for medical education, Drexel University College of Medicine, Philadelphia, Pennsylvania. Dr. Gallop is instructor in biostatistics, West Chester University, West Chester, Pennsylvania. Dr. Landis is professor and director, Division of Biostatistics, Department of Biostatistics and Epidemiology, and faculty director, Clinical Research Computing Unit, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Lapin is director of graduate medical education evaluation and research, Office of Evaluation and Assessment, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Subramaniam is team leader and medical officer, Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland. Dr. Schindler was vice dean for educational and academic affairs, Drexel University College of Medicine, at the time this study was conducted. She remains professor of psychiatry and pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Acad Med. 2015 Mar;90(3):345-54. doi: 10.1097/ACM.0000000000000506.
To examine whether an Internet-based learning module and small-group debriefing can improve medical trainees' attitudes and communication skills toward patients with substance use disorders (SUDs).
In 2011-2012, 129 internal and family medicine residents and 370 medical students at two medical schools participated in a cluster randomized controlled trial, which assessed the effect of adding a two-part intervention to the SUDs curricula. The intervention included a self-directed, media-rich Internet-based learning module and a small-group, faculty-led debriefing. Primary study outcomes were changes in self-assessed attitudes in the intervention group (I-group) compared with those in the control group (C-group) (i.e., a difference of differences). For residents, the authors used real-time, Web-based interviews of standardized patients to assess changes in communication skills. Statistical analyses, conducted separately for residents and students, included hierarchical linear modeling, adjusted for site, participant type, cluster, and individual scores at baseline.
The authors found no significant differences between the I- and C-groups in attitudes for residents or students at baseline. Compared with those in the C-group, residents, but not students, in the I-group had more positive attitudes toward treatment efficacy and self-efficacy at follow-up (P<.006). Likewise, compared with residents in the C-group, residents in the I-group received higher scores on screening and counseling skills during the standardized patient interview at follow-up (P=.0009).
This intervention produced improved attitudes and communication skills toward patients with SUDs among residents. Enhanced attitudes and skills may result in improved care for these patients.
探讨基于互联网的学习模块和小组汇报能否改善医学实习生对物质使用障碍（SUD）患者的态度及沟通技巧。
2011 - 2012年，两所医学院的129名内科和家庭医学住院医师以及370名医学生参与了一项整群随机对照试验，该试验评估了在SUD课程中增加两部分干预措施的效果。干预措施包括一个自主学习、内容丰富的基于互联网的学习模块以及一个由教师主导的小组汇报。主要研究结局是干预组（I组）与对照组（C组）自我评估态度的变化（即差异的差异）。对于住院医师，作者使用对标准化患者的实时网络访谈来评估沟通技巧的变化。分别对住院医师和学生进行的统计分析包括分层线性建模，并对地点、参与者类型、整群和基线时的个人分数进行了调整。
作者发现，基线时I组和C组在住院医师或学生的态度方面没有显著差异。与C组相比，I组的住院医师在随访时对治疗效果和自我效能感有更积极的态度（P <.006），而学生则没有。同样，与C组的住院医师相比，I组的住院医师在随访时对标准化患者的访谈中，筛查和咨询技巧得分更高（P =.0009）。
该干预措施改善了住院医师对SUD患者的态度和沟通技巧。态度和技能的提升可能会改善对这些患者的护理。
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