Abstract
BackgroundAlthough progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships.MethodsWe interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.ResultsWe identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training.ConclusionsImplementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.
Highlights
Progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians
Undergraduate medical education and postgraduate clinical training programs have not invested in the implementation of addiction medicine training for health care providers, and, when they have, it has mostly been for psychiatrists trained in small programmes [13, 16]
Focusing on the new generation of doctors, the UK’s project on ‘Substance Use in the Undergraduate Medical Education’ improved the addiction medicine knowledge of medical students [21], while the importance of addiction medicine training for clinicians has been recently highlighted in Ireland [22]
Summary
Progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. The Addiction Medicine Foundation (AMF) has established fellowships in addiction medicine and accredited 27 of these programmes (63 total slots annually) to date, including four programmes (16 slots) in Canada [18] This limited number of training opportunities falls far short of the demand for specialised addiction treatment services due to the high number of people with SUDs who need such treatment [1]. Focusing on the new generation of doctors, the UK’s project on ‘Substance Use in the Undergraduate Medical Education’ improved the addiction medicine knowledge of medical students [21], while the importance of addiction medicine training for clinicians has been recently highlighted in Ireland [22] These programmes teach addiction medicine to physicians, their content and intensity varies significantly from country to country
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