Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum

Abstract

BackgroundThis article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse.MethodsThe authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U.S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models.ResultsThis paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice.ConclusionsBroad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.

Families Affected by Parental Substance Use

“…Use motivational interviewing techniques (asking screening questions, developing discrepancy, expressing empathy, avoiding argumentation, rolling with resistance, and supporting patient selfeffi cacy), assist families in identifying problems substance use can cause and reasons a person may want to quit or cut back. 75 Assist parents who screen positive and identify treatment options. Offer information, support, and follow-up for parents who screen positive.…”

“…74 Substance use screening that is age, sex, and culturally appropriate can be included in routine pediatric health maintenance care. 75 By using motivational interviewing techniques (asking screening questions, developing discrepancy, expressing empathy, avoiding argumentation, rolling with resistance, and supporting patient self-efficacy), a provider can assist families in identifying problems substance use can cause and reasons a person may want to quit or cut back. 75 Substance use screening could include review of the mother's prenatal medical information and screening by history and, when indicated, urine toxicologic testing in the newborn period before hospital discharge.…”

“…74 It is important for pediatricians to develop respectful, compassionate approaches regardless of condition, ethnicity, age, or sexual orientation. 75 Because health care providers are mandated reporters, they should understand obligatory child abuse reporting laws in their states and should know how to make a report to the responsible agency that investigates cases of alleged child abuse or neglect in their jurisdiction. 73 …”

“…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.…”

Derivation of a Shortened Research Instrument for Measuring Alcohol and Other Drug (AOD) Attitudes in a Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training Program

“…However, physicians often lack adequate knowledge and skills about SBIRT (O'Connor, Nyquist, & McLellan, 2011). In response to this gap, specialized SBIRT training programs were developed for emergency medicine (Bernstein et al, 2007), primary care (Tanner, Wilhelm, Rossie, & Metcalf, 2012), family medicine (Seale, Shellenberger, & Clark, 2010), pediatrics (Ryan et al, 2012), and multidisciplinary programs aimed at improving healthcare professionals' SBIRT competence and AOD attitudes, knowledge, and skills (Clemence et al, 2015;Scott et al, 2012;Tetrault et al, 2012). A challenge that comes with these training programs is adequately measuring trainees' attitudes and perceptions regarding working with patients with alcohol and drug-related problems.…”