Training on how to use the INTERMED: the experience at Modena Medical School

Background: INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs and risks of patients. It consists in a structured interview leading to definition of 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. Aim: To describe the training process on the use of INTERMED and to assess its effectiveness.Methods: A training group of 9 subjects (4 student nurses, 3 residents in psychiatry, 1 consultant psychiatrist and 1 psychiatric nurse) had two-hour meetings twice a month between April and September 2009. After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing video-recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the beginning and at the end of the training and compared statistically by means of Cohen’s kappa. Results: Motivation and involvement of students in the training was high (participation was on a voluntary basis during extra-work hours), as well as satisfaction, particularly among the student nurses. Agreement between individual and consensus scores was high already at the beginning of the training (Cohen’s kappa mean value of 0.80) and slightly improved during the course. Conclusions: The training process gave positive results both on the quantitative and the qualitative sides of evaluation. A six-month 25-hour training period is a reasonable time for learning how to master the instrument, although it needs to be followed by the clinical practice. These preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena.