Core Addiction Medicine Competencies for Doctors: An International Consultation on Training

Abstract

Background Despite the high prevalence of substance use disorders, associated comorbidities, and the evidence base upon which to base clinical practice, most health systems have not invested in standardized training of health care providers in addiction medicine. As a result, people with substance use disorders often receive inadequate care, at the cost of quality of life and enormous direct health care costs and indirect societal costs. Therefore, this study was undertaken to assess the views of international scholars, representing different countries, on the core set of addiction medicine competencies that need to be covered in medical education. Methods A total of 13 members of the International Society of 20 Addiction Medicine (ISAM), from 12 different countries (37% response rate), were interviewed over Skype, e-mail survey, or in person at the annual conference. Content analysis was used to analyze interview transcripts, using constant comparison methodology. Results We identified recommendations related to the core set of the addiction medicine competencies at 3 educational levels: (i) undergraduate, (ii) postgraduate, and (iii) continued medical education (CME). The participants described broad ideas, such as knowledge/skills/attitudes towards addiction to be obtained at undergraduate level, or knowledge of addiction treatment to be acquired at graduate level, as well as specific recommendations, including the need to tailor curriculum to national settings and different specialties. Conclusions Although it is unclear whether a global curriculum is needed, a consensus on a core set of principles for progression of knowledge, attitudes, and skills in addiction medicine to be developed at each educational level amongst medical graduates would likely have substantial value.

Towards competency-based medical education in addictions psychiatry: a systematic review

“…4,42 Early on, fellowship programs in addiction psychiatry have emphasized three pillars: knowledge base, skills, and attitudes. 43 In recent years, competency-based models in addiction psychiatry have highlighted attitudinal skills, 3,[5][6][7] biopsychosocial-spiritual formulation, 1,3,5,72 addiction neurobiology, 5,72 psychological treatments, 3,[5][6][7] pharmacotherapy, 1,4,5,7,73 and concurrent disorder management. 1,4,73 To that end, CBD in addiction psychiatry has been successfully implemented outside of Canada, with several dedicated EPAs integrated into residency training programs in Australia and New Zealand 74 and the United States.…”

“…3,4 Ultimately, psychiatry residents must gain competence with primary addiction treatment modalities, such as detoxification, ambulatory care, and rehabilitation. 3,[5][6][7] Surveys of Canadian psychiatry residents and psychiatrists report they feel most unequipped to manage patients who present with addiction-related issues. 5,8,9 As we usually consider psychiatrists the experts in mental illness and addiction, this discrepancy between professional responsibility and real-world practice points to a more systemic problem in psychiatry residents' training.…”

The Design and Outputs of the Pilot Implementation of the “Enhancing Skills in Screening and Assessment for Physicians and Rehabilitation Practitioners Level 2 Course”, Philippines, 2014

“…Of note, only Norway was noted in our review of the literature to have utilized a multidisciplinary approach to training in the field of substance use disorder (as a co-occurring disorder among individuals with severe mental illness) 21,22 , as all other training programs were conducted for each professional group separately. [9][10][11][12][13][14][15][16][17][18][19] While it can be argued that different professionals have varying job descriptions and, hence, will require development of diverse set of competencies, a counterclaim can be made that, at least within the ambit of drug rehabilitation, the focus of service provision by physicians and rehabilitation practitioners is the same individual. Thus, interdisciplinary collaboration becomes imperative to ensure convergence and synergy of efforts to attain a common treatment outcome.…”

“…Among others, the plan was to deploy advanced courses in screening and assessment (Level 2a) as well as treatment planning and management (Level 2b); a refresher course for physicians accredited by the Dangerous Drugs Board (DDB) under the prior dangerous drugs statute; and an executive course for heads of drug rehabilitation facilities, and decision-makers and policymakers involved in drug rehabilitation. This paper describes the design and presents the outputs of the Level 2a course implemented in 2014 (the only advanced course implemented to date since the policy direction of DOH in 2016 focused on accrediting more physicians and rehabilitation practitioners under the basic training course), with the end in view of contributing to the published literature [7][8][9][10][11][12][13][14][15][16][17][18][19] on drug rehabilitation training. It is also our purpose to document the efforts of the DOH, together with CPH-UPM, PCAM, and GAPP, in addressing the country's drug problem through the development and implementation of a local capability-building initiative.…”

Closing the gap between training needs and training provision in addiction medicine

“…In the absence of scientific evidence, recommendations have been made by international scholars that highlight a core set of competencies to be covered at undergraduate and postgraduate levels, as well in continued medical education. 10 Although relevant, these recommendations cannot be assumed to be representative of the competencies required in day-to-day practice. As members of the international Network of Early Career Professionals in Addiction Medicine (NECPAM), we call for a web-based survey to enable systematic assessment of the training needs of the professionals working in addiction medicine, at various educational levels and in a wide variety of countries.…”