Resident Training:

The University of Washington has a large residency program in all specialties. In addition, there are numerous other residency programs in family medicine in Seattle and throughout the region. Residency training extends from three to 8 years, depending on the medical specialty. It is a time of intense learning experiences. Unfortunately, with rare exceptions, training in the screening for, and identification, of alcohol abusers has not been routine.

The behavior change methods we taught to residents for this project were distilled from motivational interviewing, a brief counseling style that avoids argument and applies behavior change strategies (Miller & Rollnick, 1991). These strategies are matched to patients’ stages of change readiness in Prochaska’s and DiClemente’s model (Prochaska, 1986). Skilled clinicians intervene according to the patient’s stage of change readiness rather than trying to get every patient they see to take immediate action. This principle also applies to trainers who must consider residents’ varying stages of readiness to screen their patients and intervene. These motivational interviewing techniques have been shown to be successful in decreasing problem drinking (e.g., Gentilello, 1999; Fleming, 1997).

Our training goals were to instill optimism in residents by using this readiness to change model, to teach them to ask standardized screening questions, and to apply behavior change techniques when necessary. During this training we showed residents outcome data from brief intervention studies and taught them screening and intervention skills using demonstration and role-play.

The curriculum of each residency program has regularly scheduled conferences. We asked residency coordinators for substance abuse training time with residents, and depending upon the amount of training time made available to us, we offered one of two training options:

A brief (20-min.) introduction to the concepts of screening and brief intervention. Handouts summarizing the brief intervention approach were distributed (see Appendices). A laminated card was given to residents to carry in their pockets. This card contained alcohol screening questions, guidelines for low-risk alcohol consumption, and condensed brief counseling protocols for patients abusing and dependent on alcohol. These cards included local phone numbers for appropriate local resources for patients needing specialized chemical dependence treatment.

Intensive (60-120 min.) skills training during which residents were presented with various case vignettes (or they were encouraged to present their own) which included alcohol abuse as a confounding factor of some medical condition. Residents discussed these cases, and these discussions were used as jumping-off points for demonstrating and practicing brief intervention skills. These residents were given the same handouts.

Immediately prior to receiving their training (Time 1), residents willing to comply with our request for data collection completed a questionnaire asking them to estimate the following:

• The prevalence of alcohol problems among patients in their current rotations

• The percentage of all their patients whom they had screened for alcohol problems in the past week

• The percentage of all their patients to whom they had provided brief interventions for alcohol problems in the past week

• Their confidence levels in their ability to screen for alcohol problems (on a scale from 1-10)

• Their confidence levels in their ability to provide brief counseling for patients with alcohol problems (on a scale from 1-10)