1. OBJECTIVES METHODS CONCLUSIONS RESULTS REFERENCES ACKNOWLEDGMENTS
Medical Students’ Suicide Risk Assessment Proficiency after Interaction with a
Virtual Patient in Crisis or a Video teaching module– Preliminary Results
Adriana Foster1, Josephine Albritton1, Benjamin Lok2, Edna Stirewalt1, Rebecca Nichols1, Jennifer Waller1, Christie Palladino1, Peter Buckley1
1Medical College of Georgia, Georgia Regents University, Augusta, Georgia, 2Computer and Informatics Science and Engineering, University of Florida
OBJECTIVES
Fig. 3: Percentage of students in the VP (active) and video (control) group, who asked the five suicide risk questions in the bipolar SP interaction:
Suicide risk assessment skills are taught and evaluated inconsistently in medical schools. We studied the effect of:
a Web-based interaction with a bipolar virtual patient (VP) who attempts suicide, OR
completion of a video teaching module on interviewing a bipolar patient,
on medical students’ proficiency to assess suicide risk in standardized patients (SPs).
Hypothesis: students who interact with a bipolar-VP, will be more likely to assess suicide risk than their peers who completed a video-module.
METHODS
Randomized, controlled study
Subjects: 2nd-year medical students at Medical College of Georgia.
Teaching tools:
Measures:
SP interview checklists for the 5 suicide risk questions (Fig. 3) and symptoms of bipolar disorder (Fig. 4)
Communication checklist for the SP satisfaction with the interview
Student satisfaction surveys for:
The intervention (VP) group
The control (Video) group
Analysis:
We used Fisher’s Exact, t-test, or Wilcoxon Rank Sum test to compare the frequency with which the VP-intervention and video-control groups’ students asked each one of five suicide assessment questions and other symptomatology.
Intervention (VP) Group : Denise bipolar VP (Fig 1 A and 1 B)
Fig. 4: Percentage of students in the VP (active) and video (control) group, who asked about each symptom of bipolar disorder
Fig. 1A
Fig. 1B
Control (Video) Group: Bipolar patient video - Fig. 2
CONCLUSIONS
Information about suicide risk assessment skills in medical trainees is limited. Our prior data on student-bipolar VP interactions show that only approximately 34% of students inquire about suicide plan and none inquire about means or family history of suicide. Edelstein and Ruder (1990) videotaped internal medicine interns performing a full history and physical exam on patients with medical and psychiatric complaints, and found that while 80% diagnosed major depression, only 40% asked about suicidal ideation . Our preliminary results show that both the VP and video, although rated differently in student satisfaction, seem to improve students’ assessment of suicide risk. Although our sample size does not give us enough power to detect a statistically significant difference, the VP group inquired more frequently than the Video group in 4 of 5 suicide risk areas., bipolar symptoms and alcohol use history. The immediate post-interaction feedback given to students by the VP appears to contribute to their proficiency in assessing suicide risk in SP interviews.
Limitations: 1) No study group without intervention and 2) small sample size.
Impact: 1) The VP seems to teach suicide risk assessment better than the video. 2) Students like the video more than the VP. 3) Both tools help medical students to improve their ability to perform suicide risk assessments. 4) Even after instruction, students are not complete in their assessment of suicide risk, thus our teaching tools need refinement.
Fig. 2
RESULTS
N=24 students in the VP-intervention, N= 22 in the video-control group completed the study so far. We found no statistically significant differences between the VP and video groups in:
Demographics,
Suicide risk assessment questions checklist (Fig. 3)
Bipolar disorder symptoms checklist (Fig. 4) or
Communication checklist items.
There was one statistically significant difference in the other symptomatology detected in between the VP and Video groups with those in the VP group being more likely to detect the alcohol use history than those in the video group (p=0.0236) .
The VP-group had significantly lower medians than the video on the survey items, including the rating of the technology module overall (p=0.0007), indicating that students found the VP less helpful than the video.
REFERENCES
Foster A, et al, Evaluation of Medical Student Interaction with a Bipolar Virtual Patient Scenario, in Proceedings of the 2010 Annual Meeting of the Association of Directors of Medical Student Education in Psychiatry, Teaching and Learning in Medicine 23(1), , 2011.
Edelstein DR and Ruder HJ, Assessment of Clinical Skills using Videotapes of the Complete Medical Interview and Physical Examination, Medical Teacher, 12(2), , 1990.
ACKNOWLEDGMENTS
This study is sponsored by the American Foundation of Suicide Prevention.