Alcohol-Related Brief Interventions as a Criterion for American College of Surgeons Level I Trauma Center Verification: How Best to Train the Interventionists?

Background: The American College of Surgeons Committee on Trauma recently required that Level I trauma centers have the capability to perform counseling in the form of brief interventions (BIs) for injured patients identified as problem drinkers. However, it is not yet known what type of training is optimal for trauma center personnel who will conduct these BIs. Methods: We conducted a prospective cohort study at the University of California, Davis Medical Center, a Level I trauma center. We compared two methods of training trauma nurse practitioners (NPs) without prior counseling expertise to conduct BIs: formal workshop training versus "on-the-job" (OTJ) training. throughout the text. Is this OK? -- We also evaluated whether a further "booster" training session would improve BI skills. We assessed BI skills in blinded fashion during interviews with a standardized patient actor using a 21-point checklist of BI counseling tasks ("FLO" score). Results: Nine workshop-and five OTJ-trained NPs participated. FLO scores did not markedly differ between the two groups after initial training (total FLO score, 9.6 +/- 2.4 and 7.8 +/- 0.4, workshop vs. OTJ, respectively; 95% confidence interval of difference, -4.1 to 0.6). FLO scores did however improve in both groups after booster training (9.1 +/- 2.0 and 16.0 +/- 2.2, time 1 vs. time 2, respectively; 95% confidence interval of difference, 4.7-9.1). The magnitude of improvement in FLO scores after the booster session did not differ between the workshop and OTJ groups. Conclusions: In preparing NPs to conduct BIs, OTJ training by an experienced peer does not seem to differ markedly from workshop training by expert counselors. Interventionist knowledge and performance can be improved in the short term by follow-up training. This indicates that NP's taught by either method should undergo periodic continuing education to maintain the necessary skill set for performing BIs.