When less is more: Optimizing SBIRT/MI training for primary care medical residents

Screening, brief intervention, and referral to treatment (SBIRT) has been shown to reduce substance use and related consequences in primary care settings. Indiana University School of Medicine (IUSM) trains all primary care medical residents to implement SBIRT at an adult primary care clinic. Training methods include web-based modules, face-to-face trainings, and interactive workshops. Continuous process evaluation and training modification is important to institutional adoption of new protocols. Further, time spent in training often is related to participants' satisfaction. Following six months of SBIRT training, 26.5% of medical residents trained (N=49) indicated dissatisfaction with the length of the training. These responses highlighted the need to develop a shorter training without adversely affecting learning outcomes. We therefore streamlined the curriculum by removing extraneous demonstrative materials (i.e., videos) and carefully pruning non-essential didactic information. Medical residents who received the modified training (n1=28) were compared to a random sample of those who had received the original training (n2=28). Those who participated in the modified training reported significantly higher satisfaction with training quality, materials, experience, organization, and instructor preparedness, and were more likely to recommend the training to a colleague (p < .05). Simultaneously, there were no significant reductions in reported likelihood of using SBIRT/MI techniques during clinical practice or in levels of confidence in stating medical concerns about patients' substance use patterns. These findings highlight the utility of formative evaluation and iterative curriculum development. Both our approach and the resulting training provide a model for other organizations planning similar training.