With support from NIAAA (#4R44AA016724-02) we are developing an online curriculum to educate and further clinical skill development in Year 2 to 4 medical students on at risk drinking and alcohol disorders. Through a convenience sampling approach, fifteen medical school faculty took an on-line survey to obtain preference information regarding case-based instruction. Almost all of the faculty (n=14) preferred multiple short cases to cover one topic, rather than one long case in a module. In a course with both didactic and case information, half of the faculty (n=7) preferred three cases per one hour course. When presenting the case to students, 66.7% (n=10) preferred that information be general. To enhance clinical skill development, we queried respondents as to their preferences for using a remote live Standardized Patient (SP) interview within the learning experience. Fourteen out of fifteen (93%) felt that an online SP experience would be an interesting way to teach skills and 87% (13/15) would be willing to use the online SP with their students. Faculty preferred that students receive basic patient case information online through the website (80%; 12/15) and an Internet chat (i.e. Google or Skype) was rated high for conversing with the live SP. We queried about potential topics. Respondents showed a clear interest in supplementing their teachings with materials on assessment and screening (80%, n=12), providing brief interventions (87%, n=13), common co-morbidities of alcohol use disorders (80%, n=12), and referring patients for treatment (87%, n=13). Based on their experience with medical students, the respondents felt that medical students would be interested in learning more about the biology behind addiction (80%, n=12), co-morbid diseases associated with long-term alcohol use (67%, n=10), and recognizing abuse in health case professions (80%, n=12). Support for the planned curriculum including the method of providing online learning was high.

Through a convenience sampling approach, we performed 5 detailed needs analysis interviews of PCPs. We also asked interviewees about typical primary care practice to better understand current behavior so that interactive educational materials would be realistic. With respect to typical primary care practice, we found that most of the PCPs screen for current substance abuse, but over half do not screen for past substance abuse. Most participants only ask about substance abuse during the patient interview if the medical history screening question(s) were positive or if there is another red flag. The fact that followup questioning only happens in these situations underscores the need for the medical history questions to be sensitive and evidence-based. Interviewees reviewed the early plans for the website to see if it met their needs and to identify further needs. Interviewees described a strong interest in information on: 1) reimbursement, 2) how to handle resistance from patients, especially when alcohol is the substance, 3) brief intervention, and 4) referral resources. They also noted a lack of a protocol for updating screening info for patients in ongoing care. The planned curriculum is a core course on each of the following: screening, brief intervention, and referral to treatment plus an advanced course addressing variations in patients or settings. The planned educational approach is live, standardized patient interviews via online chat. Support among the interviewees for the planned curriculum including the method of providing online learning was high. All participants said they were likely or very likely to take a course on SBIRT. The need for a curriculum including evidenced-based recommendations and skills training in SBIRT is clear.