Category: qualitative interviews

Hospital teaching team keeps fighting opioid crisis

Overdose grafitti

Which student learns best with hospital teams fighting opioid crisis? Understanding how students learn is perhaps the most important way to improve addiction training.

In a new article published by the Substance Abuse journal,  we report findings suggesting that the completion of an elective with a hospital-based Addiction Medicine Consult Team appeared to improve knowledge of medical students more than of other types of students. Read more below or listen to the podcast.

Firstly, we found that both emerging and established physicians appear to be responsive to this type of training.  Secondly, the learner self-assessment can provide valuable feedback to the consultants. Then, consultants can focus more on the students who learn less.

Keep fighting opioid crisis through training

The study sample was drawn from medical students, residents and physicians who took part in a month-long rotation with a hospital-based addiction medicine consult team in Vancouver, Canada. The addiction rotation includes full-time clinical training involving intake assessment and treatment planning. And referrals to community agencies and starting people on evidence-based medications for substance use disorders. The students take part in didactic lectures, bedside teaching, journal clubs and some prepare papers for submission to peer-reviewed journals. Each year, about 80 learners go through the program. Furthermore, learners rate their knowledge before and after the training.

At the end, all learners reported increased knowledge. One group, however, learned more than the others – the medical students. This two-year study confirms that a structured clinical training program can lead to an increased knowledge on addiction and that medical students benefit from it the most.

For more info read the full article at:

Gorfinkel, L., Klimas, J., Ahamad, K., Mead, A., McLean, M., Fairgrieve, C., Nolan, S., Small, W., Cullen, W., Wood, E., Fairbairn, N. (2019) In-hospital training in addiction medicine:  A mixed methods study of health care provider benefits and differences. Substance Abuse (Published online Jan 28) doi: 10.1080/08897077.2018.1561596

If interested, you can also read: What can hospital teams teach medical students about addiction to help curb the opioid overdose epidemic?

Hospital teaching teams confront iatrogenic opioid addiction

 

Or visit a post that talks about this research as it was presented at the Canadian Society for Addiction Medicine link here

Canadian Society of Addiction Medicine, CSAM conference

Addiction social work fellowship launched

man and boy

Addiction social work fellowship launched!

Substance use disorders disproportionately contribute to the global social and economic burden of disease.

Sadly, their treatment has been inadequate in large part due to an enduring research to practice gap. Here, the competencies for treating and preventing substance use disorders are often lacking from social work education curricula.

Addiction social work fellowship launched in Canada

Recently, the British Columbia Centre on Substance Use started a new interdisciplinary fellowship in addiction social work, nursing and medicine in Vancouver, Canada. We describe the new fellowship program and outline initial impact of the training on knowledge and skills in addiction social work from our qualitative evaluation of the fellowship.

“The Addiction Social Work Fellowship program accepts two positions in Social Work annually. The program strives for excellence in clinical training, scholarship, research, and advocacy and includes specialty training in inpatient and outpatient addiction services, as well as related concurrent disorders training. The program prepares Fellows to work clinically in the field of addictions and take leadership roles in academic and/or research settings.” (www.bccsu.ca)

 

To read the whole story, please visit the journal website https://www.tandfonline.com/loi/wswp20 or lookup the paper using the following citation:

Callon, C., Reel, B., Bosma, H., Durante, E., Johnson, C., Wood, E., Klimas, J.  (In Press) Addiction Social Work Fellowship in Addiction Medicine: A Novel Programme in a Canadian setting. (Early Online July 30th) Journal of Social Work Practice in the Addictions 

If you enjoyed reading this post, you may also enjoy reading about the fellowship here.

Place matters, teachers and learners #CCME18

mountain climber

We learn best in places that support our learning and our bio psycho socio spiritual development – from toddlers to elders, reports Jan Klimas from the Canadian Medical Education conference #CCME18.

Starting in Toronto, Justin Hsu and colleagues from University of Toronto described how they improved spaces for communities in teaching ambulatory care, or the so called Medical Education Teaching Clinics (METC). They plan to evaluate METC clinics via audit of referrals to the teaching clinic and the learner satisfaction survey.
Presentation title: Creating unique spaces to support community-based ambulatory care education: the E3 experience.
Presentation authors: Jerry Maniate, Elizabeth Wooster, Douglas Wooster, Justin Hsu

British Columbia quality matters

Jan Klimas’ team from University of British Columbia evaluated hospital as a place of learning about substance use disorders. Who learns most about addictions in hospitals? Using mixed-methods approach, this team showed that medical students get more out of a rotation in hospital than residents or senior learners. Especially in the areas of safe prescribing, screening and withdrawal management. Why is that? Do residents know more or are they more resistant to new learning? For many medical students, hospital could be the first place where they see someone with addiction and that could be why they learn more in this setting.
Presentation title: Who learns most about addiction in the hospitals? A mixed methods study.
Presentation authors: Jan Klimas, Evan Wood, Walter Cullen, Will Small, Seonaid Nolan, Annabel Mead, Mark McLean, Christophe Fairgrieve, Keith Ahamad, Huiru Dong, Breanne Reel, Lauren Gorfinkel, Nadia Fairbairn

Derek Wilson and colleagues from the same university focused on the quality of health education learning environment (HELES study). HELES survey tool looked at relationship, personal development and program culture as the key parts of the learning environment at the faculty of medicine. For example, the evaluation asked whether the learners have developed a strong sense of community.
Presentation title: Evaluating the Quality of Health Professions Learning Environments: Validation of the Health Education Learning Environment Survey (HELES).
Presentation authors: Derek Wilson, Shayna Rusticus, Derek Wilson, Oscar Casiro, Kevin Eva, Lisa Hazlett, Chris Lovato

Calgary explores and experiences

Maureen Topps and collaborators from University of Calgary, Cumming School of Medicine, asked whether in addition to focusing on the deficiencies and gaps in education, whether we could research the successful activities related to professionalism. The postgraduate education is a key stage in training the next generation of competent and professional clinicians. Professionalism is hard to define and to define it may “limit it,” as Dr Barnhoorn writes in the Academic Medicine journal (2006, Vol. 91, No. 9). But how does the place of learning make for more professional doctors? Slowing down and taking time to plan interactions appears to foster professionalism among other factors such as communication training.
Presentation title: Contexts and Experiences of Postgraduate Residents that support successfully meeting professionalism challenges.
Presentation authors: Janet de Groot, Maureen Topps, Aliya Kassam, Maureen Topps

Nicole Delaloye and colleagues from the same university presented results from her Masters research of the MSc/MD program. Clinicians should be both polite and respective, but not overly submissive. Why do we follow orders? Resuscitation requires wise action, not passive deference. What happens when learners hold back too much and how does the place of learning impact submissiveness? Mechanisms that underly submission in the moment of revival include learner’s mental state, what was going on inside and outside the room, team and motivation.
Presentation title: An Exploration of Deference Behaviours Exhibited within the Paediatric Resuscitation Environment and the Educational Implications.
Presentation authors: Nicole Delaloye, Elaine Gilfoyle, Rachel Ellaway, Aliya Kassam, Elizabeth Oddone Paolucci

In summary, the best learning places not only support our learning, but also challenge us to learn knew knowledge, adopt the discipline’s values, overcome deference and become successful professionals in our own right.

The opinions and views in this article present the views of the author and not the named persons or the #CCME18 conference organisers.

6 ways to improve addiction training

new skills training

Addiction training is feasible and acceptable for doctors and junior physicians; however, important barriers persist. We need to learn more about the experience of addiction physicians in the fellowship training programs. Here are the 6 ways to help improve the training.

6 ways to better training

Recently, new programmes have emerged to train the comprehensive addiction medicine professionals internationally and one of them is in Vancouver, Canada. We interviewed 26 persons who completed this training programme. They were psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. We found six barriers and enablers of training implementation: (1) organisations, (2) structures, (3) teachers, (4) learners, (5) patients and (6) community. Human resources, a variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time as well as space limitations hindered implementation.

Why training clinicians in addictions

Addiction care is usually provided by unskilled lay-persons in most countries and thus the resulting care inadequate. Effective treatments are overlooked and millions of people suffer despite recent discovery of new treatments for substance use disorders. In rare instances when addiction care is provided by medical professionals, they are not adequately trained in caring for people with substance use disorders; therefore, feel unprepared to provide such care. Physician scientists are the bridge between science and practice. Despite large evidence-base upon which to base clinical practice, most health systems have not combined training of healthcare providers in addiction medicine and research.

Klimas, J., Small, W., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., McNeil, R. (2017) Barriers and Facilitators to Implementing Addiction Medicine Fellowships: A Qualitative Study with Fellows, Medical Students, Residents and Preceptors. Addiction Science & Clinical Practice, 12:21
https://ascpjournal.biomedcentral.com/

Nursing Fellowship in Addiction Medicine

Nursing

Traditionally, nursing and physician education have been separated through separate programmes despite working closely together in real-world practice.

Our Perspective in the Journal of Addiction Nursing, we argue that addiction training for nurses is as important as training physicians to heal the growing divide between recent discoveries in addiction science and the inadequate care delivered to people with substance use disorders, mostly by unskilled lay personnel.

Interdisciplinary education between physicians, nurses and other allied health providers can promote collaboration and improve decision-making to optimize approaches to patient care.

Why nursing education in addiction medicine matters

Nurses play an essential role in assessing and treating the full range of substance use disorders. Unfortunately, there is a systemic lack of curricula and comprehensive training programmes for nurses to learn and practice evidence-based addiction care. This lack has negative impact on nurses’ knowledge and skills, and, as a result, millions of people have suffered. Addiction science has increasingly identified a range of evidence-based approaches to treat substance-use disorders, particularly through early identification and treatment. However, most treatments are not used enough and well. Better nursing education can improve accurate use of evidence-based treatments.

To this end, a promising initiative has recently been launched at the University of British Columbia (UBC) and St. Paul’s hospital, i.e., an Addiction Nursing Fellowship. The fellowship provides 12 months of specialised training for nurses. In addition, they obtain research training through intensive mentorship. They can publish research manuscripts, visit academic half-days, journal clubs and conferences. They receive media training, learn to influence public policy, advocate for patients, and lead academic research projects.

Thus, while addiction medicine fellowships for physicians exist in many settings and play an important role in bridging the gap between science and practice in clinical care, the impact of these fellowships may be increased by training nurses and other allied health professionals alongside physicians. Nurses have huge potential of nurses to improve access to care and quality of life for people with substance use disorders. That’s why we need more nurse-specific fellowships, better undergraduate curricula in addiction nursing, and interdisciplinary training opportunities.

Source: Voon, P., Johnson, C., Small, W., Klimas, J. (2017) Nursing Fellowship in Addiction Medicine: A Novel Programme in a Canadian setting. Journal of Addiction Nursing 28(3):148-149, July/September 2017.