MS Alcohol Framework

From Clinicaltools.com

(last update 03/31/09)

Key Details

Title: Medical Student Education on Alcohol Abuse and Dependence
Federal Funding: NIAAA 4R44AA016724-02
Federal Funding Program Officer: Deidra Roach, MD
Federal Funding Grants Management Specialist: Deborah A. Hendry
State Funding: One North Carolina Small Business Match Grant FY 2007-2008 #2091929
Principal Investigator: T Bradley Tanner, MD
Co-Investigator: Mary P. Metcalf, PhD, MPH, CHES
Project Director: Susan Wilhelm, PhD
Research Assistant: Kimberly Workman, BA
Start: 09/30/07 End: 03/31/10
Product: MedStudentLearning.com Website
Project Links: Project Guide
Curriculum Plan

Framework

Need

(draft problem) Patients presenting with physical ailments many times are not having their substance use history included in the diagnosis, resulting in ineffective treatment strategies for those patients who, in fact, do have substance use issues.

(draft problem solution) The more skills a doctor possesses in the management of patients with alcohol issues, the more likely they will include it as a part of their overall treatment strategy for their patient.

Medical students lack sufficient clinical skills training in assessing alcohol misuse, which can lead to undertreatment of alcohol misuse, worsening of prior addictive disease, and a social and public health ramifications of patient alcohol misuse.

Vision

Future physicians will assess patients who misuse alcohol with a clear plan and approach to diagnose and treat alcohol misuse while placing the patient and public at minimum risk to the misuse potential of alcohol.

Mission

To create a successful online skills training experience for medical students that provides the clinical skills they need to properly assess, diagnose, and treat patients who misuse alcohol with an awareness of the risks of repeated alcohol misuse to the patient and others.

To combine remote standardized patient interviews with case studies and interactive learning to teach screening and assessment for alcohol misuse and proper treatment decision making to help patients who misuse alcohol.

Target Audience

Primary: Medical Students in years 1-4

Secondary: Medical school administrators (faculty, course directors, clerkship directors, medical curriculum boards, etc)

Goal

The medical student will be able to effectively manage patients who have substance use issues in their history.

Objectives

Develop and implement a Web-based curriculum to provide students with the knowledge and clinical skills necessary to treat alcohol use disorder patients
Test the students' knowledge, attitudes, and self-efficacy through pre/post test study design
Test the students' clinical skills through use of standardized patients

Innovations

The potential for using remote standardized patients for teaching skills is novel.
Internet-based team-based learning by role-playing different aspects of the SP experience (patient, physician, observer) is novel.

SWOT Analysis

Strengths

We have a good consultant group
Medical students are able to, and receptive of, web-based education
We have done a lot with alcohol and can learn from past work
We have demonstrated past success in web-based education
We have experience in conducting live, remote standardized patient interviews

Weaknesses (Constraints)

Phase II funding - 2 years, $750,000
Be efficient with our time, meaning sticking true to our specific aims but yet trying to enhance our product if possible
Recruiting medical schools early in the development process
Scalability of SP approach

Opportunity

Medical schools are open to novel solutions
There is a move in medical education toward clinical skills training and assessment
An online solution offers an efficient way to utilize the benefit of Sps.

Threats

Implementation

Phase II

Phase II (04/01/08 - 03/31/10) work includes the following specific aims and milestones:

Specific Aim 1 - Develop the Remaining Content Modules.

Milestone 1: Develop remaining educational content and features for modules 2 through 6.
Milestone 2: Gather and incorporate feedback from project consultants.

Specific Aim 2 - Complete Summative Evaluation of Product

Milestone 1: Design evaluation.
Milestone 2: Recruit 80 medical students in their second through fourth years of study.
Milestone 3: Perform summative evaluation.
Milestone 4: Analyze data.

Specific Aim 3 - Phase II Product Dissemination.

Milestone 1: Submission of at least one article to a peer-reviewed appropriate publication.
Milestone 2: Presentation of results to two or more appropriate scientific meetings and at the NIH's annual SBIR showcase.
Milestone 3: Contact leading medical and substance abuse organizations.

Progress Reports

Time Line

Phase II project period is 4/1/08 through 3/31/10. We will most likely ask for a NCE so that the summative evaluation can occur throughout one medical school calendar year (Aug-May).

Phase II, Specific Aim 1: Develop remaining modules

The goal is to finish Aim 1 by spring 2009.

Evaluation

Phase I

Focus Group

Thirteen (n=13) medical school faculty who are experts in the field of substance abuse participated in our survey. Focus group experts were recruited from the 2007 Association for Medical Education and Research in Substance Abuse (AMERSA) conference attendee list. We chose this conference for recruitment because these members are experts in the field of substance abuse, and many are also faculty at medical schools, which is a target audience of the project. We also invited our project consultants to participate in our survey.

We developed an extensive on-line survey that served three main purposes: 1) determine faculty interest in and need for additional on-line materials focused on alcohol use disorders, 2) determine what interactive and evaluation features are most desired by faculty, and 3) determine what subtopics are most important for medical students to learn when dealing with patients with or at risk for alcohol use disorders. Focus group experts who agreed to partake in our survey were directed to a link on our website to fill out the survey. Experts were compensated for their time (estimated time 45 minutes to one hour to complete the survey).

Focus group participants provided great detail and guidance into the design of our medical student curriculum. Participants reiterated our hypothesis that more medical student education is needed on the topic of alcohol abuse and dependence, and highlighted specific areas that we could focus on.

Pilot Study Thirty two medical students in years 2-4 of training participated in the pilot study of our module “The Scope of the Problem: Alcohol Abuse and Dependence”. As expected, knowledge scores on a 14 question test significantly increased pre/post test. Knowledge scores also significantly increased on a one week follow-up exam from post-test measures. Attitudes, self-efficacy in treating patients with alcohol use disorders, and intended behavior all showed modest increases pre/post test. Satisfaction with the module and website were high, and participants felt that the module learning objectives were achieved. Satisfaction with the website and overall learning experience was high. Study participants felt that all of the module objectives were met.

Findings

Phase I

There remains a need for our product based on faculty feedback. Students were able to learn from the module, and satisfaction with the module was high.

Commercialization

We will work with medical schools to add the modules to their curriculum. We have already developed relationships with 13 medical schools via other Clinical Tools' products and feel confident that we can create a product that will be purchased by medical schools and individual students. Three of our consultants are also directly involved in medical school curriculum review, and will guide the direction and marketing of the product.

Submitted Abstracts

Metcalf MP, Tanner TB, Wilhelm S, Buchanan A. Use of a Remote Standardized Patient to Teach Clinical Skills to Undergraduate Medical Students. Poster Accepted to the AMIA 2009 Spring Congress. May 2009. Orlando, FL.