The Impact of Simulation on Suicide Prevention Skills in a Training Program for Primary Care Providers: Design and Preliminary Results from an RCT

Introduction: Within the context of a changing health care landscape where primary care providers are likely to encounter suicidal individuals, it is critical that effective suicide prevention training be part of provider training and that such training is grounded in adult learning theory and other advances in education. Suicide is the 10^th leading cause of death overall and the 2^ndleading cause of death in adolescents and young adults (15-34 years old). Patient safety is compromised when primary care providers lack sufficient knowledge and skills to assess and respond to patients at risk for suicide. Training studies show that simulation, with affectively engaging standardized patient (SP) experiences along with feedback, is an active ingredient for effective skill acquisition and use. The presentation describes an RCT designed to test the effectiveness of suicide prevention education for three groups of providers-in-training: nurse practitioners, family medicine residents, and pediatric residents. The primary research question focuses on the impact of practice (using standardized patient simulations) over and above didactics on suicide prevention skills.

Method: We adapted “Commitment to Living,” a previously developed and evaluated suicide prevention program for mental health professionals (which has also been taught to primary care providers), for a 48-minute, 6-module online training program (“Commitment to Living for Primary Care”; CTL: PC). We developed two adolescent/young adult standardized patient (SP) scenarios to enhance the training with practice and a third for a ‘test case’ to assess suicide prevention skills. Participants in three provider groups are randomized to one of two groups (Control group = CTL: PC didactics; Experimental group = CTL: PC didactics + SP practice). In the experimental group, one SP practice interaction is conducted using a telehealth model. The two groups will be compared in terms of objectively-rated suicide prevention skills using an SP ‘test case’ at 6-month follow up as well as their pre-post didactics and follow up measures of knowledge, self-efficacy, intention to use in future practice, and reported use. Moderators of outcomes, differences among SP simulations (i.e., modalities), and growth in skills observed over multiple SP experiences will be examined. Online data will also be examined.

Results: We provide initial findings from the first cohort (n»60) including: examination of participants’ online engagement with the didactic training; demographics (i.e., individual characteristics); pre-post didactics knowledge and self-efficacy; and feedback on didactics. We also present methods for developing/conducting SP practice sessions.