title: Education for the mind and the heart? Changing residents' attitudes about addressing unhealthy alcohol use.
abstract: Screening and brief intervention counseling for unhealthy alcohol use are among the top 10 recommended clinical preventive services for US adults. Although federally funded training programs in alcohol screening, brief intervention, and referral to treatment (SBIRT) have focused on increasing physicians' professional readiness to address drinking with their patients, programs typically focus on knowledge and skill acquisition, with less attention to attitudinal change. The purpose of this study was to assess the impact of a multicomponent SBIRT training program on changes in internal medical residents' professional readiness for working with patients with unhealthy alcohol use.
  
  
  
  Between 2011 and 2013, first-year internal medicine residents (n = 80) at a large academic medical center participated in a 16-hour SBIRT training program, consisting of two 3-hour didactic sessions, online modules, and a half-day clinical experience, during the Ambulatory Care month of the residency training year. Residents completed a modified Alcohol and Problems Perceptions Questionnaire (AAPPQ) at the beginning and end of the residency year to assess changes in professional readiness to work with adults with unhealthy alcohol use across 6 domains: Role Adequacy, Role Legitimacy, Role Support, Motivation, Task-Specific Self-esteem, and Satisfaction. Wilcoxon signed-rank tests were used to evaluate changes in the 6 AAPPQ subscale scores over time.
  
  
  
  Residents reported significant increases in Role Adequacy (alcohol-related knowledge/skills; pre: 34 and post: 39.5; P < .0001) and Role Support (professional support; pre: 16 and post: 18; P = .005) scores. No significant differences in the remaining AAPPQ subscales were detected.
  
  
  
  Residents in the SBIRT training program indicated improvements in knowledge, skills, and professional role support but not in motivation, task-specific self-esteem, or satisfaction for working with patients with unhealthy alcohol use. Explicit curricular attention to these domains may be required to facilitate SBIRT skills application and sustained practice change.
authors.affiliation: a Advanced Fellowship VA Interdisciplinary Addiction Program for Education and Research (VIPER), VA Pittsburgh Healthcare System , Department of Veterans Affairs , Pittsburgh , Pennsylvania , USA.|b Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mitchell
authors.affiliation: b Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|c VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|d Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.|e Center for Research on Healthcare, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Broyles
authors.affiliation: f Program Evaluation and Research Unit, University of Pittsburgh School of Pharmacy , Pittsburgh , Pennsylvania , USA.
authors.forename: Janice L
authors.initials: JL
authors.lastname: Pringle
authors.affiliation: d Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.|e Center for Research on Healthcare, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.affiliation: d Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Julie W
authors.initials: JW
authors.lastname: Childers
authors.affiliation: d Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
authors.forename: Raquel A
authors.initials: RA
authors.lastname: Buranosky
authors.affiliation: a Advanced Fellowship VA Interdisciplinary Addiction Program for Education and Research (VIPER), VA Pittsburgh Healthcare System , Department of Veterans Affairs , Pittsburgh , Pennsylvania , USA.|b Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|c VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.|d Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.|e Center for Research on Healthcare, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology* / Q000628:therapy; D004503:Education, Medical, Graduate; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D011614:Psychotherapy, Brief; D012017:Referral and Consultation; D055815:Young Adult
keywords: Attitude; counseling; education; internship and residency; professional role; screening; unhealthy alcohol use