Results:

One month after the training (Time 2), residents were contacted by email or pager and asked the same questions. We had experimented with the use of written surveys but found that the response rate among these busy physicians was low. We therefore used the pager/email system to obtain higher response rates. Of 139 residents trained by the time data were analyzed, Time 1 and 2 data were available for 57 (41%) residents. Forty-four had Time 1 data only, 22 had Time 2 data only, and 16 had neither.

As seen in Table 1, before the Training (Time 1), residents reported screening for alcohol problems in an average of only 27.2% of all their patients. One month after the training (Time 2), this rose to an average of 38.1%. At Time 1, residents reported that they had provided brief alcohol interventions to 6.3% of all the patients they had seen in the previous week. At Time 2, this had increased to 9.9%.

Residents’ confidence in their abilities to screen their patients for alcohol problems increased from an average of 5.8 to an average of 6.8. These scores refer to a scale from 1 to 10, where 1 is not at all confident and 10 is extremely confident. Their average confidence scores in their ability to provide brief counseling for alcohol problems increased from 4.9 to 6.0 on a 1-10 scale.

Table 1 also shows that there were no changes from time 1 to Time 2 in residents’ estimates of the prevalence of patients in their practices with "no problems," "mild problems," and "severe problems."

Table 1: 
Comparison of resident’s mean behavior and attitude scores before and after training

We believe that the residents are reasonably knowledgeable about the prevalence of alcohol problems in their patient populations but do not have the sense of self-efficacy to screen for problem drinking and to manage alcohol problems. Resident training in screening for alcohol problems and in conducting brief interventions should be improved, as our intervention did for the residents exposed to the intervention. However, we believe that the intervention would be more successful if presented as a more generalizable tool with which to intervene on problem behavior, whether it be alcohol use, smoking, exercise or diet. Resident acceptance of the investment in adequately learning the means of motivational interviewing would thereby be enhanced.