News Release: School of Medicine

Feb. 10,  2009

Surgical Interns Show Promise in Counseling Patients on Alcohol Misuse

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For doctors working as surgical interns, mastering the precision and skill of surgical technique is at the pinnacle of their training.

But as a study reported in the November 2008 Journal of American College of Surgeons shows, surgical interns were highly effective in an area away from the operating room – at the bedside for counseling patients on the misuse of alcohol.

Nearly half of injured patients admitted to trauma centers have misused alcohol, which led the American College of Surgeons to mandate that Level I trauma centers provide a mechanism for brief bedside counseling interventions (BI) to patients with alcohol problems.

"Recent studies have shown brief alcohol interventions with trauma patients who have a history of alcohol misuse successfully prevented future episodes of drunk driving," says Jana B.A. MacLeod, MD, assistant professor of surgery, Emory University School of Medicine. "The opposite occurs if they did not receive interventions. They continue to drink hazardously, and they are more likely to be injured and more likely to die the second time around."

Study author MacLeod and her team hypothesized that with minimal training surgical interns could become proficient at performing bedside interventions. She believes interns are ideal candidates because they are still new on the job, spend the majority of their time on the wards and are more willing to take on newer types of intervention for patients. Moreover, interns don’t spend as much time in the operating room because they are not as focused on learning surgery as senior residents.

But when it comes to effectively counseling a patient for alcohol intervention the perception is that a surgeon would not be empathetic, says MacLeod. She says the cold, methodical and mechanical stereotype of a typical surgeon strongly exists even among surgery residents. This perception was the driving force for MacLeod’s study design.

Fifteen first-year surgical interns were trained in an eight-hour BI workshop. A group of 23 first-year internal medicine interns who were not trained in BI served as the comparison group. BI skills of both groups were assessed before and five weeks after this training using simulated interviews with standardized patient actors trained to depict a scenario of a challenging patient with an alcohol problem.

"If we had just given the instruction to go out and do this intervention without the training I think many would instinctually say 'I'm not good at that - social workers, psychologists and psychiatrists do that,'" says MacLeod. “But this training allows them to learn a valuable technique to connect with patients, and make a contribution other than just putting a broken bone back together or sewing up an injury.

"Trauma surgeons or any type of other medical professional that manages an injury as part of the treatment, it isn't just the anatomical repair that requires attention. There's an underlying root cause and we have to address that to help keep the person from coming back," says MacLeod.

Compared to trauma patients with normal blood alcohol levels, MacLeod’s research shows intoxicated trauma patients are 2.5 times more likely to suffer another injury within 28 months. She believes trauma surgeons have high credibility with their patients and a few words of respectful concern may go a long way.

"If surgeons knew how to perform BIs, they could help prevent future injuries and death," she emphasizes. "In addition, they would better understand why this preventive service should become a routine element of trauma care, and later in their careers they might be more likely to facilitate BI implementation in their trauma centers when they are in positions of leadership."

MacLeod wants to make BI training a formalized component of intern orientation training. 

"During the internship year interns learn a host of new skills like how to put in centralized lines, this is also a good time to teach patient-centered interviewing skills, training that should improve interns' ability to communicate with patients throughout their medical careers. They spend more time face to face with patients during their internship than in any other year of their training."

Reference:
"Evaluation of Training of Surgery Interns to Perform Brief Alcohol Interventions for Trauma Patients." MacLeod, Jana B.A. MD; Hungerford, Daniel W. DrPH; Dunn, Chris PhDc; Hartzler, Bryan PhDd. Journal of the American College of Surgeons: Volume 207(5) November 2008 pp 639-645.

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The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.

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