Education of preventive medicine residents

Abstract

Background

Generalist physicians’ addiction training is inadequate, but general preventive medicine residency (PMR) programs have not been studied. We determined PMR programs’ alcohol, tobacco, and other drug abuse (ATOD) training from 1995 to 2000 and identified barriers to this education.

Methods

Interviewer-administered telephone survey of program directors (PDs) of accredited PMR programs in the United States.

Results

We interviewed all 41 PMR PDs. While 78% of PMR PDs reported interest in increasing ATOD education, for 68% it was not a high educational priority. Tobacco ranked in the top third of preventive medicine topics by 58%, while alcohol and other drugs ranked in the bottom third by 48% and 52%, respectively. Twenty-two percent of programs required a clinical ATOD rotation, most commonly smoking-cessation clinics. Only 29% of PMR PDs felt that residents were well prepared in clinical aspects of ATOD, while 60% felt that residents were prepared in ATOD research and public health issues. The most commonly reported barriers to ATOD training were lack of resident interest and defined competencies (64% each); limited faculty time (59%); limited teaching time (54%); lack of available teaching materials (53%); and lack of faculty expertise (51%).

Conclusions

While the majority of PMR PDs recognize the importance of incorporating teaching about addictions into training, much of the ATOD education in PMRs focuses on tobacco alone. Setting educational standards, defining competencies, investing in faculty development, and creating ATOD curricular modules are important next steps toward preparing preventive medicine physicians to effectively reduce the public health toll of addictions.

Introduction

T he use and abuse of alcohol, tobacco, and other drugs (ATOD) is a major preventable cause of morbidity and mortality in the United States.1 It is well documented that physicians-in-training are not optimally prepared to diagnose and treat ATOD disorders.2, 3 One national survey of residencies found that ATOD training varied widely by specialty, with an average 56% of programs requiring training in substance use disorders.3 A separate survey of directors of emergency medicine residencies revealed that half do not provide adequate training in ATOD screening and intervention.4 Less than half of military residencies teach behavioral modification and relapse-prevention skills.5 The most commonly reported obstacles have been lack of faculty expertise in ATOD, lack of time, prejudicial attitudes, and lack of available clinical ATOD opportunities.3, 6, 7 Although residency programs in general preventive medicine and public health train physicians to identify opportunities for prevention in individuals, as well at the community level, ATOD education in preventive medicine residency (PMR) programs has not been studied.

Preventive medicine training consists of two components: (1) an academic year, in which residents obtain a master of public health degree; and (2) a practicum year, generally consisting of several rotations including opportunities for research and experience with state or local health departments. PMR programs offer an ideal arena for training public health professionals to identify and address ATOD issues. The purpose of this study was to determine the extent to which ATOD issues are incorporated into PMR training programs, their relative emphasis compared to other topics, and current barriers to ATOD training.