A randomized trial of two e-learning strategies for teaching substance abuse management skills to physicians

Abstract

Purpose: To compare the educational effectiveness of two virtual patient (VP)-based e-learning strategies, versus no training, in improving physicians' substance abuse management knowledge, attitudes, self-reported behaviors, and decision making.

Method: The 2011-2012 study was a posttest-only, three-arm, randomized controlled trial in 90 resident and 30 faculty physicians from five adult medicine primary care training programs. The intervention was one of two 2-hour VP-based e-learning programs, designed by national experts to teach structured screening, brief interventions, referral, and treatment skills. One used traditional problem solving with feedback (unworked example), and the other incorporated an expert demonstration first, followed by problem solving with feedback (worked example). The main outcome measure was performance on the Physicians' Competence in Substance Abuse Test (P-CSAT, maximum score = 315), a self-administered, previously validated measure of physicians' competence in managing substance abuse. The survey was completed at the outset of the study and two months later.

Results: Overall P-CSAT scores were virtually identical (202-211, P > .05) between both intervention groups and the no-training control group at both times. Average faculty P-CSAT scores (221.9, 224.6) were significantly higher (P < .01) than resident scores (203.7, 202.5) at both times.

Conclusions: This study did not provide evidence that a brief, worked example, VP-based e-learning program or a traditional, unworked, VP-based e-learning program was superior to no training in improving physicians' substance abuse management skills. The study did provide additional evidence that the P-CSAT distinguishes between physicians who should possess different levels of substance abuse management skills.

Figure 1

Flowchart of study participation. In 2011–12, 170 resident and faculty physicians from a total pool of 815 physicians in five primary care training centers agreed to participate in the evaluation of the online training programs. These physicians were randomly assigned to one of two training programs (worked or unworked virtual patients) or no training (control). All participants were requested to complete the online assessment (P-CSAT) immediately following the training or assignment (control group) and again three months later. A total of 120 physicians completed the second assessment and are the study participants for this report.