Researchers from Boston Medical Center (BMC) have found that education on addiction is inadequate during medical training, resulting in suboptimal medical care for those at risk. However, the research also found that a Chief Resident Immersion Training (CRIT) program in addiction medicine is an effective "train the trainers" model for dissemination of addiction knowledge and skills to generalist physician trainees.
The goal of the CRIT program is to provide incoming generalist chief residents from internal medicine, family medicine and emergency medicine with the scientific foundation of addiction medicine and state-of-the-art diagnosis and management skills of addiction medicine, and to facilitate the integration of addiction medicine content into residency program curricula and chief resident teaching.
A total of 86 incoming chief residents applied to the annual CRIT program over a three year period, with 64 participating in the CRIT intervention group and 22 attended the control group. Each member of the program received a questionnaire at baseline and again at six months after the program to assess changes in addiction medicine knowledge, skills, clinical practice and teaching.
Members of the intervention group were required to develop a substance use teaching project to be implemented during their chief residency and received addiction medicine resources and teaching tools, including slide presentations, case studies, instructions and role descriptions for skill practice exercises, the latest medical literature and important addiction websites to use as a resource.
At the six month follow-up, the intervention group reported a significant increase in addiction medicine knowledge, confidence and preparedness to diagnose, manage and teach and an increase in clinical and teaching practices compared to their baseline and to the control group. At baseline, both groups reported high levels of feeling responsible for teaching about addiction. While the intervention group had no change in their levels of feeling responsible to teach about addiction at follow-up, the control group had a significant decrease. Eighty-six percent of the intervention group reported that their substance use teaching project had an impact on their residency program curriculum.
"Training chief residents who have a primary responsibility for educating medical trainees, appears to be one important pragmatic strategy to address the compelling need for better physician training in the identification and management of patients with addiction," explains lead author of the study Daniel P. Alford, MD, MPH, FACP, Associate Professor of Medicine at Boston University School of Medicine and director of Chief Resident Immersion Training in Addiction Medicine Section of General Internal Medicine at BMC. "This program effectively transferred evidence-based addiction knowledge and practice to 64 chief residents in generalist disciplines and more importantly, enhanced the addiction curriculum in 47 residency programs," said Alford.
These findings appear in the Journal of General Internal Medicine.
This research was funded by the National Institute on Drug Abuse.
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