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Research ArticleOriginal Research

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 and Susan Skochelak
The Journal of the American Board of Family Medicine July 2009, 22 (4) 387-398; DOI: https://doi.org/10.3122/jabfm.2009.04.080208
Michael Fleming
MD, MPH
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Dale Olsen
PhD
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Hilary Stathes
MEd
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Laura Boteler
BS
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Paul Grossberg
MD
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Judie Pfeifer
MEd
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Stephanie Schiro
BA
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Jane Banning
MSSW
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Susan Skochelak
MD, MPH
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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 ItemsControlExperimentalt StatisticP
    Pretest (mean [SD])Posttest (mean [SD])Pretest (mean [SD])Posttest (mean [SD])
    Alcohol use
        Clinician asked about drinking frequency4.12 (1.93)4.17 (1.88)3.92 (2.08)5.00 (0.00)2.900.005
        Clinician asked about drinking amount4.90 (0.70)3.75 (2.19)4.80 (0.98)4.77 (1.07)2.770.007
        Clinician asked about 5 drinks in a row0.98 (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 family3.73 (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 alcohol2.06 (2.49)3.02 (2.47)1.67 (2.38)3.72 (2.21)1.420.160
        Clinician asked about alcohol-related injury0.39 (1.36)1.35 (2.25)0.69 (1.74)2.79 (2.51)2.880.005
        Clinician asked about alcohol-related work problems3.53 (2.30)2.81 (2.51)3.53 (2.30)3.37 (2.37)1.090.278
        Clinician asked about alcohol-related relationship problems3.53 (2.30)4.38 (1.67)3.14 (2.44)4.53 (1.47)0.480.631
        Clinician asked about alcohol treatment history2.45 (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 problems1.08 (2.08)1.56 (2.34)1.08 (2.08)1.16 (2.14)0.850.399
        Clinician asked about medication3.33 (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 drinking2.94 (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 drinking1.67 (2.38)2.40 (2.52)1.96 (2.47)2.33 (2.52)0.130.895
        Clinician asked about drinking in the morning2.35 (2.52)2.29 (2.52)1.76 (2.41)3.02 (2.47)1.400.166
    Communication skills
        Clinician gives reason for alcohol questions4.41 (1.63)4.17 (1.88)4.22 (1.84)4.07 (1.97)0.240.811
        Clinician was not sidetracked4.12 (1.93)4.90 (0.72)4.12 (1.93)5.00 (0.00)0.950.347
        Clinician was nonjudgmental4.41 (1.63)4.38 (1.67)4.51 (1.50)4.53 (1.47)0.480.631
    Overall clinician performance4.41 (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 ItemsControlExperimentalt StatisticP
    Pretest (mean [SD])Posttest (mean [SD])Pretest (mean [SD])Posttest (mean [SD])
    Advise
        Clinician is concerned about drinking4.02 (2.00)4.69 (1.22)4.41 (1.63)4.65 (1.29)0.140.891
        Clinician offered rationale for concern4.61 (1.36)4.27 (1.78)4.41 (1.63)4.53 (1.47)0.770.446
        Clinician advised to reduce drinking4.71 (1.19)4.79 (1.01)4.90 (0.70)4.77 (1.07)0.110.912
    Assessment skills
        Clinician asked about drinking pros1.76 (2.41)1.88 (2.45)1.47 (2.30)2.79 (2.51)1.760.082
        Clinician asked about drinking cons0.20 (0.98)0.63 (1.67)0.49 (1.50)2.79 (2.51)4.890<.001
        Clinician asked about readiness to change4.31 (1.74)3.65 (2.25)4.22 (1.84)4.88 (0.76)3.440<.001
        Clinician asked about alcohol harms0.10 (0.70)0.42 (1.40)0.29 (1.19)0.81 (1.87)1.160.251
        Clinician asked about stress and drinking1.67 (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 alcohol3.63 (2.25)1.88 (2.45)2.84 (2.50)2.09 (2.50)0.420.675
        Clinician asked about follow-up visit3.53 (2.30)2.71 (2.52)3.63 (2.25)3.60 (2.27)1.780.079
        Clinician asked about social support0.98 (2.00)1.04 (2.05)0.98 (2.00)1.28 (2.21)0.530.596
        Clinician offered continued support3.43 (2.34)2.60 (2.52)3.73 (2.20)2.56 (2.53)0.090.931
        Clinician offered education material1.47 (2.30)0.94 (1.97)0.98 (2.00)0.58 (1.62)0.930.353
    Communication skills
        Clinician used open-ended questions3.24 (2.41)3.65 (2.25)3.33 (2.38)3.95 (2.06)0.680.499
        Clinician was nonjudgmental4.12 (1.93)4.27 (1.78)3.82 (2.14)4.53 (1.47)0.770.446
        Clinician was empathic4.31 (1.74)4.17 (1.88)4.02 (2.00)4.42 (1.62)0.680.498
        Clinician dealt with resistance3.43 (2.34)3.75 (2.19)3.43 (2.34)3.26 (2.41)1.030.308
    Overall clinician performance4.22 (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.”

    • View popup
    Table 3.

    Scores for the Referral Scenario Skills

    SIMmersion ItemsControlExperimentalt StatisticP
    Pretest (mean [SD])Posttest (mean [SD])Pretest (mean [SD])Posttest (mean [SD])
    Advise
        Clinician advised to reduce drinking4.22 (1.84)4.69 (1.22)3.73 (2.20)5.00 (0.00)1.670.098
        Clinician offered reasons for concern3.82 (2.14)4.90 (0.72)3.92 (2.08)4.65 (1.29)1.130.261
        Clinician discussed consequences2.16 (2.50)3.85 (2.12)2.06 (2.49)3.37 (2.37)1.020.309
    Assessment skills
        Clinician asked about treatment history1.47 (2.30)0.83 (1.88)1.27 (2.20)0.81 (1.87)0.050.961
        Clinician asked about readiness to change2.06 (2.49)3.85 (2.12)1.27 (2.20)4.19 (1.87)0.790.433
    Negotiation skills
        Clinician asked about joining AA group1.76 (2.41)3.23 (2.42)2.25 (2.51)2.21 (2.51)1.970.052
        Clinician asked about insurance0.20 (0.98)0.31 (1.22)0.20 (0.98)0.23 (1.07)0.330.742
        Clinician asked about willingness to receive alcohol assessment2.45 (2.52)4.69 (1.22)3.04 (2.47)4.30 (1.75)1.230.224
        Clinician scheduled alcohol assessment1.27 (2.20)1.25 (2.19)1.76 (2.41)1.98 (2.47)1.490.141
        Clinician asked to come for follow-up1.76 (2.41)2.40 (2.52)1.76 (2.41)3.37 (2.37)1.900.061
        Clinician asked about social support1.18 (2.14)1.67 (2.38)1.37 (2.25)2.09 (2.50)0.830.407
        Clinician offered continued support1.08 (2.08)3.44 (2.34)1.67 (2.38)3.72 (2.21)0.590.555
        Clinician tried to match referrals to preferences1.47 (2.30)4.48 (1.54)1.37 (2.25)4.30 (1.75)0.510.613
    Communication Skills
        Clinician used open-ended questions2.75 (2.51)4.27 (1.78)2.16 (2.50)4.53 (1.47)0.770.446
        Clinician responded positively to resistance3.53 (2.30)4.90 (0.72)3.53 (2.30)4.77 (1.07)0.680.499
        Clinician was nonjudgmental4.41 (1.63)4.79 (1.01)4.31 (1.74)4.77 (1.07)0.110.912
        Clinician was empathic3.82 (2.14)4.38 (1.67)3.73 (2.20)4.65 (1.29)0.880.384
    Overall clinician performance4.12 (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.

    • View popup
    Table 4.

    Sociodemographic Characteristics of Study Population

    CharacteristicControl Group (n = 51)Simulation Group (n = 51)Total (n = 102)
    Age* (years)
        20–3027 (53)32 (63)59 (58)
        31–4015 (29)8 (16)23 (23)
        >409 (18)11 (22)20 (20)
    Sex*
        Male16 (31)10 (20)26 (26)
        Female35 (69)41 (80)76 (75)
    Student status*
        Medical student18 (35)18 (35)36 (35)
        Nurse practitioner, physician assistant, or pharmacy student13 (26)13 (26)26 (26)
    Practicing clinician*
        Physician5 (10)5 (10)10 (10)
        Nurse practitioner or physician assistant15 (29)15 (29)30 (29)
    Previous alcohol intervention training* (hours)
        044 (86)51 (100)95 (93)
        ≤56 (12)0 (0)6 (6)
        >101 (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 (%).

    • View popup
    Table 5.

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

    SIMmersion ItemsControl Group (n = 51)Simulation Group (n = 51)t StatisticP
    Pretest (mean [SD])Posttest (mean [SD])Pretest (mean [SD])Posttest (mean [SD])
    Screening
        Total score54.41 (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 score53.73 (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 score43.53 (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.

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The Journal of the American Board of Family Medicine: 22 (4)
The Journal of the American Board of Family Medicine
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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
The Journal of the American Board of Family Medicine Jul 2009, 22 (4) 387-398; DOI: 10.3122/jabfm.2009.04.080208

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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
The Journal of the American Board of Family Medicine Jul 2009, 22 (4) 387-398; DOI: 10.3122/jabfm.2009.04.080208
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