title: Efficacy of an internet-based learning module and small-group debriefing on trainees' attitudes and communication skills toward patients with substance use disorders: results of a cluster randomized controlled trial.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Lanken
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Novack
authors.forename: Christof
authors.initials: C
authors.lastname: Daetwyler
authors.forename: Robert
authors.initials: R
authors.lastname: Gallop
authors.forename: J Richard
authors.initials: JR
authors.lastname: Landis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lapin
authors.forename: Geetha A
authors.initials: GA
authors.lastname: Subramaniam
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Schindler
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D016000:Cluster Analysis; D003142:Communication; D003194:Computer-Assisted Instruction; D003479:Curriculum; D020375:Education, Distance; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D020377:Self Efficacy; D012647:Self-Assessment; D019966:Substance-Related Disorders / Q000628:therapy*