Evaluation of a Gatekeeper Training Program

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
American Foundation for Suicide Prevention
Information provided by (Responsible Party):
Shay-Lee Belik, University of Manitoba
ClinicalTrials.gov Identifier:
NCT01252927
First received: August 18, 2010
Last updated: July 23, 2014
Last verified: July 2014
  Purpose

The main objective of the proposed study is to evaluate the efficacy of a gatekeeper training suicide intervention program, Applied Suicide Intervention Skills Training (ASIST), in improving medical students' knowledge about suicide intervention, impact of attitudes on someone at risk for suicide and competent use of intervention skills to recognize risk and intervene effectively compared to medical education as usual. This research project will be undertaken using a randomized-controlled trial design. Questionnaires and objective structured clinical examinations using simulated patients will be completed at three time points: 1) before training, 2) after training, and 3) at one year following the training. Medical students' clinical skills in recognizing risk and intervening with simulated patients, as well as knowledge about suicide intervention and the impact of attitudes on someone at risk for suicide will be evaluated.


Condition Intervention
Suicide
Other: ASIST

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Evaluation of a Gatekeeper Training Program as Suicide Intervention Training for Medical Students

Resource links provided by NLM:


Further study details as provided by University of Manitoba:

Primary Outcome Measures:
  • OSCE checklist total score [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    Four Objective Structured Clinical Examinations (OSCEs) stations were developed for each time point in the study. All student-patient interactions were videotaped. Raters blind to the student's group assignment rated the videos according to a checklist of desired gatekeeper behaviors based on the key components of the ASIST program. A total score was the sum of all behaviours performed.

  • SIRI-2 score [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    The Suicide Intervention Response Inventory (SIRI-2) is a self-administered questionnaire designed to measure competence in choosing appropriate responses to a series of clinical scenarios with suicidal individuals. It contains 25 items, each of which consists of a "client" remark and two "helper" responses. Respondents were instructed to evaluate the appropriateness of each of the two helper responses on a 7-point Likert scale, ranging from +3 (highly appropriate response) through 0 (neither appropriate nor inappropriate response) to -3 (highly inappropriate response). Ratings by a group of expert suicidologists and crisis interventionists provided a mean expert response criterion against which individual respondents are compared. The sum of the absolute value of the differences between the students' rating and the mean response from experts was calculated to obtain an overall score of how well the student performed with respect to expert responses.

  • OSCE global rating total score [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    Four Objective Structured Clinical Examinations (OSCEs) stations were developed for each time point in the study. All student-patient interactions were videotaped. Raters blind to the student's group assignment rated the videos. Raters were asked to give a global rating score according to the performance of each student in each of the 3 key areas trained by the ASIST program, and a global rating of the student's performance on the station in general. The sum of all global ratings was used to determine a total score.


Secondary Outcome Measures:
  • self-perceived knowledge about suicide [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    A single question measured the level of knowledge about suicide that the individual believes they have. Response options were on a 4-point Likert scale from very to not at all.

  • self-perceived skill in helping a suicidal individual [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    A single question measured the level of ability that the individual believes they have in helping a suicidal person. Response options were on a 4-point Likert scale from very to not at all.

  • self-perceived confidence in helping a suicidal individual [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    A single question measured the level of confidence that the individual believes they have in helping a suicidal person. Response options were on a 4-point Likert scale from very to not at all.

  • Attitudes towards suicide total score [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    The Attitudes Towards Suicide Questionnaire (ATTS) was used to measure attitudes toward suicide. This scale is comprised of 37 items. Each item is rated on a 5-point Likert scale ranging from Strongly Disagree (1) to Strongly Agree (5). The total score of all 37 items was used for evaluation.

  • self-perceived preparedness [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    A single question measured the level of preparedness that the individual believes they have in dealing with a suicidal individual. Response options were on a 4-point Likert scale from very to not at all.

  • Total score on Interpersonal Skills Rating Scale [ Time Frame: 1 week before training, 1 week following training, and 4 years following training ] [ Designated as safety issue: No ]
    Interpersonal skills as rated by standardized patients in the OSCE setting according to the Interpersonal Skills Rating Scale. The IPS Rating Scale used 13 items to evaluate communication skills in the OSCE setting between patient and student from the patient's perspective, and included concepts such as empathy, respect, sensitivity, and listening skills. Each item was scored on a 7-point Likert scale from strongly agree to strongly disagree. The sum score of all 13 items was used for analysis.


Estimated Enrollment: 110
Study Start Date: October 2010
Estimated Study Completion Date: December 2015
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: ASIST intervention
The gatekeeper training intervention group received the Applied Suicide Intervention Skills Training (ASIST) 10.0 in addition to TAU. ASIST is a two-day (fourteen hour), intensive, interactive and practice-dominated course aimed at enabling people to recognize risk and learn how to intervene immediately to prevent suicide. The intervention was offered to students on a weekend and was conducted by three senior ASIST trainers and one junior trainer, with two trainers assigned to each training group.
Other: ASIST
The gatekeeper training intervention group will receive the Applied Suicide Intervention Skills Training (ASIST) workshop in addition to training as usual. ASIST is a 2-day intensive, interactive and practice-dominated course aimed at enabling people to recognize risk and learn how to intervene immediately to prevent suicide.
Other Name: ASIST
No Intervention: Control group: training as usual
Training as usual consisted of didactic teaching and a tutorial with case-based examples around suicide risk factors in their first year of medical school. Third- and fourth-year students may also have the opportunity to practice their skills with real patients during their clerkship rotations or in the emergency department.

Detailed Description:

The current proposal plans to implement and evaluate a secondary suicide intervention skills training program (gatekeeper training) in medical school students in Winnipeg, Manitoba, Canada. The main objective of the current proposal is to evaluate the effectiveness of a gatekeeper training program, Applied Suicide Intervention Skills Training (ASIST), in improving medical students' intervention skills with suicidal patients compared to training as usual. Secondary aims include comparisons of changes in knowledge, perceived competence and attitudes around suicide.

Findings from previous studies have demonstrated a significant positive effect of gatekeeper training on suicide prevention attitudes, skills and knowledge. As well, general studies in medical education reveal that students who have been able to practice, observe, and receive feedback in small groups showed an improvement in skills and confidence over those who were given didactic teaching only. Therefore, the investigators anticipate that the ASIST training program will significantly improve medical students' knowledge about suicide intervention, and will increase their recognition and response to suicide risk compared to education as usual. The investigators also expect that ASIST training will help them to understand the impact of attitudes on suicide prevention, and will increase their perceived competence and ability to recognize and treat a suicidal individual compare over training as usual. It is hypothesized that medical students trained in ASIST will differ significantly in their ability to correctly recognize and intervene with suicidal individuals based on their use of a standardized suicide intervention model and objective assessment using standardized patients.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • all medical students at University of Manitoba

Exclusion Criteria:

  • those who choose not to participate
  • those who have already taken ASIST training or related SafeTALK training
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01252927

Locations
Canada, Manitoba
University of Manitoba
Winnipeg, Manitoba, Canada, R3E 3N4
Sponsors and Collaborators
University of Manitoba
American Foundation for Suicide Prevention
Investigators
Principal Investigator: Shay-Lee Bolton, MSc University of Manitoba
  More Information

No publications provided

Responsible Party: Shay-Lee Belik, PhD Candidate, University of Manitoba
ClinicalTrials.gov Identifier: NCT01252927     History of Changes
Other Study ID Numbers: H2009:073
Study First Received: August 18, 2010
Last Updated: July 23, 2014
Health Authority: Canada: Ethics Review Committee

Additional relevant MeSH terms:
Suicide
Behavioral Symptoms
Self-Injurious Behavior

ClinicalTrials.gov processed this record on October 23, 2014