Michael Fleming, MD MPH is the Principal Investigator for the project, titled "Training Simulation to Teach Alcohol Screening and Brief Intervention." It is funded by the National Institute of Alcohol Abuse and Alcoholism, in partnership with SIMmersion LLC of Columbia, MD, Dale Olsen, PhD, CEO.

The simulation program, using the SIMmersion technology, is expected to significantly advance our ability to train medical professionals in human processing and interaction skills. The primary goal is to develop and evaluate a prototype interactive personal computer-based training simulation, designed to teach healthcare providers to conduct alcohol screening and brief intervention.

Description of the simulation technology to be tested in this study:

SIMmersion's proprietary simulation technology was developed at the Johns Hopkins University Applied Physics Laboratory. These computer training simulations help learners:

• build skills,
• clarify concepts, and
• increase retention.

They are exceptionally realistic. In order to make the simulation as life-like as possible, an actor in the role of the simulated character is videotaped. The circumstances of the simulation are made more challenging because the simulated characters have memory, and an advanced emotional model drives their behavior. Consequently, their responses can be modeled to quite accurately emulate the range of actual human behavior in similar circumstances.

Learners conduct a face-to-face conversation with the simulated character using a microphone or a computer-mouse to communicate. Their questions and statements are scripted to include a variety of natural choices. The simulated character's responses emulate what a real person might say at the current stage of the conversation given the character's motives and personality. The result is a nearly free-form conversation that is different every time the simulation is used. Users receive feedback from an on-screen help agent who provides non-verbal cues regarding the user's choice of questions. The system scores the user's performance, and an instant replay feature enables users to review portions of dialogue or their entire conversation.

University of Wisconsin Expert Panel:

An Expert Panel was created to oversee and review the contents and presentation of the simulation. The Panel met four times and consisted of University of Wisconsin physicians, fellows and nurse practitioners. Those from the Department of Family Medicine include:

• Randy Brown, MD;
• Richard Brown, MD, MPH;
• Bhushan Bhamb, MD;
• Aleksandra Zgierska, MD, and
• members of Dr. Fleming's Research Team.

The alcohol simulation program will be completed by January, 2008 and then will be tested by Dr. Fleming's research team.

Description of the study:

The study is being conducted by Dr. Fleming and his research team consisting of:

• Paul Grossberg, MD, Co-Investigator,
• Judie Pfeifer, MEd, Study Coordinator, and
• Stephanie Schiro, BA, Research Specialist

in collaboration with the UW School of Medicine and Public Health Clinical Assessment Center directed by Jane Banning, MSSW. A randomized education trial with 6 months follow-up will be used to test the efficacy of the simulated patient technology. One hundred ten health care professional students and practitioners have been recruited from the Madison, Wisconsin area to participate in the study. Fifty five research subjects will be randomly assigned to a control group and fifty five subjects will be assigned to the educational intervention arm of the study. The various tasks to be completed in the educational trial are as follows:

• Three standardized patient scenarios have been developed and 8 live standardized patients (SPs) have been recruited and trained.
• One hundred ten study subjects have been recruited.
• The pre-test measure of skills is being conducted. It consists of interaction with SPs in three testing stations that will test the ability to: 1) screen for alcohol use disorders; 2) conduct brief alcohol intervention; and 3) convince alcohol dependent patients to accept a referral to alcohol treatment.
• The Intervention group will use the simulation training before the post-test.
• The 6-month follow-up post-test will be the same as the pre-test.
• Analysis of results. The effectiveness of the SIMmersion computer-based training module will be demonstrated through the analysis of relative pre-post changes in clinical skills.
• Final results are expected by fall of 2008.