Trainers in a number of health professions where patient conversations about substance use need to take place are employing role-playing technology to help make professionals more comfortable with the subject.
At Children's Hospital of Pittsburgh, for example, “We are helping pediatricians improve their ability to screen and intervene,” says Abigail Schlesinger, MD, clinical director of community-based services in the hospital's Behavioral Science Division. Role-playing technology from New York City-based Kognito allows the physicians to practice conversations with virtual humans so that they are better prepared to broach substance use subjects with their patients.
Schlesinger says the virtual effort is supplemented with some in-person training as well. “You can never have enough practice,” she says.
Kognito is a health simulation company that engages learners in role-playing conversations for a number of real-world purposes, from helping teachers identify students who may be depressed to helping counselors of military families develop stress management strategies.
Its simulation in screening and brief intervention with adolescents is its first effort in the area of Screening, Brief Intervention and Referral to Treatment (SBIRT), says Cyrille Adam, MEd, senior director of health programs at Kognito. Adam says that if traditional in-person role playing is part of the scant amount of substance use training that most physicians and nurses receive, that can be too stressful and didactic an environment for practicing communication skills.
The simulation offers a more comfortable and less threatening setting for learning these skills through trial and error, he says. In a scenario resembling the playing of a video game, the user sees his/her character on screen as well as the patient sitting across. The trainee's verbal cues trigger responses by the patient. So, the opening comment “We need to talk about your alcohol use” would result in the patient recoiling, while “May I talk with you about your responses on this screening form?” would generate a more open response from the virtual patient. In essence, the person being trained can undo what was done in a virtual setting, with no real damage done.
The program includes the presence of a virtual coach who offers feedback, and the trainee is able to track his/her performance throughout the session. Adam says the simulation can be used either as a stand-alone exercise or as a complement to face-to-face training.
He says the simulation, which was established with the support of the Hilton Foundation, is being sent to 60 schools of nursing and social work under a foundation initiative.
Schlesinger says that within the University of Pittsburgh Medical Center network, every young patient receives a substance use screening at the annual well child visit. The screening instrument from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is used, and it is supplemented with additional questions. Her facility follows the American Academy of Pediatrics' recommendation that all children ages 11 and over receive a screening for substance use.
“If you can put off the onset of substance use, you can alter someone's life,” Schlesinger says.