Evaluation of training of surgery interns to perform brief alcohol interventions for trauma patients

Because nearly half of injured patients admitted to trauma centers misuse alcohol, the American College of Surgeons has required that Level I trauma centers have a mechanism for providing brief bedside counseling interventions (BI) to patients with alcohol problems. We hypothesized that with minimal training, surgical interns could become proficient at performing BI.

First-year surgical interns were trained in an 8-hour BI workshop. A group of first-year medicine interns who were not trained in BI served as the comparison group. BI skills of both groups were assessed before and 5 weeks after this training using simulated interviews with standardized patient actors trained to depict a scenario of a challenging patient with an alcohol problem. Audiotapes of those interviews were rated by trained, blinded coders.

Before the training, both groups demonstrated similar BI skill levels. Compared with the control group, after training, the surgical interns showed marked improvements in BI skills, including more frequently giving patients feedback on their blood alcohol concentration results (p=0.000), providing guidelines for low-risk drinking (p=0.000), offering patients more than 1 change option (p=0.000), asking permission to discuss drinking (p=0.003), and offering patients hope and encouragement (p=0.003).

After training, surgery interns effectively demonstrated BI skills when challenged to do so in a standardized patient actor scenario. This model of intern screening and brief intervention training constitutes a viable alternative for trauma centers as they look for options to meet the American College of Surgeons' new requirement to provide BI for trauma patients with alcohol problems. Future research should further evaluate surgical interns' ability to routinely implement these skills in their daily clinical environments.