RESUMO
OBJECTIVES: Adequate training of mental health professionals in suicide risk assessment and intervention is crucial. Simulation-based education is a relevant method to acquire competences for challenging health interventions. Here, we aimed to evaluate the effects of a simulation-based training program on first-year psychiatry residents' skills, knowledge, attitudes and satisfaction. METHODS: We conducted pre- and immediately post-training assessments in 153 psychiatry residents during their first or second postgraduate semester in Paris, France, in 2020 and 2021. The simulation-based training occurred a few weeks after a two-hour theoretical lecture on suicidal behaviors. It consisted of a full-day training of small groups (n=5 to 9) with six scenarios played by professional actors and facilitated by two trained psychiatrists, and a 45-60minute debriefing session after each simulation. Educational objectives focused on basic aspects of patient-psychiatrist relation, the investigation of suicidal ideation, and basic interventions in various contexts (outpatient consultation, emergency room, telephone) and patient profiles. Outcome measures included the Suicide Intervention Response Inventory (SIRI-2), a short questionnaire on basic knowledge, a self-confidence four-item scale, and a satisfaction questionnaire. RESULTS: There were significant improvements in skills, basic knowledge, and self-confidence from pre- to post-training. Trainees also expressed a high level of satisfaction, an appreciation for this innovative pedagogy and a wish for more similar training. CONCLUSIONS: This practical training program based on simulation improved self-confidence, knowledge and skills in suicide risk assessment and intervention in the short-term among first year psychiatry residents. Results from this study are therefore promising. Longitudinal studies are, however, needed to evaluate the persistence of changes over time, positive changes in care in real settings and health benefits for patients. In a time of easily accessible and rapidly growing factual medical knowledge, of necessary need for skilled professionals and of growing demand in mental health care, the development of simulation training in psychiatry should be a pedagogical and a public health priority.
RESUMO
PURPOSE: Suicide is a major cause of preventable death worldwide. Adequate training in risk assessment and intervention is key to suicide prevention. The use of simulation (role plays, simulated patients, virtual reality ) for practical training is a promising tool in mental health. The purpose of this study was to assess the effectiveness of simulation training in suicide risk assessment and intervention for healthcare professionals and gatekeepers. METHODS: We conducted a systematic review in Medline and PsycINFO up to 31 July 2021 of randomized controlled trials (RCTs), non-randomized controlled trials, and pre/post-test studies. RCTs were furthermore included in a meta-analysis. We assessed the methodological quality of all studies with the Medical Education Research Study Quality Instrument, and the Cochrane Risk of Bias tool 2.0 for RCTs. Primary outcomes were changes in Kirkpatrick criteria: attitudes, skills, knowledge, behaviors, and patient outcomes. RESULTS: We included 96 articles representing 43,656 participants. Most pre/post-test (n = 65) and non-randomized controlled (n = 14) studies showed significant improvement in attitudes, skills, knowledge, and behaviors. The meta-analysis of 11 RCTs showed positive changes in attitudes immediately after training and at 2-4 months post-training; in self-perceived skills at 6 months post-training; but not in factual knowledge. Studies assessing benefits for patients are still limited. CONCLUSIONS: The heterogeneity of methodological designs, interventions, and trained populations combined with a limited number of RCTs and studies on patients' outcomes limit the strength of the evidence. However, preliminary findings suggest that simulation is promising for practical training in suicidal crisis intervention and should be further studied.