USE OF A REMOTE, LIVE STANDARDIZED PATIENT TO ASSESS MASTERY OF CLINICAL SKILLS ON ALCOHOL ABUSE AND DEPENDENCE Susan Wilhelm, PhD, T Bradley Tanner, MD, and Mary P Metcalf, PhD, MPH Clinical Tools Inc, Chapel Hill, NC, USA Introduction: With funding from a NIH/NIAAA grant (#1R44AA016724– 01A1), we created an online medical student curriculum on alcohol abuse. To assess mastery of clinical concepts, we developed a novel method of conducting remote live standardized patient (SP) interviews using Google® chat, with a trained staff member as the SP. In advance of a summative evaluation in 2010, we conducted a pilot test to assess the utility of the case and gather student feedback. Methods: We developed a standardized patient case, Cynthia Stewart, who presents with insomnia and is diagnosed with alcohol abuse. Five third-year students interviewed Cynthia during a 45-minute Google® chat experience. Students completed eight online courses, then performed a second SP interview. Clinical skill competency was measured using a 13-item done/not done checklist completed by both the SP and an independent reviewer. Interpersonal skills were evaluated by the SP using a 9-item checklist and a 5- point Likert scale. Student self-assessment, assessment of the SP by the student, and patient notes were also collected. Results: Clinical skill competency rose modestly from pre-test (64%) to post-test (77%). Interpersonal skills rose modestly from pre-test (2.65) to post-test (3.22). Although sample size (n
5) was too small for determination of statistical significance, the results are encouraging for future studies. Student self-assessment of interpersonal skills were much higher (4.03 pre and 4.11 post) than those assessed by the SP. A majority of students (80%) rated the SP performance as very good or excellent. All students correctly identified alcohol abuse as a possible differential diagnosis on patient notes. We obtained usability feedback about the standardized patient post-experience. Eighty percent (4/5) agreed or strongly agreed that the interviewing process was a valuable learning experience, that the SP interviews were consistent pre/post experience, and that the patient case was typical of a real patient. All students (n
5) agreed or strongly agreed that the SP interview via Google® chat was an interesting way to practice clinical skills. Students provided open-ended feedback on ways to increase the difficulty of the SP case. Conclusions: Students were able to improve clinical skills through a chat-based SP interview. Improvements in advance of a more thorough evaluation with a larger n include refinements to the patient case and assessments and creation of a second SP case to increase variability pre/post experience.

Assessing the Impact on Medical Students of an Online Curriculum on Opioid Dependence and Treatment

Mary P. Metcalf, PhD, MPH; T. Bradley Tanner, MD; Susan Wilhelm, PhD

Clinical Tools, Inc. 1506 E. Franklin St, #200, Chapel Hill, NC

Objectives: To develop and assess the impact of an online supplemental curriculum for medical students on various medical knowledge/competency, attitude, and performance measures.

Background: Treatment with buprenorphine is effective and can be conducted in a variety of settings by primary care providers. However, a number of biases exist towards treatment of opioid dependence in primary care. Medical school is an opportune time to addresses -and hopefully decrease – these biases with future physicians.

Methods: An online curriculum of 5 modules for medical students was created, focusing on basic skills of opioid abuse detection and treatment. A convenience sample of 24 volunteer medical students (n=24) at different institutions in years 2-4 completed a OSCE style interview of an SP via chat, completed the educational program, and then re-interviewed the SP. Measures assessed impact on medical knowledge, competency, attitude, and self-efficacy/intended behavior. Clinical skills were assessed using a Communication/Interpersonal Skills rating form and a Clinical Encounter Performance Checklist completed by the SP and an observer.

Results: Medical knowledge/competency increased from a pre-experience average of 68% to an post-test average of 83% ( p<0.05). Average self-efficacy scores increased (p<0.05) and Clinical Encounter Performance Checklist score increased for 84% of participants (p<0.05). Two-thirds of students improved Interpersonal Skills/Communication checklist scores, although the improvement was not statistically significant for this measure. Additional analysis are in process.

Conclusion: Medical student knowledge, competency, self-efficacy and performance were shown to be improved by the educational intervention. Attitude towards treatment of opioid dependence and interpersonal skills related to clinical encounters with possibly substance abusing patients did not show the improvement we had hoped. The intervention is being modified to address these issues more directly.

Background: Using NIH/NIDA SBIR funds, we are developing a Web-based curriculum for medical students to improve competence and clinical skills performance on treating pain patients with opioids and minimizing risk of opioid misuse.

Objective: To obtain faculty feedback regarding the ability of the proposed curriculum to fill practice gaps and impact clinical skill through practice via chat-based, online standardized patient interviews.

Methods: Through consultants and the AMERSA member list, we recruited preclinical and clinical faculty who teach students about pain or addiction topics. Faculty completed an on-line survey, consisting of structured and open-ended questions about the preliminary curriculum, and a short follow-up phone interview.

Results: Nine faculty (n=9) from seven medical schools participated. They identified topics that are well covered or not fully covered in medical curricula. Faculty provided constructive feedback to improve learning objectives and align topics with curriculum gaps. Suggestions included: 1) simplifying material on patient monitoring and risk reduction, 2) stressing proper screening to assess risk of misuse or diversion before prescribing opioids, and 3) focusing on adequately treating pain while minimizing the risk of potential opioid misuse. Faculty reported that students were under-prepared in most of the topics proposed. Most faculty (89%) agreed or strongly agreed that each proposed course would strengthen clinical skills. A majority (67%) felt that a SP interview in each course would enhance mastery of clinical skills, and 78% agreed or strongly agreed that a chat-based standardized patient interview would be beneficial to student learning.

Conclusions: Faculty needs analysis affirmed that curriculum and performance gaps exist on adequately treating pain patients with opioids. Constructive feedback allowed us to revise our curriculum plan and more closely align each module with ACGME and medical student competencies. Our revised curriculum plan will be re-reviewed by faculty before module development. Preliminary findings lend support to future acceptance of our finalized program.

In April 2010, Apple released the iPad; a tablet/slate computer (a flat, touchscreen computer that one can hold in one's hand) for general use. As of Sept 25th, they have sold about 7.5 million iPads and the concept of a "slate" version of a tablet computer has taken off. Competition is ramping up in the form of the HP Slate, Acer, Asus Eee Pad [Windows 7], Dell Streak, NookColor, HTC, Samsung Galaxy [Android], and RIM Playbook [Blackberry]. Just as affordable and powerful computers now exist in a phone form, computers will soon be popular in a tablet format.

The tablet computer (especially in its slate version) is likely to first succeed in medical education as a replacement for paper textbooks. E-book textbooks can become lightweight, portable, indexed, searchable, hypertext learning environments. Schools will migrate from paper textbooks to e-books and use tablet computers as e-book readers [just as Kindle is replacing the standard book]. Potentially, in a few years, all students would have access to a tablet computer. How else can medical educators take advantage of this new technology?

This workshop offers attendees a chance to first get up to speed on this rapidly developing technology. Once the group has a common understanding, the group can identify and share ideas and ways this technology can enhance medical education beyond the simple e-book reader potential. Specific solutions will be sought for training in basic sciences, pre-clerkship training in clinical care [including the full range of competencies], clerkship training, and internship/residency.

The workshop will brainstorm ideas, define potential benefit and challenges for each, and identify possible implementation steps. Post-workshop, attendees can investigate the new technology, share ideas and experiences, and build solutions that can be shared broadly and are implemented widely.

ABSTRACT The authors have developed and assessed 2 innovative, case-based, interactive training programs on substance abuse, one for health professional students on alcohol and one for primary care providers on screening, brief intervention, and referral to treatment (SBIRT). Both programs build skills in substance abuse SBIRT. Real-world effectiveness trials involving medical students (n = 10) and nursing students (n = 60) were completed; trials involving primary care providers (n = 65) are in progress during 2011. Medical students and nursing students had similarly low baseline scores on assessments that benefited from training: knowledge, confidence, and clinical performance measured via an online standardized patient case and encounter note all improved post-training. Preliminary results indicate that practicing providers improved on knowledge, attitude, and brief intervention skill performance after a similar training. Results suggest that SBIRT skills can be improved with this model for case-based interactive training programs, and thus, that this training has the potential to impact patient outcomes.

1. Objectives:
   1. The presenters will discuss the development of an Internet based educational program designed to teach medical students about alcohol use disorders.
   2. The presenters will discuss the research methods and results of a pilot study with medical students to measure the effectiveness of a prototype module.
   3. The presenters will discuss the implications of the research results as they relate to medical student education.
2. Content (Topics):
   1. Research hypotheses and aims (Obj 1)
   2. Development of curriculum plan and prototype module (Obj 1)
   3. Research methods and results of effectiveness pilot study with the target audience (Obj 2)
   4. Implementation of research results (Obj 3)
3. Teaching Strategies:
   We will employ both didactic and case based learning approaches to educate medical students about alcohol use disorders. The outcome measures will assess learning and will emphasize clinical experience.
   

1. Objectives:
   1. The presenters will discuss the development of a curriculum plan for an Internet based educational program designed to teach medical students about alcohol use disorders.
   2. The presenters will provide needs analysis data and conclusions as supported by an asynchronous focus group of medical school faculty with substance abuse expertise.
2. Content (Topics):
   1. Research hypotheses and aims (Obj 1)
   2. Research methods with asynchronous faculty focus group (Obj 2)
   3. Research results of asynchronous faculty focus group (Obj 2)
   4. Implementation of research results into final curriculum plan (Obj 2)
3. Teaching Strategies:
   We will employ both didactic and case based learning approaches to educate medical students about alcohol use disorders. The outcome measures will assess learning and will emphasize clinical experience.