Virtual Reality Skills Training for Health Care Professionals in Alcohol Screening and Brief Intervention

Michael Fleming; Dale Olsen; Hilary Stathes; Laura Boteler; Paul Grossberg; Judie Pfeifer; Stephanie Schiro; Jane Banning; Susan Skochelak

doi:10.3122/jabfm.2009.04.080208

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Figure 1.
The basic computer screen for the simulation.

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Table 1.

Scores for the Screening Scenario Skills

SIMmersion Items	Control		Experimental		t Statistic	P
SIMmersion Items	Pretest (mean [SD])	Posttest (mean [SD])	Pretest (mean [SD])	Posttest (mean [SD])	t Statistic	P
Alcohol use
Clinician asked about drinking frequency	4.12 (1.93)	4.17 (1.88)	3.92 (2.08)	5.00 (0.00)	2.900	.005
Clinician asked about drinking amount	4.90 (0.70)	3.75 (2.19)	4.80 (0.98)	4.77 (1.07)	2.770	.007
Clinician asked about 5 drinks in a row	0.98 (2.00)	0.73 (1.78)	0.49 (1.50)	3.14 (2.45)	5.410	<.001
Family history
Clinician asked about drinking in the family	3.73 (2.20)	4.17 (1.88)	3.92 (2.08)	4.19 (1.87)	0.050	.961
Consequences
Clinician asked about legal problem due to alcohol	2.06 (2.49)	3.02 (2.47)	1.67 (2.38)	3.72 (2.21)	1.420	.160
Clinician asked about alcohol-related injury	0.39 (1.36)	1.35 (2.25)	0.69 (1.74)	2.79 (2.51)	2.880	.005
Clinician asked about alcohol-related work problems	3.53 (2.30)	2.81 (2.51)	3.53 (2.30)	3.37 (2.37)	1.090	.278
Clinician asked about alcohol-related relationship problems	3.53 (2.30)	4.38 (1.67)	3.14 (2.44)	4.53 (1.47)	0.480	.631
Clinician asked about alcohol treatment history	2.45 (2.52)	2.60 (2.52)	2.84 (2.50)	2.56 (2.53)	0.090	.931
Health issues
Clinician asked about alcohol-related medical problems	1.08 (2.08)	1.56 (2.34)	1.08 (2.08)	1.16 (2.14)	0.850	.399
Clinician asked about medication	3.33 (2.38)	3.96 (2.05)	3.53 (2.30)	3.37 (2.37)	1.260	.209
CAGE questions
Clinician asked about attempts to reduce drinking	2.94 (2.49)	2.60 (2.52)	2.45 (2.52)	3.60 (2.27)	1.980	.051
Clinician asked about being annoyed when confronted about drinking	1.67 (2.38)	2.40 (2.52)	1.96 (2.47)	2.33 (2.52)	0.130	.895
Clinician asked about drinking in the morning	2.35 (2.52)	2.29 (2.52)	1.76 (2.41)	3.02 (2.47)	1.400	.166
Communication skills
Clinician gives reason for alcohol questions	4.41 (1.63)	4.17 (1.88)	4.22 (1.84)	4.07 (1.97)	0.240	.811
Clinician was not sidetracked	4.12 (1.93)	4.90 (0.72)	4.12 (1.93)	5.00 (0.00)	0.950	.347
Clinician was nonjudgmental	4.41 (1.63)	4.38 (1.67)	4.51 (1.50)	4.53 (1.47)	0.480	.631
Overall clinician performance	4.41 (4.08)	4.90 (2.63)	4.61 (3.98)	6.51 (3.37)	2.560	.012

The 17 clinical skills received a score of 5 points if the learner successfully demonstrated skill. The remaining 15 points were based on the learners “overall clinical performance.”

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Table 2.

Scores for the Brief Intervention Scenario Skills

SIMmersion Items	Control		Experimental		t Statistic	P
SIMmersion Items	Pretest (mean [SD])	Posttest (mean [SD])	Pretest (mean [SD])	Posttest (mean [SD])	t Statistic	P
Advise
Clinician is concerned about drinking	4.02 (2.00)	4.69 (1.22)	4.41 (1.63)	4.65 (1.29)	0.140	.891
Clinician offered rationale for concern	4.61 (1.36)	4.27 (1.78)	4.41 (1.63)	4.53 (1.47)	0.770	.446
Clinician advised to reduce drinking	4.71 (1.19)	4.79 (1.01)	4.90 (0.70)	4.77 (1.07)	0.110	.912
Assessment skills
Clinician asked about drinking pros	1.76 (2.41)	1.88 (2.45)	1.47 (2.30)	2.79 (2.51)	1.760	.082
Clinician asked about drinking cons	0.20 (0.98)	0.63 (1.67)	0.49 (1.50)	2.79 (2.51)	4.890	<.001
Clinician asked about readiness to change	4.31 (1.74)	3.65 (2.25)	4.22 (1.84)	4.88 (0.76)	3.440	<.001
Clinician asked about alcohol harms	0.10 (0.70)	0.42 (1.40)	0.29 (1.19)	0.81 (1.87)	1.160	.251
Clinician asked about stress and drinking	1.67 (2.38)	0.42 (1.40)	1.08 (2.08)	0.58 (1.62)	0.520	.604
Negotiation skils
Clinician asked to cut down to specific amount of alcohol	3.63 (2.25)	1.88 (2.45)	2.84 (2.50)	2.09 (2.50)	0.420	.675
Clinician asked about follow-up visit	3.53 (2.30)	2.71 (2.52)	3.63 (2.25)	3.60 (2.27)	1.780	.079
Clinician asked about social support	0.98 (2.00)	1.04 (2.05)	0.98 (2.00)	1.28 (2.21)	0.530	.596
Clinician offered continued support	3.43 (2.34)	2.60 (2.52)	3.73 (2.20)	2.56 (2.53)	0.090	.931
Clinician offered education material	1.47 (2.30)	0.94 (1.97)	0.98 (2.00)	0.58 (1.62)	0.930	.353
Communication skills
Clinician used open-ended questions	3.24 (2.41)	3.65 (2.25)	3.33 (2.38)	3.95 (2.06)	0.680	.499
Clinician was nonjudgmental	4.12 (1.93)	4.27 (1.78)	3.82 (2.14)	4.53 (1.47)	0.770	.446
Clinician was empathic	4.31 (1.74)	4.17 (1.88)	4.02 (2.00)	4.42 (1.62)	0.680	.498
Clinician dealt with resistance	3.43 (2.34)	3.75 (2.19)	3.43 (2.34)	3.26 (2.41)	1.030	.308
Overall clinician performance	4.22 (3.37)	5.94 (3.95)	4.51 (3.50)	6.28 (3.79)	0.420	.676

The 17 clinical skills listed above received a score of 5 points if the learner successfully demonstrated skill. The remaining 15 points were based on the learners “overall clinical performance.”

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Table 3.

Scores for the Referral Scenario Skills

SIMmersion Items	Control		Experimental		t Statistic	P
SIMmersion Items	Pretest (mean [SD])	Posttest (mean [SD])	Pretest (mean [SD])	Posttest (mean [SD])	t Statistic	P
Advise
Clinician advised to reduce drinking	4.22 (1.84)	4.69 (1.22)	3.73 (2.20)	5.00 (0.00)	1.670	.098
Clinician offered reasons for concern	3.82 (2.14)	4.90 (0.72)	3.92 (2.08)	4.65 (1.29)	1.130	.261
Clinician discussed consequences	2.16 (2.50)	3.85 (2.12)	2.06 (2.49)	3.37 (2.37)	1.020	.309
Assessment skills
Clinician asked about treatment history	1.47 (2.30)	0.83 (1.88)	1.27 (2.20)	0.81 (1.87)	0.050	.961
Clinician asked about readiness to change	2.06 (2.49)	3.85 (2.12)	1.27 (2.20)	4.19 (1.87)	0.790	.433
Negotiation skills
Clinician asked about joining AA group	1.76 (2.41)	3.23 (2.42)	2.25 (2.51)	2.21 (2.51)	1.970	.052
Clinician asked about insurance	0.20 (0.98)	0.31 (1.22)	0.20 (0.98)	0.23 (1.07)	0.330	.742
Clinician asked about willingness to receive alcohol assessment	2.45 (2.52)	4.69 (1.22)	3.04 (2.47)	4.30 (1.75)	1.230	.224
Clinician scheduled alcohol assessment	1.27 (2.20)	1.25 (2.19)	1.76 (2.41)	1.98 (2.47)	1.490	.141
Clinician asked to come for follow-up	1.76 (2.41)	2.40 (2.52)	1.76 (2.41)	3.37 (2.37)	1.900	.061
Clinician asked about social support	1.18 (2.14)	1.67 (2.38)	1.37 (2.25)	2.09 (2.50)	0.830	.407
Clinician offered continued support	1.08 (2.08)	3.44 (2.34)	1.67 (2.38)	3.72 (2.21)	0.590	.555
Clinician tried to match referrals to preferences	1.47 (2.30)	4.48 (1.54)	1.37 (2.25)	4.30 (1.75)	0.510	.613
Communication Skills
Clinician used open-ended questions	2.75 (2.51)	4.27 (1.78)	2.16 (2.50)	4.53 (1.47)	0.770	.446
Clinician responded positively to resistance	3.53 (2.30)	4.90 (0.72)	3.53 (2.30)	4.77 (1.07)	0.680	.499
Clinician was nonjudgmental	4.41 (1.63)	4.79 (1.01)	4.31 (1.74)	4.77 (1.07)	0.110	.912
Clinician was empathic	3.82 (2.14)	4.38 (1.67)	3.73 (2.20)	4.65 (1.29)	0.880	.384
Overall clinician performance	4.12 (3.56)	6.56 (3.29)	3.53 (3.91)	7.09 (3.82)	0.710	.478

The 17 clinical skills listed above received a score of 5 points if the learner successfully demonstrated skill. The remaining 15 points were based on the learners “overall clinical performance.”
AA, Alcoholics Anonymous.

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Table 4.

Sociodemographic Characteristics of Study Population

Characteristic	Control Group (n = 51)	Simulation Group (n = 51)	Total (n = 102)
Age^* (years)
20–30	27 (53)	32 (63)	59 (58)
31–40	15 (29)	8 (16)	23 (23)
>40	9 (18)	11 (22)	20 (20)
Sex^*
Male	16 (31)	10 (20)	26 (26)
Female	35 (69)	41 (80)	76 (75)
Student status^*
Medical student	18 (35)	18 (35)	36 (35)
Nurse practitioner, physician assistant, or pharmacy student	13 (26)	13 (26)	26 (26)
Practicing clinician^*
Physician	5 (10)	5 (10)	10 (10)
Nurse practitioner or physician assistant	15 (29)	15 (29)	30 (29)
Previous alcohol intervention training^* (hours)
0	44 (86)	51 (100)	95 (93)
≤5	6 (12)	0 (0)	6 (6)
>10	1 (2)	0 (0)	1 (1)
Number of plays with simulation (minimum 20 min per play)
0	-	4 (8)	-
1–4	-	7 (14)	-
5–9	-	10 (20)	-
≥10	-	30 (59)	-

* There were no significant differences (P < .05) between groups.
All data provided as n (%).

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Table 5.

Scores for the Screening, Brief Intervention, and Referral Testing Scenarios

SIMmersion Items	Control Group (n = 51)		Simulation Group (n = 51)		t Statistic	P
SIMmersion Items	Pretest (mean [SD])	Posttest (mean [SD])	Pretest (mean [SD])	Posttest (mean [SD])	t Statistic	P
Screening
Total score	54.41 (15.58)	58.13 (15.51)	53.24 (16.09)	67.67 (12.42)	3.43	<.001
Total score change	-	3.71 (19.16)	-	14.44 (16.17)	3.06	.003
Intervention
Total score	53.73 (19.34)	51.67 (18.09)	52.55 (13.86)	58.37 (15.89)	1.99	.050
Total score change	-	2.06 (23.27)	-	5.82 (20.13)	1.83	.070
Referral
Total score	43.53 (17.79)	64.48 (12.01)	42.94 (14.28)	66.05 (14.02)	0.61	.546
Total score change	-	20.95 (17.34)	-	23.11 (20.44)	0.57	.567

The Total potential score for each scenario was from 0 to 100. Intention to treat procedures were followed and baseline values were imputed for the 11 professionals who did not participate in the 3 posttest scenarios.