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Erschienen in: Journal of General Internal Medicine 1/2009

01.01.2009 | Original Article

Promoting Substance Use Education Among Generalist Physicians: An Evaluation of the Chief Resident Immersion Training (CRIT) Program

verfasst von: Daniel P. Alford, MD, MPH, Carly Bridden, MA, MPH, Angela H. Jackson, MD, Richard Saitz, MD, MPH, Maryann Amodeo, MSW, PhD, Henrietta N. Barnes, MD, Jeffrey H. Samet, MD, MA, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2009

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ABSTRACT

BACKGROUND

Education about substance use (SU) disorders remains inadequate in medical training.

OBJECTIVE

To describe the Chief Resident Immersion Training (CRIT) program in addiction medicine and to evaluate its impact on chief resident (CR) physicians’ substance use knowledge, skills, clinical practice, and teaching.

DESIGN

A controlled educational study of CRIT programs (2003, 2004, and 2005) for incoming CRs in generalist disciplines. Intervention CRs were trained to diagnose, manage, and teach about SU. The control CRs sought but did not receive the intervention.

PARTICIPANTS

Eighty-six CR applicants to the CRIT program.

MEASUREMENTS

Baseline and 6-month questionnaires assessing substance use knowledge, skills, clinical practice, and teaching. Outcomes were compared within groups from baseline to follow-up and between groups at follow-up.

RESULTS

The intervention (n = 64) and control (n = 22) CRs were similar demographically. At 6-month follow-up, the intervention CRs reported a significant increase in SU knowledge, confidence, and preparedness to diagnose, manage, and teach and an increase in SU clinical and teaching practices compared to their baseline and control CRs.

CONCLUSIONS

This intensive training for chief residents (CRs) improved knowledge, confidence, and preparedness to diagnose, manage, and teach about substance use (SU), affecting both the CRs’ SU clinical and teaching practices. The CRIT program was an effective model for dissemination of SU knowledge and skills to educators in a key position to share this training with a broader audience of medical trainees. This model holds potential to address other high priority medical, yet under-addressed, content areas as well.
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Literatur
1.
Zurück zum Zitat Fiellin D, Butler R, D’Onofrio G, Brown R, O’Connor P. The physician’s role in caring for patients with substance use disorders: Implications for medical education and training. Subst Abus. 2002;23:207–12.CrossRef Fiellin D, Butler R, D’Onofrio G, Brown R, O’Connor P. The physician’s role in caring for patients with substance use disorders: Implications for medical education and training. Subst Abus. 2002;23:207–12.CrossRef
2.
Zurück zum Zitat Michaud CM, Murray CJ, Bloom BR. Burden of disease—implications for future research. JAMA. 2001;285:535–9.PubMedCrossRef Michaud CM, Murray CJ, Bloom BR. Burden of disease—implications for future research. JAMA. 2001;285:535–9.PubMedCrossRef
6.
Zurück zum Zitat Friedmann PD, Saitz R, Samet JH. Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA. 1998;279:1227–31.PubMedCrossRef Friedmann PD, Saitz R, Samet JH. Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA. 1998;279:1227–31.PubMedCrossRef
7.
8.
Zurück zum Zitat McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689–95.PubMedCrossRef McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689–95.PubMedCrossRef
9.
Zurück zum Zitat Saitz R, Horton NJ, Larson MJ, Winter M, Samet JH. Primary medical care and reductions in addiction severity: a prospective cohort study. Addiction. 2005;100:70–8.PubMedCrossRef Saitz R, Horton NJ, Larson MJ, Winter M, Samet JH. Primary medical care and reductions in addiction severity: a prospective cohort study. Addiction. 2005;100:70–8.PubMedCrossRef
10.
Zurück zum Zitat Samet JH, Friedmann P, Saitz R. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Arch Intern Med. 2001;161:85–91.PubMedCrossRef Samet JH, Friedmann P, Saitz R. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Arch Intern Med. 2001;161:85–91.PubMedCrossRef
11.
Zurück zum Zitat McCormick KA, Cochran NE, Back AL, Merrill JO, Williams EC, Bradley KA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–72.PubMedCrossRef McCormick KA, Cochran NE, Back AL, Merrill JO, Williams EC, Bradley KA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–72.PubMedCrossRef
12.
Zurück zum Zitat Kuehn BM. Despite benefit, physicians slow to offer brief advice on harmful alcohol use. JAMA. 2008;299:751–3.PubMedCrossRef Kuehn BM. Despite benefit, physicians slow to offer brief advice on harmful alcohol use. JAMA. 2008;299:751–3.PubMedCrossRef
13.
Zurück zum Zitat Vastag B. Addiction poorly understood by clinicians: experts say attitudes, lack of knowledge hinder treatment. JAMA. 2003;290:1299–303.PubMedCrossRef Vastag B. Addiction poorly understood by clinicians: experts say attitudes, lack of knowledge hinder treatment. JAMA. 2003;290:1299–303.PubMedCrossRef
14.
Zurück zum Zitat Saitz R, Friedmann PD, Sullivan LM, et al. Professional satisfaction experienced when caring for substance-abusing patients: faculty and resident physician perspectives. J Gen Intern Med. 2002;17:373–6.PubMed Saitz R, Friedmann PD, Sullivan LM, et al. Professional satisfaction experienced when caring for substance-abusing patients: faculty and resident physician perspectives. J Gen Intern Med. 2002;17:373–6.PubMed
15.
Zurück zum Zitat Stimmel B, Cohen D, Colliver J, Swartz M. An Assessment of house staff’s knowledge of alcohol and substance abuse utilizing standardized patients. Subst Abus. 2000;21:1–7.PubMedCrossRef Stimmel B, Cohen D, Colliver J, Swartz M. An Assessment of house staff’s knowledge of alcohol and substance abuse utilizing standardized patients. Subst Abus. 2000;21:1–7.PubMedCrossRef
16.
Zurück zum Zitat Institute of Medicine. Improving the quality of health care for mental and substance-use conditions. Washington, DC: The National Academies Press; 2006. Institute of Medicine. Improving the quality of health care for mental and substance-use conditions. Washington, DC: The National Academies Press; 2006.
17.
Zurück zum Zitat Fleming MF, Barry KL, Davis A, Kropp S, Kahn R, Rivo M. Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992. Acad Med. 1994;69:362–9.PubMedCrossRef Fleming MF, Barry KL, Davis A, Kropp S, Kahn R, Rivo M. Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992. Acad Med. 1994;69:362–9.PubMedCrossRef
18.
Zurück zum Zitat Miller NS, Sheppard LM, Colenda CC, Magen J. Why physicians are unprepared to treat patients who have alcohol— and drug-related disorders. Acad Med. 2001;76:410–8.PubMedCrossRef Miller NS, Sheppard LM, Colenda CC, Magen J. Why physicians are unprepared to treat patients who have alcohol— and drug-related disorders. Acad Med. 2001;76:410–8.PubMedCrossRef
19.
Zurück zum Zitat Foley ME, Garland E, Stimmel B, Merino R. Innovative clinical addiction research training track in preventive medicine. Subst Abus. 2000;21:111–9.PubMedCrossRef Foley ME, Garland E, Stimmel B, Merino R. Innovative clinical addiction research training track in preventive medicine. Subst Abus. 2000;21:111–9.PubMedCrossRef
20.
Zurück zum Zitat Fleming MF, Manwell LB, Kraus M, Isaacson JH, Kahn R, Stauffacher EA. Who teaches residents about the prevention and treatment of substance use disorders? A national survey. J Fam Pract. 1999;48:725–9.PubMed Fleming MF, Manwell LB, Kraus M, Isaacson JH, Kahn R, Stauffacher EA. Who teaches residents about the prevention and treatment of substance use disorders? A national survey. J Fam Pract. 1999;48:725–9.PubMed
21.
22.
Zurück zum Zitat Wyatt SA, Vilensky W, Manlandro JJ Jr., Dekker MA. Medical education in substance abuse: from student to practicing osteopathic physician. J Am Osteopath Assoc. 2005;105:S18–S25.PubMed Wyatt SA, Vilensky W, Manlandro JJ Jr., Dekker MA. Medical education in substance abuse: from student to practicing osteopathic physician. J Am Osteopath Assoc. 2005;105:S18–S25.PubMed
24.
Zurück zum Zitat Klamen DL, Miller NS. Integration in education for addiction medicine. J Psychoactive Drugs. 1997;29:263–8.PubMed Klamen DL, Miller NS. Integration in education for addiction medicine. J Psychoactive Drugs. 1997;29:263–8.PubMed
25.
Zurück zum Zitat Alford DP, Richardson JM, Chapman SE, Dube CE, Schadt RW, Saitz R. A web-based Alcohol Clinical Training (ACT) curriculum: is in-person faculty development necessary to affect teaching? BMC Med Educ. 2008;8:11.PubMedCrossRef Alford DP, Richardson JM, Chapman SE, Dube CE, Schadt RW, Saitz R. A web-based Alcohol Clinical Training (ACT) curriculum: is in-person faculty development necessary to affect teaching? BMC Med Educ. 2008;8:11.PubMedCrossRef
26.
Zurück zum Zitat Parish SJ, Ramaswamy M, Stein MR, Kachur EK, Arnsten JH. Teaching about substance abuse with objective structured clinical exams. J Gen Intern Med. 2006;21:453–9.PubMedCrossRef Parish SJ, Ramaswamy M, Stein MR, Kachur EK, Arnsten JH. Teaching about substance abuse with objective structured clinical exams. J Gen Intern Med. 2006;21:453–9.PubMedCrossRef
27.
Zurück zum Zitat Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996;156:2287–93.PubMedCrossRef Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996;156:2287–93.PubMedCrossRef
28.
Zurück zum Zitat Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144:127–34.PubMed Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144:127–34.PubMed
29.
Zurück zum Zitat Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000;61:912–5.PubMed Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000;61:912–5.PubMed
30.
Zurück zum Zitat Abrams-Weintraub T, Saitz R, Samet JH. Education of preventive medicine residents: alcohol, tobacco, and other drug abuse. Am J Prev Med. 2003;24:101–5.PubMedCrossRef Abrams-Weintraub T, Saitz R, Samet JH. Education of preventive medicine residents: alcohol, tobacco, and other drug abuse. Am J Prev Med. 2003;24:101–5.PubMedCrossRef
31.
Zurück zum Zitat Karam-Hage M, Nerenberg L, Brower KJ. Modifying residents’ professional attitudes about substance abuse treatment and training. Am J Addict. 2001;10:40–7.PubMedCrossRef Karam-Hage M, Nerenberg L, Brower KJ. Modifying residents’ professional attitudes about substance abuse treatment and training. Am J Addict. 2001;10:40–7.PubMedCrossRef
32.
Zurück zum Zitat Chossis I, Lane C, Gache P, et al. Effect of training on primary care residents’ performance in brief alcohol intervention: a randomized controlled trial. J Gen Intern Med. 2007;22:1144–9.PubMedCrossRef Chossis I, Lane C, Gache P, et al. Effect of training on primary care residents’ performance in brief alcohol intervention: a randomized controlled trial. J Gen Intern Med. 2007;22:1144–9.PubMedCrossRef
33.
Zurück zum Zitat Geller G, Levine DM, Mamon JA, Moore RD, Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA. 1989;261:3115–20.PubMedCrossRef Geller G, Levine DM, Mamon JA, Moore RD, Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA. 1989;261:3115–20.PubMedCrossRef
34.
Zurück zum Zitat Marcus MT, Brown RL, Straussner SL, et al. Creating change agents: a national substance abuse education project. Subst Abus. 2005;26:5–15.PubMedCrossRef Marcus MT, Brown RL, Straussner SL, et al. Creating change agents: a national substance abuse education project. Subst Abus. 2005;26:5–15.PubMedCrossRef
35.
Zurück zum Zitat Madden TE, Graham AV, Straussner SL, et al. Interdisciplinary benefits in Project MAINSTREAM: a promising health professions educational model to address global substance abuse. J Interprof Care. 2006;20:655–64.PubMedCrossRef Madden TE, Graham AV, Straussner SL, et al. Interdisciplinary benefits in Project MAINSTREAM: a promising health professions educational model to address global substance abuse. J Interprof Care. 2006;20:655–64.PubMedCrossRef
36.
Zurück zum Zitat Doughty RA, Williams PD, Seashore CN. Chief resident training. Developing leadership skills for future medical leaders. Am J Dis Child. 1991;145:639–42.PubMed Doughty RA, Williams PD, Seashore CN. Chief resident training. Developing leadership skills for future medical leaders. Am J Dis Child. 1991;145:639–42.PubMed
37.
Zurück zum Zitat Levine SA, Caruso LB, Vanderschmidt H, Silliman RA, Barry PP. Faculty development in geriatrics for clinician educators: a unique model for skills acquisition and academic achievement. J Am Geriatr Soc. 2005;53:516–21.PubMedCrossRef Levine SA, Caruso LB, Vanderschmidt H, Silliman RA, Barry PP. Faculty development in geriatrics for clinician educators: a unique model for skills acquisition and academic achievement. J Am Geriatr Soc. 2005;53:516–21.PubMedCrossRef
38.
Zurück zum Zitat Steel K. The medical chief residency in university hospitals. Ann Intern Med. 1972;76:541–4.PubMed Steel K. The medical chief residency in university hospitals. Ann Intern Med. 1972;76:541–4.PubMed
39.
Zurück zum Zitat Alpert JJ, Levenson SM, Osman CJ, James S. Does being a chief resident predict leadership in pediatric careers? Pediatrics. 2000;105:984–8.PubMed Alpert JJ, Levenson SM, Osman CJ, James S. Does being a chief resident predict leadership in pediatric careers? Pediatrics. 2000;105:984–8.PubMed
40.
Zurück zum Zitat Mygdal WK, Monteiro M, Hitchcock M, Featherston W, Conard S. Outcomes of the first family practice chief resident leadership conference. Fam Med. 1991;23:308–10.PubMed Mygdal WK, Monteiro M, Hitchcock M, Featherston W, Conard S. Outcomes of the first family practice chief resident leadership conference. Fam Med. 1991;23:308–10.PubMed
41.
Zurück zum Zitat Bigby J, Barnes HN. Evaluation of a faculty development program in substance abuse education. J Gen Intern Med. 1993;8:301–5.PubMedCrossRef Bigby J, Barnes HN. Evaluation of a faculty development program in substance abuse education. J Gen Intern Med. 1993;8:301–5.PubMedCrossRef
42.
Zurück zum Zitat Rose AJ, Stein MR, Arnsten JH, Saitz R. Teaching internal medicine resident physicians about alcoholics anonymous: a pilot study of an educational intervention. Subst Abus. 2006;27:5–11.PubMedCrossRef Rose AJ, Stein MR, Arnsten JH, Saitz R. Teaching internal medicine resident physicians about alcoholics anonymous: a pilot study of an educational intervention. Subst Abus. 2006;27:5–11.PubMedCrossRef
43.
Zurück zum Zitat D’Onofrio G, Nadel ES, Degutis LC, et al. Improving emergency medicine residents’ approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med. 2002;40:50–62.PubMedCrossRef D’Onofrio G, Nadel ES, Degutis LC, et al. Improving emergency medicine residents’ approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med. 2002;40:50–62.PubMedCrossRef
44.
Zurück zum Zitat Nigwekar SU, Morse DS. Educational half day: an innovative way to incorporate substance abuse curriculum into residency training. Subst Abus. 2006;27:1–3.PubMedCrossRef Nigwekar SU, Morse DS. Educational half day: an innovative way to incorporate substance abuse curriculum into residency training. Subst Abus. 2006;27:1–3.PubMedCrossRef
45.
Zurück zum Zitat Institute of Medicine. Broadening the base of treatment for alcohol problems. Washington DC: The National Academies Press; 1990. Institute of Medicine. Broadening the base of treatment for alcohol problems. Washington DC: The National Academies Press; 1990.
46.
Zurück zum Zitat Renner JA Jr. How to train residents to identify and treat dual diagnosis patients. Biol Psychiatry. 2004;56:810–6.PubMed Renner JA Jr. How to train residents to identify and treat dual diagnosis patients. Biol Psychiatry. 2004;56:810–6.PubMed
47.
Zurück zum Zitat Levine S, Chao S, Brett B, et al. Chief resident immersion training in the care of older adults: an innovative inter-specialty education and leadership intervention. J Am Geriatr Soc. 2008;56:1140–5.PubMedCrossRef Levine S, Chao S, Brett B, et al. Chief resident immersion training in the care of older adults: an innovative inter-specialty education and leadership intervention. J Am Geriatr Soc. 2008;56:1140–5.PubMedCrossRef
Metadaten
Titel
Promoting Substance Use Education Among Generalist Physicians: An Evaluation of the Chief Resident Immersion Training (CRIT) Program
verfasst von
Daniel P. Alford, MD, MPH
Carly Bridden, MA, MPH
Angela H. Jackson, MD
Richard Saitz, MD, MPH
Maryann Amodeo, MSW, PhD
Henrietta N. Barnes, MD
Jeffrey H. Samet, MD, MA, MPH
Publikationsdatum
01.01.2009
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 1/2009
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-008-0819-2

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