Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design

Abstract

BackgroundUnhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge.DiscussionWe review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula.SummaryGiven the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues.

Developing and Implementing a Multispecialty Graduate Medical Education Curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT)

“…Regarding learners, residents nationally have identified the need for more training in how to screen for and treat alcohol and other substance use (26,34,35) and this also has been the case at our institution. To address this need, members of our SBIRT core senior faculty previously developed and implemented brief intervention curricula using standardized patient scenarios for practitioners in the emergency department (36) and for medical students (27).…”

Families Affected by Parental Substance Use

“…In addition, it is helpful for pediatricians to provide brief interventions to adolescent patients with positive screens for substance use. 75,77,78 Be able to direct families to community, regional, or state resources available for children and adolescents in families with substance use. Discussing identified concerns with the family and offering information, support, and follow-up are components of quality pediatric care.…”

Hospitalists and alcohol withdrawal: Yes, give benzodiazepines but is that the whole story?

“…[3][4][5][6] Yet despite the large numbers and great costs to the healthcare system, the inpatient treatment of alcohol withdrawal syndrome remains the ''ugly stepsister'' to more exciting topics, such as acute myocardial infarction, pulmonary embolism and procedures. 7,8 We hospitalists typically leave the clinical studies, research, and interest on substance abuse to addiction specialists and psychiatrists, perhaps due to our discomfort with these patients, negative attitudes, or belief that there is nothing new in the treatment of alcohol withdrawal syndrome since Dr Leo Henryk Sternbach discovered benzodiazepines in 1957. 7,9 Many of us just admit the alcoholic patient, check the alcohol-pathway in our order entry system, and stop thinking about it.…”

“…7,8 We hospitalists typically leave the clinical studies, research, and interest on substance abuse to addiction specialists and psychiatrists, perhaps due to our discomfort with these patients, negative attitudes, or belief that there is nothing new in the treatment of alcohol withdrawal syndrome since Dr Leo Henryk Sternbach discovered benzodiazepines in 1957. 7,9 Many of us just admit the alcoholic patient, check the alcohol-pathway in our order entry system, and stop thinking about it.…”