Framework for implementing physician education in substance use disorders

Education should be a window, not a wall. One would expect latest developments in research and science to move straight into practice, but it often hits a wall, preventing its translation into practice through education. What is this ‘implementation gap’ a wall, and how can we overcome it?

We explored this question with my co-authors in our recent paper published in the November issue of the Drug and Alcohol Dependence Reports. The paper is called: Towards a framework for implementing physician education in substance use disorders. You can find it by entering the title or journal name in your preferred search engine or by clicking on the links in this blog. Our focus in this paper was on medical education, but ultimately it can serve any educational field.

Why is it that the best, most solid new scientific ideas do not reach the world of practice?

There are three dimensions to this question that we need to understand: access, application and environment.

Access is how the latest information reaches learners. There are major differences in information accessibility from country to country, and the latest insights are not included in education.

Application has two main issues. One, education is not being tailored to how learners learn best. And second, new knowledge is taught at a late stage in the curriculum. Teaching future doctors issues like empathy towards patients with complex problems only comes after four years of pure medical education.

And last, what are the effects of environment, or context on the implementation gap? How do local settings, such as the socioeconomic issues, affect how they learn and get information? How does the educational institution, curriculum or teacher impact the education you receive, and how you learn after you graduate? Essentially, this can determine for example the gap between effective treatment and the actual treatment patients receive.


Framework and hypothesis:

Our hypothesis is that the training neglects the environment where the teaching happens. We’ve chosen to focus on the problem of substance use disorders because it has relevant use right away.

So how can we measure the impact of the environment?

Once we know the key factors and how they relate to each other we can go back to the students and faculty and ask them in focus groups and individually. That way, we can deliver that information in a way that will apply to them and help them to change their behavior, right away.

And yes, we must start with substance use disorders. Once we have a new conceptual framework, we can apply it across other disciplines beyond medical education, such as mental health. This is how we can make sure that education will be a window and not a wall.


Cited study: Klimas, J., McCracken, R., Robertson, R., Cullen, W. (2021) Towards a framework for implementing physician education in substance use disorders. Drug and Alcohol Dependence Reports 1 (100001)




  • Substance use education is inadequate despite the urgent need to equip health care professionals to effectively treat substance use disorders.
  • Ineffective timing of substance use education within the timeline of medical training contributes to a lack of knowledge and negative attitudes.
  • The imminent implementation or scaling up of the various training initiatives calls for an urgent examination of their methods from a contextual perspective.

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