Suicide Prevention Training for PC Providers-in-training

Study Overview
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Brief Summary
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This randomized control study responds to the need for effective suicide prevention education/training that is grounded in adult learning theory and advances in education, in the context of a changing health care landscape where primary care providers are likely to encounter suicidal individuals. The study will test the effectiveness of suicide prevention education for providers-in-training by comparing two conditions: 1) A Control learning group: includes suicide prevention didactics (Commitment to Living: Primary Care) delivered online via brief videos, and 2) An Experimental learning group: includes didactics plus two standardized patient (SP) interactions. One Experimental learning group SP interaction will be in person and the other will be conducted remotely using a secure webcam service (OoVoo). All SP interactions will be recorded. Both groups will be compared in terms of their suicide prevention skills using an SP 'test case' at 6-month follow up. The primary research question is to learn about the impact of practice (though SP simulation) over and above didactics alone.

Detailed Description
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Suicide is a national public health crisis and a critical patient safety issue. Suicide is the 10th leading cause of death overall and, shockingly, the 2nd leading cause of death in adolescents and young adults (15-34 years old). 1 A recent U.S. study of suicide reported that 45% of individuals who died by suicide had contact with primary care services within one month before their death. 2 Another study found that 80% of youth who died by suicide saw their primary care provider within the year of their death. 3 Patient safety is compromised when primary care providers lack the knowledge and skills to assess and respond to patients at risk for suicide. This randomized control study responds to the need for effective suicide prevention education/training that is grounded in adult learning theory and advances in education, in the context of a changing health care landscape where primary care providers are likely to encounter suicidal individuals. 4 We will test the effectiveness of suicide prevention education for providers-in-training by comparing two conditions: 1) A Control learning group: includes suicide prevention didactics (Commitment to Living: Primary Care) delivered online via brief videos, and 2) An Experimental learning group: includes didactics plus two standardized patient (SP) interactions. One Experimental learning group SP interaction will be in person and the other will be conducted remotely using a secure webcam service (OoVoo). All SP interactions will be recorded. Both groups will be compared in terms of their suicide prevention skills using an SP 'test case' at 6-month follow up. The primary research question is to learn about the impact of practice (though SP simulation) over and above didactics alone. The hypotheses are as follows: H1: All subjects will demonstrate improved suicide prevention knowledge from pre to post didactics and maintain improvement 6 months after didactics. H2: Subjects in the experimental learning group will report greater satisfaction with the training, greater self-efficacy in identifying and responding to patients at risk for suicide, greater intention to use, as well as use of suicide prevention skills. H3: Subjects in the experimental learning group will also be more skillful in responding to patients at risk for suicide (in an SP interview, measured by objective observed ratings) compared to the control learning group 6 months after didactics. Exploratory Aims: We will examine moderators of outcomes, differences among SP simulations (i.e., face-to-face vs. telehealth modalities), and if there is growth in improved skills observed over multiple SP experiences in the experimental learning group.

Official Title
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Suicide Prevention Training for Primary Care Providers-in-training

Conditions
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Suicide Prevention

Intervention / Treatment
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* Other: Didactic training
* Other: Standardized patient interaction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: trainee in family medicine residency, pediatrics residency, or nurse practitioner program at URMC. speaks/writes English. Exclusion Criteria: on academic probation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Didactic training<br>Behavioral; participants will view the approximately one hour Commitment to Living: Primary Care (CTL:PC) didactic training videos. | Other: Didactic training<br>* Six online training modules pertaining to suicide prevention in primary care.<br>|
| Experimental: Didactics and standardized patients<br>Behavioral; participants will view the approximately one hour Commitment to Living: Primary Care (CTL:PC) didactic training videos plus two practice standardized patient interactions. | Other: Didactic training<br>* Six online training modules pertaining to suicide prevention in primary care.<br>Other: Standardized patient interaction<br>* Two standardized patient practice interactions - 1 face-to-face, 1 remote/telehealth.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean score using the Commitment to Living: Primary Care Observational Rating form | Each participant will be evaluated via standardized patient interactions which are video taped and reliably coded using the Commitment to Living: Primary Care Observational Rating form. Score will range from 0 - 32. | through study completion, an average of 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in suicide prevention knowledge | Participants will complete a 17-item knowledge questionnaire prior to and following the online didactic training. Number of correct responses will be compared. | 1 day following enrollment and 15 days from enrollment | 
| Changes in suicide prevention self-efficacy | Participants will complete a 20-item 5-point likert scale self-efficacy questionnaire prior to and following the online didactic training. Average responses will be compared. | 1 day following enrollment and 15 days from enrollment | 
| Changes in suicide prevention knowledge | Participants will complete a 17-item knowledge questionnaire following the online didactic training and end of study. Number of correct responses will be compared. | 15 days from enrollment and through study completion, an average of 6 months | 
| Number of participants intending to transfer training to practice | Participants will complete a 8-item intentions to use training in practice on a 5-item likert scale questionnaire following the online didactic training and end of study. Number of participants who report positive intentions to use the training in practice will be compared. | 15 days from enrollment and through study completion, an average of 6 months | 
| Changes in suicide prevention self-efficacy | Participants will complete a 20-item 5-point likert scale self-efficacy questionnaire following the online didactic training and end of study. Average responses will be compared. | 15 days from enrollment and through study completion, an average of 6 months | 
| Use of suicide prevention skills | Participants will self-report whether they used suicide prevention skills in practice on 0-4 point likert scale, with 0 defined as no use and 4 as frequently used. | through study completion, an average of 6 months | 
| Feedback on training | Participants will provide feedback on their experience with suicide prevention training on 15 items using a 5-point likert scale. | through study completion, an average of 6 months |