Absence of conflict of interest.
Citation
Highlights
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The study examined the impact of an online patient simulation (OPS) for screening, brief intervention, and referral to treatment (SBIRT) on nursing and social work college students’ attitudes, knowledge, and perceived skills.
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The study was a randomized control trial that compared the outcomes of students who received treatment as usual plus OPS to those that received treatment as usual using self-reported survey data.
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The study did not find any statistically significant effects of OPS on student scores on the SBIRT Attitudes, Self-Perception of Skills, and Knowledge survey (AKS).
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The quality of causal evidence presented in this report is low because the authors did not provide information on baseline equivalence for the participants or attrition rates for the analytic sample. This means we are not confident that the estimated effects are attributable to OPS; other factors are likely to have contributed.
Intervention Examined
Online Patient Simulation (OPS)
Features of the Intervention
Frontline healthcare professionals and social workers often do not receive adequate training in substance use prevention and treatment, particularly in evidenced-based interventions. Such training deficits can lead to negative biological and psychological effects for individuals as well as negative effects within the educational system, the justice system, the workplace and the economy. Efforts have been made to integrate screening, brief intervention, and referral to treatment (SBIRT), an evidence-based practice recommended by the U.S. Prevention Services Task Force, into healthcare training programs through in-person didactic instruction, but have fallen short.
Online patient simulation (OPS) helps healthcare and social work students develop and practice SBIRT skills using patient simulations on a virtual reality platform. The platform gives real time feedback on the clinical interactions in the simulation. OPS is provided as a self-paced, online training component that lasts about 20 minutes. OPS is intended to be an addition to in-person training on SBIRT.
Features of the Study
The study was a randomized control trial with 308 social work and nursing students at one northeastern college in the U.S. that received a Substance Abuse and Mental Health Services Administration (SAMHSA) SBIRT Health Professions training grant. Students were randomly assigned to treatment as usual (TAU) or the treatment of TAU plus access to OPS. Treatment as usual consisted of 40 minutes of introductory pre-training videos and 1.5 hours of in-person instruction and role-plays on SBIRT. Participants were predominately female (85%) and white (77%) social work and nursing students, with an average age of 26. The authors compared the outcomes of TAU and intervention students (OPS) using self-reported survey data collected in person and online through the SBIRT Attitudes, Self-Perception of Skills, and Knowledge Survey (AKS). TAU and OPS students were compared on composite AKS scores and along the sub-domains of confidence, importance, and attitudes at pre-training, post-training, and 30 days post-training.
Findings
Attitudes
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The study found no statistically significant differences between OPS and TAU groups on composite AKS scores or sub-domain (confidence, importance, and attitudes) scores from pre-training to post-training, from pre-training to 30 days post-training, or from post-training to 30 days post-training.
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However, the study suggested those who received OPS showed improved composite AKS scores at each stage: pre to post-training, pre-training to 30 days post-training and post-training to 30 days post-training.
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The study also suggested there was improvement among those who received OPS within each subdomain between pre-training and post-training and between each domain except for confidence between post-training and 30 days post-training.
Considerations for Interpreting the Findings
The authors did not account for preexisting differences between the groups before program participation or include sufficient control variables. These preexisting differences between the groups—and not OPS—could explain the observed differences in outcomes. The authors also did not provide enough information about the statistical models to fully understand their results. Therefore, the study is not eligible for a high causal evidence rating, the highest rating available for experimental designs.
The authors note that there was limited intervention uptake: the majority of intervention students (80%) who had access to OPS did not end up utilizing it, and only 56% of those who used it did so more than once. This practice may have contributed to the lack of statistically significant findings. The authors also note that the lack of findings could also be due to a strong treatment as usual condition, making the OPS intervention ineffective on the skills of students on its own. Further, the study sample was limited to participants from one college, and therefore the results may not be generalizable.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to OPS; other factors are likely to have contributed.