Curriculum

In order to maximize learning and transfer of this information into practice we have provided a variety of tools. This section includes suggested formats for educational programs as well as vital components. This includes: a basic slide set for a 45 minute didactic lecture; a video depicting actual ED scenarios and didactic information (40 minutes); role play scenarios for skills–based workshops; and additional information/enhancements for further educational sessions. While it is relatively easy to teach this technique to emergency practitioners, the real power of this technique is realized only if they are used in clinical practice. The additional content is provided to assist with transfer of learning.

Rationale for specific teaching tools

Basic Slide Set

We have created a slide presentation in PowerPoint™ format for use in a lecture to learners. The purpose of the lecture is several–fold:

• Introduce the topic of unhealthy drinking as it pertains to the ED
• Review the pertinent literature in the field of alcohol screening and intervention
• Describe a recommended process of screening, brief intervention (SBI), namely the “Brief Negotiation Interview,” and referral to treatment in the emergency department
• Stress to learners that interventions in the ED can make a difference

The basic slide set can be easily covered in about 45 minutes. These slides can be used “as–is” or can be customized (see Supplementary slides). Several barriers exist to screening and intervention that may be raised by the learners. The key job of the lecturer is to address these barriers and provide information to raise the awareness of the learner regarding the burden of illness related to unhealthy alcohol use and the proven efficacy of offering SBI and referral to treatment in the ED setting. In addition other factors that promote change in an institution such as system changes, use of opinion leaders for example can be discussed to enhance success. (See slide set)

Role Play

Didactic sessions alone are not enough to maximize the learning of this important topic. Effective screening, brief intervention and referral to treatment (SBIRT) are skills. Instructors would not have residents perform a skill such as central venous access or lumbar puncture after having only heard a lecture on the topic. Insufficient preparation of learners is an invitation for failure. Also, the initial attempts at using this technique will be awkward. If the learners encounter difficulties in implementing this technique due to lack of familiarity while with patients in a busy ED, they will be less likely to incorporate it into their clinical practice.

A sample role–play should be viewed by the learners after the didactic session. This can be accomplished by two instructors in real time, or a short video clip can be used that is provided on the website.

Skills–based sessions are critical. Ideally the learners should split into groups of three. One learner plays the provider, another plays the patient and the third acts as the observer. The provider and patient receive a scripted handout with information pertaining to his or her part in the case they are role–playing that includes their alcohol screen, and history. The patient has their readiness to change response including cons and pros of drinking. The observer should have provider’s page. He/she should note what things the provider did well, that evoked a positive response on the part of the patients, and what things were said that elicited a negative response. They should also note that all the critical “prescribed” components of the intervention were adhered to as well as that “proscribed” components such as labeling the patient, or argumentative statements were not used. When time is limited, an alternative method is to split into groups of 2 without the observer, however there is potential for much to be lost in translation with this method as both participants are usually engrossed in their role and will miss some important responses to each other.

Once all pairs are finished, the entire group should reflect briefly on successes and difficulties encountered (ie, debrief). After that, another role–play is done, with learners reversing roles. This process is repeated as time permits. We recommend each learner gets to portray the provider.

Video Examples

We have provided several examples of the SBIRT in video format. We suggest these be used as a supplement to the lecture and role play. Most learners will only need to see one or two videos to grasp the technique. The video is versatile as it can be used in a large group format to show an example of the technique or in a small group, where the video can serve as a springboard for discussion.

Supplementary slides

We have provided extra slides that can be inserted into the lecture as determined by the instructor. Instructors are encouraged to customize the slides as they see fit; for example, inserting data on regional alcohol use trends.

Learner Materials

A number of materials can be provided to learners. The primary purpose of these materials is to increase learning transfer. This includes:

• 2–sided reference sheet for providers which includes screening questions, drink equivalents, readiness to change scale and the intervention. This can easily be made into a laminated card that can fit in a white coat pocket.
• Copies of selected articles, or links sent to resident’s email addresses.