Evaluation of a Gatekeeper Training Program

• OSCE scores [ Time Frame: March 27-28 , 2011 (baseline) ] [ Designated as safety issue: No ]
  Objective Structured Clinical Examinations (OSCEs) will also be used to test clinical skill performance and competence in identifying and intervening with simulated suicidal patients. For the purposes of our study, we will create six (6) OSCE stations for each time point in the study.
• SIRI-2 questionnaire [ Time Frame: March 27-28, 2011 (baseline) ] [ Designated as safety issue: No ]
  The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in medical students over the course of the trial. The SIRI-2 is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention.
• OSCE scores [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  Objective Structured Clinical Examinations (OSCEs) will also be used to test clinical skill performance and competence in identifying and intervening with simulated suicidal patients. For the purposes of our study, we will create six (6) OSCE stations for each time point in the study.
• OSCE scores [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  Objective Structured Clinical Examinations (OSCEs) will also be used to test clinical skill performance and competence in identifying and intervening with simulated suicidal patients. For the purposes of our study, we will create six (6) OSCE stations for each time point in the study.
• SIRI-2 questionnaire [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in medical students over the course of the trial. The SIRI-2 is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention.
• SIRI-2 questionnaire [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in medical students over the course of the trial. The SIRI-2 is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention.

• OSCE scores [ Time Frame: January 10-14 , 2011 (baseline) ] [ Designated as safety issue: No ]
  Objective Structured Clinical Examinations (OSCEs) will also be used to test clinical skill performance and competence in identifying and intervening with simulated suicidal patients. For the purposes of our study, we will create six (6) OSCE stations for each time point in the study.
• SIRI-2 questionnaire [ Time Frame: January 10-14, 2011 (baseline) ] [ Designated as safety issue: No ]
  The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in medical students over the course of the trial. The SIRI-2 is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention.
• OSCE scores [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  Objective Structured Clinical Examinations (OSCEs) will also be used to test clinical skill performance and competence in identifying and intervening with simulated suicidal patients. For the purposes of our study, we will create six (6) OSCE stations for each time point in the study.
• OSCE scores [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  Objective Structured Clinical Examinations (OSCEs) will also be used to test clinical skill performance and competence in identifying and intervening with simulated suicidal patients. For the purposes of our study, we will create six (6) OSCE stations for each time point in the study.
• SIRI-2 questionnaire [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in medical students over the course of the trial. The SIRI-2 is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention.
• SIRI-2 questionnaire [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  The Suicide Intervention Response Inventory (SIRI-2) will be used to detect enhancement of intervention skills in medical students over the course of the trial. The SIRI-2 is a self-administered test that was designed to measure competence in choosing appropriate response to a series of clinical scenarios with suicidal individuals. Research on the SIRI-2 has shown its good psychometric properties, freedom from social desirability effects, and responsiveness to training in suicide prevention.

• self-perceived knowledge about suicide [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  measures the level of knowledge about suicide that the individual believes they have
• self-perceived skill in helping a suicidal individual [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  measures the level of ability that the individual believes they have in helping a suicidal person
• self-perceived confidence in helping a suicidal individual [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  measures the level of confidence that the individual believes they have in helping a suicidal person
• whether the individual has helped someone who is suicidal since the last time point [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  assess whether the person has helped someone who is suicidal
• self-perceived knowledge about suicide [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  measures the level of knowledge about suicide that the individual believes they have
• self-perceived skill in helping a suicidal individual [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  measures the level of ability that the individual believes they have in helping a suicidal person
• self-perceived confidence in helping a suicidal individual [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  measures the level of confidence that the individual believes they have in helping a suicidal person
• whether the individual has helped someone who is suicidal since the last time point [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  assess whether the person has helped someone who is suicidal
• attitudes towards suicide [ Time Frame: April 10-11, 2011 ] [ Designated as safety issue: No ]
  measures attitudes toward suicide
• attitudes towards suicide [ Time Frame: April 1-2, 2012 ] [ Designated as safety issue: No ]
  measures attitudes toward suicide
• attitudes towards suicide [ Time Frame: March 27-28, 2011 ] [ Designated as safety issue: No ]
  measures attitudes toward suicide
• whether the individual has helped someone who is suicidal since the last time point [ Time Frame: March 27-28, 2011 ] [ Designated as safety issue: No ]
  assess whether the person has helped someone who is suicidal
• self-perceived confidence in helping a suicidal individual [ Time Frame: March 27-28, 2011 ] [ Designated as safety issue: No ]
  measures the level of confidence that the individual believes they have in helping a suicidal person
• self-perceived skill in helping a suicidal individual [ Time Frame: March 27-28, 2011 ] [ Designated as safety issue: No ]
  measures the level of ability that the individual believes they have in helping a suicidal person
• self-perceived knowledge about suicide [ Time Frame: March 27-28, 2011 ] [ Designated as safety issue: No ]
  measures the level of knowledge about suicide that the individual believes they have

• self-perceived knowledge about suicide [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  measures the level of knowledge about suicide that the individual believes they have
• self-perceived skill in helping a suicidal individual [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  measures the level of ability that the individual believes they have in helping a suicidal person
• self-perceived confidence in helping a suicidal individual [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  measures the level of confidence that the individual believes they have in helping a suicidal person
• whether the individual has helped someone who is suicidal since the last time point [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  assess whether the person has helped someone who is suicidal
• self-perceived knowledge about suicide [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  measures the level of knowledge about suicide that the individual believes they have
• self-perceived skill in helping a suicidal individual [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  measures the level of ability that the individual believes they have in helping a suicidal person
• self-perceived confidence in helping a suicidal individual [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  measures the level of confidence that the individual believes they have in helping a suicidal person
• whether the individual has helped someone who is suicidal since the last time point [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  assess whether the person has helped someone who is suicidal
• attitudes towards suicide [ Time Frame: January 17-21, 2011 ] [ Designated as safety issue: No ]
  measures attitudes toward suicide
• attitudes towards suicide [ Time Frame: October 1-2, 2011 ] [ Designated as safety issue: No ]
  measures attitudes toward suicide

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.

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.

• Experimental: ASIST intervention
  Intervention: Other: ASIST
• No Intervention: Control group: training as usual
  clerkship training as usual

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