Commentary Article: Transforming an Educational Ecosystem for Substance use Disorders: A Multi-Modal Model for Continuous Curricular Improvement and Institutional Change

Abstract

Health professions curricula are created to prepare learners to effectively address health issues affecting individ uals and their communities. Ideally, curricula emphasize the predominant biopsychosocial influences impacting the health of diverse populations. However, despite decades of investment and advances in educational research and design, we have failed to create a health professional workforce capable of equitably meeting the health care needs of the public. Particular communities, geographic regions, and patients with stigmatized diagnoses continue to be underserved, and the potential contributions of multidisciplinary health professionals and advanced practice providers continue to be unrealized within a predominantly physician-centric health care model. Genuine educational transformation requires multidimensional, iterative strategies used to meaningfully evolve traditional classroom curricula, break from the implicit and “hidden” curricula, and enrich the educational ecosystem in which all operate. This manuscript elaborates the construct and process of “educational ecosystem transformation” as a tool for the evolution of the educational ecosystem and its situated curriculum that will eventually drive the enrichment of the healthcare workforce. Drawing from traditional models of curriculum development, recent work on transforming the hidden curriculum, the clinical learning environment, and change management strategies, this new approach uses a health equity and structural competence lens to interrogate and deconstruct a learning system in order to identify opportunities to change, strengthen, and deepen a learner's experience around a specific topic. This process requires an in-depth, multidimensional assessment followed by the identification of key change targets and a stepwise, iterative plan for improvement and transformation. The topic area of substance use disorders (SUD) is used to illustrate how this complex process might be employed to improve the quality of care, realize and amplify the contributions of the entire healthcare team, stimulate interest in addiction medicine as a career, and reduce the stigma and disparities patients with SUDs often experience.

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

“…ACS provide a disruptive innovation to jump-start this revision and align with calls to transform the educational ecosystem for SUD through continuous curriculum improvement and institutional change. 27 With recent elimination of the Drug Addiction Treatment Act 2000 waiver for buprenorphine prescribing came a new requirement for anyone renewing or applying for a Drug Enforcement Agency license to complete an 8-h training on SUD management starting in June 2023. 28 This training can be waived for those who graduate from a health professional program that provides qualifying addiction training within their curriculum.…”

CE: Reducing Bias Against People with Substance Use Disorders

“…Instead, students often draw lessons from the implicit messages about values, norms, and attitudes conveyed by the behavior of role models or influential groups, such as nursing professors, preceptors, and other nurses. 28 Attitudes of first-year nursing students toward people with SUDs can be changed with educational interventions such as teaching the disease model of addiction and hearing firsthand accounts from people in recovery. 30 Role modeling or demonstrating skills such as screening, assessing, and providing medication for SUDs can improve nursing students' knowledge and provide opportunities to approach instances of discomfort as moments to discuss evidence and therapeutic interventions.…”

“…The Joint Commission's effort to improve pain management by stating in its Pain Standards for 2001 that “pain is considered a ‘fifth’ vital sign in the hospital's care of patients,” may have led to unintended consequences, such as the more aggressive use of opioids to treat pain 27. The U.S. government's punitive “war on drugs” initiative contributed to incarceration and failed to recognize addiction as a medical disease requiring treatment 28. These factors further promoted stigma and marginalization, creating barriers to lifesaving therapies 28.…”

“…27 The U.S. government's punitive "war on drugs" initiative contributed to incarceration and failed to recognize addiction as a medical disease requiring treatment. 28 These factors further promoted stigma and marginalization, creating barriers to lifesaving therapies. 28 Moreover, traumatic events such as the COVID-19 pandemic have increased social isolation and restricted access to treatment providers and facilities as well as to harm reduction interventions.…”

“…28 These factors further promoted stigma and marginalization, creating barriers to lifesaving therapies. 28 Moreover, traumatic events such as the COVID-19 pandemic have increased social isolation and restricted access to treatment providers and facilities as well as to harm reduction interventions. 29 While not all risk factors for developing a SUD can be prevented (the risk conferred by genetics, for example), many can be modified or eliminated.…”