Substance use disorders constitute one of the most significant public health issues in the United States, and, in addition, there is solid evidence of an unmet need for care among those with these disorders. Although physicians are well placed to address this unmet need, there is also evidence that they frequently do not appropriately screen, diagnose, provide treatment interventions, or make referrals to specialists for those with these disorders.
Providing Competency-Based Family Medicine Residency Training in Substance Abuse in the New Millennium: A Model Curriculum (2010)
Published on line at Biomedical Central Section on Medical Education, this core curriculum (commissioned by the Betty Ford Institute and MERF) is focused on screening, brief intervention and referral to treatment. It can be adapted by residency programs to meet their individual needs. Includes links to two additional files: specific modules with curriculum objectives associated with ACGME competencies and strategies for overcoming substance abuse training barriers.
This is an early working draft (incomplete in some areas) of the report of the third ONDCP conference held in January 2008. That meting was designed to share information about what had been accomplished since the first and second national leadership conferences and to focus on SBIRT (Screening, Brief Intervention, Referral to Treatment) and getting screening and brief intervention incorporated broadly into clinical practice.
The report from the second national leadership conference (2006) convened by the White House Office of National Drug Control Policy (ONDCP). It contains sections called "Goals and Strategies" for these areas: undergraduate, graduate and continuing medical education; licensing, accreditation and certification standards; and for payers.
This is the report from the first national leadership conference convened by the White House Office of National Drug Control Policy (ONDCP) in 2004. It includes findings, recommendations and action plans about undergraduate, graduate and continuing medical education. These leadership conferences were repeated in 2006 and 2008.
The rigors of medical training sharpen a doctor’s ability to diagnose and treat a wide variety of human afflictions. However, drug abuse and addiction are often insufficiently covered in medical school curricula, despite the fact that drug use affects a wide range of health conditions and drug abuse and addiction are themselves major public health issues. To improve drug abuse and addiction training of future physicians, the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, unveiled (on Nov. 6, 2009) a series of new teaching tools, through its Centers of Excellence for Physician Information Program (NIDA CoEs), at the Association of American Medical Colleges 2009 Annual Meeting’s "Innovations in Medical Education" Exhibit in Boston.
Miller: Why Physicians Are Unprepared to Treat Patients With Alcohol and Drug-Related Disorders (2001)
The authors, Norman S. Miller, M.D. and others, review the findings of the literature on these problems, discuss the barriers to educational reform, and propose recommendations for developing an effective medical school curriculum about alcohol- and drug-related disorders. J Acad Med 2001;7:410-418.
A review of medical education in alcohol and other drug abuse by David C. Lewis, MD, Robert G. Niven, MD, Dorynne Czechowicz, MD and Jeanne G. Trumble, MSW. JAMA 1987; 257(21):2945-8.
To determine the amount of formal training in substance use disorders that occurs in selected residency programs and to identify the perceived barriers to such training, a national survey was conducted (by Isaacson JH, Fleming M, Kraus M, Kahn R) of program directors in emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic medicine, pediatrics and psychiatry. J Stud Alcohol 2000; 61: 912-915.
Internal Medicine Residency Training for Unhealthy Alcohol and Other Drug Use: Recommendations for Curriculum Design (2010)
An outline of a curriculum in unhealthy substance use with examples from common teaching venues. Specific topics are recommended and the content is linked to ACGME core competencies. Commissioned by the Betty Ford Institute and MERF; published on line at Biomedical Central Section on Medical Education.
Integrating Addiction Medicine Into Graduate Medical Education in Primary Care: The Time Has Come (2011)
This article (from Annals of Internal Medicine, January 2011) discusses five specific recommendations for getting core competencies about addiction into the curriculum of residency training programs in internal medicine and family medicine. The recommendations were made at the consensus conference held by the Betty Ford Institute and MERF in 2008.
Healthcare Access Among U.S. Adults Who Drink Excessively: Missed Opportunities for Prevention (2006)
Data from a 2002 Behavioral Risk Factor Surveillance System of 246,964 study participants. Results indicate 79% of “excessive drinkers” have health insurance and 78% had a “recent” check up with a physician. Highlights low screening rates of excessive drinkers and physician missed opportunities to help persons with harmful or potentially harmful drinking practices. Prev Chronic Dis 2006; 3(2):A53.
Fleming: Who Teaches Residents About the Prevention and Treatment of Substance Use Disorders? (1999)
1999 national survey by Michael F. Fleming and others, via telephone interviews, of the faculty who taught residents about substance use disorders. J Fam Pract 1999; 48(9):725-9.
Research published in Addiction by Nady El-Guebaly et. al. Aims. To analyze the process of acquisition by physicians of a body of knowledge and skills in the management of substance abuse. Design. A comprehensive search of English-speaking literature was conducted over 20 years. Articles assessing the outcome of educational strategies in undergraduate, graduate and continuing medical education were examined to determine the targeted sample, the educational strategies involved and the outcomes assessed. Findings. Nine studies in undergraduate education, 11 in graduate and 11 in continuing education met the inclusion criteria. They were generally difficult to compare in design, strategy and outcome analysis. Cognitive knowledge and behavioral skills appear to be easier to obtain compared to more complex attitudinal shifts. Conclusions. There is growing consensus in the selection of a combined didactic and interactive educational strategy but few empirical data as to the more cost-effective learning interventions. Training must be reinforced at regular intervals. While the expanding panoply of interventions available to physicians should enhance the perceptions of role legitimacy and treatment optimism, cohort studies across levels of education, specialty groups and across-substance and other addictive behaviors are required to determine cost-effective educational strategies. Addiction 2000; 95(6): 949-957.
Davis: Substance Abuse Units Taught by Four Specialties in Medical Schools and Residency Programs (1988)
A survey by Ardis K. Davis, F. Cotter and D. Czechowicz of medical schools and residency programs in four specialties (family practice, internal medicine, pediatrics, and psychiatry) sought information on the number and type of curriculum units on substance abuse offered by them. Considerable variation in offerings was found among the specialties. J Med Educ 1988; 63(10):739-746.
D'Onofrio: Improving Emergency Medicine Residents' Approach to Patients With Alcohol Problems (2002)
Two groups in a Level 1 trauma center were studied: the intervention group and a control group. The intervention was a 4-hour didactic, a video and a skills-based workshop. Change was measured by record review before and after intervention. Ann Emerg Med July 2002; 40:50-62.
Medical education shapes student attitudes toward substance-abusing patients,often in negative ways. Curricular interventions to foster more positive attitudes toward such patients and their treatment can have lasting effects on clinical practice. The nature and duration of such interventions, however, requires clarification. To test the hypothesis that spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site would improve attitudes toward substance-abusing patients without reducing the clerkship benefits on attitudes toward, and knowledge about, psychiatry patients. Conclusions: Spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site increased regard for patients with alcoholism without adversely affecting measures of attitudes toward, and knowledge about, psychiatric patients. Teach Learn Med 2003; 15(2): 93-97.
An outstanding, and the most comprehensive, survey of primary care physicians and patients with substance abuse. The paper reveals how physicians identify, or fail to identify, substance abuse in their patients, efforts that physicians make, or don’t make, to help patients with substance use problems. The article includes an extensive discussion and assessment of the barriers to effective diagnosis and treatment. The Forward (pages i-iv), authored by Joseph Califano, is a “must read” for any primary care physician.
Bigby: Editorial—Substance Abuse Education During Internal Medicine Training (1989)
Julia H. Arnsten et. al. wrote case scenarios for OSCE stations based on their clinical experience and the core competencies described by Fiellin et. al., in the AMERSA "Strategic Plan." This article describes the process and the results. The immediate feedback provided during an OSCE helped teach needed skills for assessing and managing substance abuse disorders. J Gen Intern Med 2006; 21(5): 453-459.
This document contains the most commonly cited list of core competencies (starting on page 207) in the chapter written by David Fiellin, MD, Gail D’Onofrio, MD, Richard Brown, MD, Patrick O’Connor, MD, Richard Butler, DO.
This paper by Daniel P. Alford, M.D. et. al. describes the Chief Resident Immersion Training (CRIT) program in addiction medicine and evaluates its impact on chief resident (CR) physicians' substance use knowledge, skills, clinical practice, and teaching. The CRIT program in addiction medicine effectively transferred evidence-based SU knowledge and practice to 64 CRs in generalist disciplines and more importantly, enhanced the substance use curriculum in 47 residency programs. CRIT is designed to capitalize on the potential to shift the values and culture of a residency program to include more substance use training. J Gen Intern Med DOI: 10.1007/s11606-008-0819-2
The RRC for Internal Medicine revises its requirements about every two years and posts them for comment. The comment period ended May 2008. This 25-page document shows the revisions, which will become effective July 2009.
The RRC proposed these revisions “to match the intent of the Outcomes Project and base the residency training on the competencies, rather than on curriculum or process.” This 6-page impact statement discusses the intended impact of the changes.
ACGME Program Requirements for Internal Medicine (2007)
ACGME program requirements for residents in Family Medicine
ACGME program requirements for residents in Addiction Psychiatry
Pages one to five (the table of contents) give a detailed list of everything covered in this 110-page document. For example, the section "Procedures for the Develoment and Approval of Requirements" shows that changes originate with the Residency Review Committees and proceed through specific steps itemized here, including notifying the "communities of interest."