MDs PRACTICE A TRICKY PATIENT INTERACTION
Talking to teens about their drinking and drug use can easily go sideways.
We provided guidance and an opportunity to practice.
The SBIRT program supports providers in helping adolescents to change their substance use when they come into the office for a routine visit.
Doctors and other providers need training for a 5-10 minute intervention that can have a life-long impact for young people.
The Problem + The Solution
Doctors are good at sharing their expertise. But having a conversation about drugs or drinking, especially with a teenager, uses a different skill set.
When doctors sit down with a patient, they review their health issues, administer advice, give recommendations, and they generally need to be a little bossy.
Talking to teenagers about drugs and alcohol calls for a different strategy. Research shows that using the spirit and techniques of Motivational Interviewing (MI), and following a specific six-step protocol, is the most effective way to create change.
Although the state of Virginia has been able to provide in-person training for new partners to learn how to conduct a brief negotiated interview, they needed an asynchronous method to learn and practice the skills when trainings were not otherwise available - for new hires, future SBIRT participating partners, or those who needed to brush up.
We created a four-module course. It’s a low-stakes way to practice the conversation, with increasing levels of difficulty and plenty of support for learners, like mentor tips, downloadable job aids, and ample feedback along the way.
Target audience
MDs, mental health clinicians, and behavioral interventionists who work with adolescents in treatment for substance use
Responsibilities
Research & analysis
Scriptwriting
Storyboarding
Consulting closely with subject-matter experts
Asset and graphics development
Creation of promotional pocket cards, posters, and website
Project Management
Visual design
Development
Video and audio management
Supervision of QA & voiceover contractors
Communication with and data collection from beta testers
Implementation and LMS management
Tools used
Articulate Storyline 360
Adobe Illustrator
PowerPoint for graphics design
Miro / Zoom Whiteboard
Google Docs
Canva
The Process
Needs Assessment
My stakeholders were already experienced in delivering in-person training and support around MI (Motivational Interviewing) and administering the Brief Intervention (BI). When I joined their team, I was able to draw upon my long educational background and expertise in eLearning to guide them towards the best practices for that particular learning format.
In addition, I advised my stakeholders to keep the learner’s experience front and center during the entire design process. Each module is designed to provide engagement from the beginning, with non-mandatory options to learn more through downloads, explanatory videos and walk-throughs. We wanted to allow for different levels of learning - for those brushing up, to those who were starting fresh - and therefore, avoided the unpleasant and boring, click-through-til-you’re-done eLearning. Learners autonomously explore their options.
“We avoided the unpleasant and boring, click-through-til-you’re-done eLearning. Learners autonomously explore their options.”
Text-based Storyboard
Once we had identified our learning objectives, we wrote an outline for four modules that would cover the six steps of the BI, instruction on how to score and interpret the drug and alcohol questionnaire that patients complete before their visit, and some of the basics of Motivational Interviewing.
We worked in an iterative process with review cycles. I kept my stakeholders up to speed on our progress with weekly update emails that included timelines, landmarks and accomplishments, and callouts for action for each team member.
Design: Visuals
As the Module 1 storyboard was coming together, I developed and suggested design ideas for the look and feel of the modules. Stakeholders provided the VA Y-SBIRT logo, which I adapted into the palette, and I experimented with a few different characters to represent the youth patients and MDs.
The cartoony characters were stock images from StoryLine, and I liked that there were somewhat young-looking patients, and a few characters dressed like doctors.
However, in the end, I decided that photorealistic characters would provide a more realistic and opportunity for more emotional expression.
Early Style Guide
Design: Learner Autonomy
I knew that I wanted to engage learners and throw them right into action from the beginning, and the first module is designed to offer non-mandatory explanations and instruction. Each module offers a choice to review the materials or to jump into the practice scenario.
Design: Interactive Activities with Increasing Levels of Difficulty
I knew that I wanted to engage learners and throw them right into action from the beginning, and the first module is designed to offer non-mandatory explanations and instruction.
I studied up on how to design branching scenarios from these masters of eLearning: Christy Tucker, Kimberly Goh, and Tim Slade.
Knowing that I wanted to increase the level of difficulty throughout the four modules, I designed them with the following major features:
Module 1: Gina Scenario - a forced success simple mastery loopModule 2: Plentiful practice scoring the screening tool questionnaireModule 3: Jackson Scenario - a continuous story with scored endingModule 4: Minh Scenario - branch and bottleneck with twelve possible endings (whew!)Read on for more detail on the three scenarios.
Scenario #1 - Gina
For my first module, I wrote a 6-question simple mastery loop. If the learner chooses one of the incorrect answers, they receive immediate feedback and the chance to choose again until they make the correct selection. There are mentor tips, slide titles, a success bar and other cues to support the learning.
In Module 1, learners get immediate feedback from their choice, and an opportunity to choose again.
Scenario #2 - Jackson
The next branching scenario had to be more difficult for the learner to succeed, so I created a 6-question continuous story with scored endings. There were still some support measures, like the success bar and mentor tips, but this time the learner only received a story consequence for incorrect answers, but no feedback.
Our needs analysis determined that our target audience was motivated by seeing a numerical score, so we included that in the results screen.
Learners receive one of six endings, either passing or failing, depending on their score.
CONTINUOUS STORY WITH SIX ENDINGS (DEPENDENT ON SCORE) Our module had six questions.
By the second scenario, learners are earning points for their answers. In this Results Screen, they receive feedback and consequences of their choices, and opportunity to try again to increase their score.
Failing Results Screen - learners are required to try again until they pass.
Scenario #3 - Minh
The final branching scenario was very complex, and included sixty slides.
It was a true branching scenario, with dead endings (try-again opportunities) for two sequential wrong answers, and two bottlenecks to keep the scenario under control.
With my team, I wrote all of the different options, and twenty different possible endings. It was sometimes a challenge to weave the interview back together after all of the diversions, and a programming challenge as well, but in the end, it is a true representation of the MI skills and practice that the learners need to successfully affect change in their young patients.
While learners still have access to downloadable learning aids and hints, more advanced practitioners can navigate the scenario without any of the learning scaffolding that was provided in earlier modules.
BRANCH AND BOTTLENECK WITH 12 ENDINGSThis is a screenshot of the Storyline Story View of the Minh Scenario. Don’t let this hurt your brain.
Minh’s consequence from an early fail after only two questions.
Minh - Try Again.
Voiceover, QA, and Beta-Testing
I had the pleasure of leading a team of talented subcontractors, including a voiceover narrator, a QA team, and a group of beta testers. Working with the narrator was a collaborative process where we fine-tuned the tone and pacing to make the content both engaging and clear for learners. We went through several revisions to ensure the narration matched the goals of the module and resonated with the target audience.
With the QA team, I organized a smooth review process to catch any technical issues or inconsistencies. Together, we scheduled rounds of testing to make sure everything worked seamlessly across different devices and browsers. I made sure feedback flowed easily between the developers and the QA team, so any adjustments were handled quickly and efficiently.
For the beta testing phase, I guided a group of testers who helped us see the course through fresh eyes. Their insights were incredibly valuable, and I worked closely with them to gather feedback on the overall experience, content clarity, and user interaction. Thanks to their input, we made some final tweaks that really improved the modules, ensuring they were easy to use and met the needs of our learners.
Results & Takeaways
As the learning designer and consultant throughout the entire process - from conception, design, development, and implementation - I oversaw every step of the process. In the end, the stakeholders were very happy with the results.
Comprehensive Needs Analysis: Through thorough consultations with subject matter experts (SMEs) and stakeholders, the project ensured that each module addressed key learning objectives, resulting in content that was highly relevant and targeted to the audience.
Effective Instructional Design: The use of a learner-centered design approach—incorporating clear learning outcomes, engaging multimedia elements, and interactive scenarios—led to an increase in learner engagement and knowledge retention.
Streamlined Development Process: By creating detailed design documents and storyboards for all four modules, I had a clear roadmap to follow. This approach minimized revisions and kept the project on schedule, ensuring timely completion of each module.
Effective coordination and communication: By coordinating the voiceover, QA, and beta testing teams, I ensured that we met every project milestone on time, contributing to an efficient and collaborative workflow.
Seamless QA and Testing: A structured QA process helped ensure an error-free launch, with rigorous testing across devices and browsers. The end result was a highly polished, user-friendly product with many accessibility features, and no reported technical issues post-launch.
Statewide Distribution: The four modules, plus a collection of references, will be disseminated through multiple statewide channels to encourage more pediatric providers to start delivering YSBIRT services.
High Satisfaction Rates: The course received an average satisfaction rating of 4.5/5 from beta testers, highlighting the success of the interactive elements and clear instructional design.
Error-Free Launch: Thanks to the comprehensive QA process, the course launched with no reported technical issues, providing a smooth experience across all devices and browsers.
Key Takeaway: A solid foundation in the analysis and design phases, combined with close collaboration with SMEs and contractors, is key to creating an effective learning experience. Detailed planning and communication during the development phase and a well-managed QA process ensure the final product meets both educational and technical standards.