Clinician-Scientist Training in Addiction Medicine

clinician-scientist
In a new article from the Academic Medicine, we argue that clinician-scientist training is one of the most important bridges to cross the growing divide between recent advances in addiction science and care.
Often, unskilled lay personnel deliver inadequate care, reports state.
Medical education has long been the missing piece in the response to the global addiction problem. Instead of treating addiction as a disease, governments have focused on drug prohibition and control. This approach has failed by many measures, and, as a result, millions of people have suffered. Addiction science has identified a range of more and more evidence-based approaches to treat substance-use disorders.  Especially through early identification and treatment. However, most interventions are not used to their full potential. Better physician education can improve the accurate use of evidence-based treatments.
 
To this end, the British Columbia Centre on Substance Use (BCCSU) and St. Paul’s hospital, have recently opened a large Addiction Medicine Fellowship. The fellowship is 12 months long and trains doctors from general practice, internal medicine and psychiatry. The Addiction Medicine Foundation (AMF) accredited the fellowship and the alumni can write AMF exams. Also, they get research training through intensive mentorship and quality opportunities to write and publish research manuscripts, through academic half-days, journal clubs and conferences. They also get media training, learn to influence public policy, advocate for patients, and lead academic research projects.
 

Why clinician-scientist matters

Most health systems don’t specifically train generalist doctors in addiction medicine; when they do, this is often for a handful of psychiatry programmes that train a definite number of addiction psychiatrists. Our fellowship trains family physicians, internists and other disciplines. This expands the specialist treatment workforce to professionals seeing many people with substance use disorders and well positioned to bridge the implementation gap. Access to effective treatments grows.

Source: Klimas, J., McNeil, R., Small, W., Cullen, W. Clinician-Scientist Training in Addiction Medicine: A Novel Programme in a Canadian Setting.  Academic Medicine 92(10):1367, October 2017. 

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.

Community first responders for out of hospital cardiac arrest

defibrilator

When a heart stops beating, first responders can revert the cardiac arrest. But how efficient are they? Can they help save the person before the ambulance arrives?  A new project by the Centre for Emergency Medical Science at University College Dublin seeks to find answers to these questions.

This project will be a systematic review of scientific literature on the topic.

Cocrane

We will follow a strict guide for doing systematic reviews by the Cochrane Collaboration. Cochrane reviews are used to inform decisions in health care. First, we will search for every published study about the topic. We will include only the best studies. Then, we will use their findings to calculate the impact of mobilizing community first responders.

“For the purpose of this study, Community first responders (CFRs) are defined as individuals who live or work within a community and are organized in a framework which offers OHCA care in that community, to support the standard ambulance service response.”

The ambulance service dispatch centre, or another service, activates CFRs in real time to attend OHCA in that community.

They can be anyone, including professionals like nurses, police, or fire fighters. But also lay people who volunteer for local community groups. Sometimes, fire fighters act as the designated first responders.

Cardiac arrest in the community

If we do nothing people who have a cardiac arrest die. Community members can save lives by being the first responders on the scene before the ambulance arrives. Especially in remote places without access to medical professionals. However, their training and activation take time and resources. We need to know whether it’s worth it.

Citation example: Barry T, Masterson S, Conroy N, Klimas J, Segurado R., Codd M, Bury G. (2017) Community first responders for out of hospital cardiac arrest [Protocol]. Cochrane Database of Systematic Reviews, Issue 8.