Investigating Computer-Based Simulation Training for Prescription Drug Abuse Screening

A new research project at the Department of Family Medicine (DFM) is investigating whether computer-based simulation training can help primary care clinicians more effectively screen patients for prescription drug abuse.

The project received Phase I funding in January from the National Institute on Drug Abuse (NIDA). Co-principal investigators are Michael Fleming, MD, MPH, and Dale Olsen, PhD, president of SIMmersion, LLC, the company that developed the simulation technology.

During Phase I, the research team is creating a short, working prototype of the simulation. Two groups of expert reviewers will then evaluate the prototype, provide feedback, and assess the feasibility of applying for Phase II funding to expand it into a full-length simulation.

How Simulation Training Works

The interactive simulation uses audio and video footage plus proprietary software to re-create realistic versions of the patient-doctor interactions during prescription drug abuse screening.

In a full-length simulation, clinicians ask a random selection of "virtual patients" screening questions about their prescription drug use. Some of these patients are currently abusing prescription drugs, others are merely at risk, and others are not abusing at all.

The virtual patient responds to each question as the conversation progresses; in a full simulation, conversations can get quite in depth and last for up to an hour.

Throughout the simulation, an onscreen help agent offers positive and negative feedback on the questions asked. The clinician can click on the feedback at any time to learn more about why it was given.

The simulation is also attuned not only to the content of the question, but also the tone in which it was asked. "It has a lot of depth on the patient's mood and character," said Judie Pfeifer, M Ed, the study's content coordinator. "For example, if you ask a question offensively, the patient can get irritated, angry, or even walk out."

In many ways, the simulation is similar to role-playing used during in-person medical education training, but it has several advantages over live training.

"With live role-playing, there's no standardization," said Pfeifer. "It also can be challenging to find instructors who can lead those kind of demonstrations."

"Plus, since the simulation runs on a computer, clinicians can practice as often as they want, wherever they want," she added.

View SIMMersion's online demonstration of its technology »

Related Success and Future Steps

Dr. Fleming's team has had recent success using the same simulation technology for alcohol abuse screening and intervention.

In a recent Phase I and Phase II project, funded by the National Institute on Alcohol Abuse and Alcoholism, the team compared whether clinicians who underwent simulation training achieved higher standardized alcohol screening skill scores than clinicians who did not undergo the training.

Results of that study, which will be published later this year in the Journal of the American Board of Family Medicine, found that repeated practice with the simulation resulted in significant improvement in screening skills, as demonstrated by higher scores.

The research team is hopeful that the current project will result in similar skills improvement for prescription drug abuse screening. Phase I of the project will most likely be completed in the summer, she said, and if feasibility assessments from the expert panel are positive, the team will begin applying for Phase II funding in August of this year.

Phase II funding will enable the team to expand and "road-test" the simulation to determine whether it truly leads to skills improvement in prescription drug abuse screening. Phase II of the project will also include an intervention training component.

Both projects directly support Dr. Fleming's research mission: to prevent and treat alcohol and drug use disorders. "Ultimately, if we can better identify abuse," Pfeifer said, "not only can we help patients better, we can work on ways to prevent the problems in the first place."