Kidd Jeremy D, Smith Jennifer L, Hu Mei-Chen, Turrigiano Eva M, Bisaga Adam, Nunes Edward V, Levin Frances R
Department of Psychiatry, Columbia University, New York, NY, USA.
Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA.
Adv Med Educ Pract. 2020 Jun 30;11:455-461. doi: 10.2147/AMEP.S251391. eCollection 2020.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based framework for assessing and addressing risky substance use. This study evaluated the substance-related attitudes of medical students who participated in an Enhanced Pre-Clinical SBIRT Curriculum designed to reduce stigma, help students empathize with the experiences of people using alcohol and drugs, understand substance use in-context, and feel more optimistic about efforts to prevent and treat substance use disorders (SUDs).
Students (N=118; 73.8% of eligible) completed the Attitudes and Opinions Survey for alcohol and drugs before and after this 2-year, multi-modality curriculum. The authors classified attitudes as "positive" or "negative" and grouped students by pre-post attitudinal change: persistently negative, persistently positive, negative-to-positive, positive-to-negative. Using chi-square tests, the authors assessed differences by sex, race/ethnicity, and whether students had a family member or friend with an SUD.
Most students (>90%) reported persistently positive attitudes regarding physicians in recovery, societal contributions of patients with SUDs; ability to learn from such patients; and general attitudes toward SUD treatment. This skewed distribution precluded the investigation of subgroup differences. Fewer students reported persistently positive attitudes regarding SUD patients' healthcare utilization (alcohol 58.5%; drug 57.8%) and impact on other patients' care (alcohol 73.7%; drug 72.4%), compared to other attitudinal domains (at p-values < 0.0001 in the McNemar's tests). Approximately, 1 in 5 students reported more negative healthcare utilization attitudes on follow-up. There were no demographic differences in these two attitudinal domains.
Unlike previous studies of medical student attitudes, most students who participated in the Enhanced Pre-Clinical SBIRT Curriculum reported an enduring appreciation for the educational and societal contributions of patients with SUDs. Attitudes toward healthcare utilization and the impact of patients with SUDs on the care of other patients were more resistant to change, possibly due to the predominance of acute-care inpatient settings in clinical training.
筛查、简短干预及转介治疗（SBIRT）是一种基于证据的框架，用于评估和处理危险物质使用问题。本研究评估了参与强化临床前SBIRT课程的医学生与物质相关的态度。该课程旨在减少污名化，帮助学生同情使用酒精和毒品者的经历，理解实际情境中的物质使用情况，并对预防和治疗物质使用障碍（SUDs）的努力更具乐观态度。
学生（N = 118；占符合条件者73.8%）在这个为期两年的多模式课程前后完成了关于酒精和毒品的态度及意见调查。作者将态度分为“积极”或“消极”，并根据前后态度变化对学生进行分组：持续消极、持续积极、由负变正、由正变负。作者使用卡方检验评估了性别、种族/族裔以及学生是否有患有SUDs的家庭成员或朋友之间的差异。
大多数学生（>90%）报告对康复中的医生、SUDs患者对社会的贡献、向此类患者学习的能力以及对SUD治疗的总体态度持持续积极态度。这种偏态分布妨碍了对亚组差异的调查。与其他态度领域相比，较少学生报告对SUD患者的医疗保健利用（酒精58.5%；毒品57.8%）以及对其他患者护理影响（酒精73.7%；毒品72.4%）持持续积极态度（在麦克尼马尔检验中的p值<0.0001）。约五分之一的学生在随访时报告对医疗保健利用的态度更消极。在这两个态度领域没有人口统计学差异。
与之前关于医学生态度的研究不同，大多数参与强化临床前SBIRT课程的学生报告对SUDs患者的教育和社会贡献有着持久的赞赏。对医疗保健利用以及SUDs患者对其他患者护理影响的态度更难改变，这可能是由于临床培训中急性护理住院环境占主导地位所致。
