How to integrate addiction medicine in psychiatry training: results of an experiment with two educational methods

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Letter to editor

Addiction medicine is an evolving field that requires specialized training to address the complexities of substance use disorders. This review evaluates the training in addiction medicine within psychiatry residency programs across Europe, highlighting current practices, challenges, and opportunities for improvement. Substance use disorders are a significant public health concern, with high prevalence rates and substantial societal impact, often compounded by dual diagnoses and comorbidities. Effective management requires a multidisciplinary approach and specialized training to address the biological, psychological, and social aspects of addiction. The analysis reveals notable disparities in training programs across European countries. While some countries, such as the UK and the Netherlands, have established comprehensive addiction psychiatry curricula, others provide minimal exposure to addiction medicine. In several nations, training consists of short, often under-supervised internships, with limited emphasis on harm reduction, evidence-based treatment modalities, and psychoeducation. Less than 60% of psychiatry residents in Europe reported completing a structured addiction medicine rotation during residency, and global studies highlight a lack of standardized programs in nearly 30% of countries. This review emphasizes the urgent need for standardized, high-quality addiction medicine training within psychiatry residency programs. Addressing these gaps would equip psychiatrists with the necessary skills to manage the complexities of addiction, improve patient outcomes, and support workforce mobility across Europe. Additional training opportunities and curriculum updates are essential to meet the growing demand for specialized addiction care in an increasingly interconnected healthcare environment.

IntroductionEthical practices are fundamental to the training and professional development of psychiatry and child psychiatry residents. However, challenges such as stigmatization, discrimination, and ethical dilemmas in clinical and research settings can impact the quality of their training experience.ObjectivesTo assess the degree of exposure of residents to stigmatization during their residency training.To explore the level of awareness among residents regarding the practice of ethics in their clinical and research activities.MethodsThis is a cross-sectional study conducted by the National College of Psychiatry and Child Psychiatry from January 13 to January 16, 2024. An anonymous Google Forms questionnaire about ethic aspects during during residency training was sent to psychiatry and child psychiatry residents via the college email and private groups.ResultsWe received 71 responses. The participants had an average age of 29.9 years, with a sex ratio of 0.1. Among them, 50.7% were child psychiatry residents, and 49.3% were psychiatry residents. Residents reported experiencing discrimination in 49% of cases, with the following breakdown: from senior staff (61.1%), paramedical staff (47.2%), and doctors from other specialties (33.3%). The primary cause of discrimination was the residency level (56.3%). Residents reported experiencing discrimination in role distribution within the department (35.2%) and in scientific work (31%).Regarding their thesis work, 8.5% of residents felt obliged in choosing their thesis supervisor, and 16.9% felt pressured in selecting their thesis topic. Residents submitted their thesis work to the local committee in 58.5% of cases, informed participants about the study in a satisfactory manner in 75.4% of cases, and obtained oral informed consent from participants (or their parents) in 46.2% of cases. The residents felt that training in psychiatric ethics was necessary in 94.5% of cases and that specific training in research ethics in psychiatry was necessary in 91.8% of cases.ConclusionsTaking into account the various findings of our survey and raising awareness among different stakeholders, including doctors and paramedical team members, are essential measures to ensure that psychiatry and child psychiatry residents can complete their specialty training while adhering to fundamental ethical principles.Disclosure of InterestNone Declared

Substance Use Among Older Adults: Ethical Issues.

Research Training in Psychiatry Residency: Strategies for Reform

IntroductionIncorporating psychotherapy into the curricula of psychiatry residency programs has been proven difficult, even in countries where psychotherapy training is a requirement for psychiatry residents to become psychiatrists. There is a risk that future psychiatrists lacking psychotherapy skills will be restricted in managing the wide scope of disorders and personalities they will face in clinical practice. It is important to assess what psychiatry trainees around the globe have to say about psychotherapy training as part of their residency curricula.ObjectivesThe primary purpose of the article was to assess psychiatry trainees’ perspectives on psychotherapy training in residency programs worldwide.MethodsThe authors performed a narrative review, resulting 19 original research studies, published between 2001 and 2021, evaluating psychiatry residents’ perspectives by the application of a questionnaire.ResultsNineteen articles were included in this review. Most of the studies were developed across European countries (47.4%) and in the USA (36.8%). Psychiatry residents are interested in and value psychotherapy training, and some consider it should be an obligatory competency for psychiatrists, as it already occurs in some countries worldwide. Even though, most psychiatry trainees feel dissatisfaction with the existing training in residency curricula, pointing out concerns related to the quality of resources such as courses of psychotherapy and supervision of cases, time within the residency period, and financial constraints. In terms of personal psychotherapy, we found contrasting views of its importance in psychotherapy training for psychiatry residents. A crucial finding was that psychiatry residents tend to lose interest in psychotherapy during the years of the residency, and dissatisfaction with the quality of the psychotherapy curricula, lack of support, and low self-perceived competence in psychotherapy by trainees were factors associated with reduced interest in psychotherapy training.ConclusionsAt a time when psychotherapy is increasingly becoming acknowledged to play a central role in the treatment of most psychiatric disorders, current training is failing to provide these competencies to psychiatry trainees. Serious reflection must be given to both the extent of the guidelines and the practical opportunities for psychotherapy training so future psychiatrists can be qualified to provide an accurate biopsychosocial model of psychiatric care. The authors postulate that maintaining residents’ interest in psychotherapy requires improvements in the residency curricula and departmental leadership must support trainees’ goals of becoming comprehensively trained psychiatrists.Disclosure of InterestNone Declared

Substance use is endemic in the USA. In 2012, an estimated 22 million Americans, or 8.5 % of the population, met criteria for a substance use disorder in the past year [1]. In 2011, there were 2.5 million emergency department visits that involved drug misuse or abuse, a 52 % increase since 2004. Half of these visits involved the nonmedical use of pharmaceuticals, which is an increase of 132 % since 2004 [2]. Yet despite the tremendous need for treatment, only 11 % of addicted individuals received specialized substance abuse treatment in 2012 [1]. So, how can this enormous treatment deficit be addressed? Given the high prevalence of substance use disorders in a variety of clinical settings (ranging from 8 to 29% in inpatient settings and up to 20 % in primary care) [3, 4], it would make sense to identify individuals with substance use disorders in these settings and then connect them to treatment. Screening and brief intervention have been shown to be effective in primary care and an increasing number of settings, and models of integration into routine practice have been described [5]. Successful referral to substance abuse treatment from a primary care setting has even been shown to improve depression [6]. However, many surveys have found that physicians do not feel prepared to diagnose or treat addiction, and residents do not feel that they have received sufficient training in addictive disorders during residency [7]. In addition to proposals for curriculum design in residencies and medical schools, online-based programs have been implemented to teach skills to physicians, residents, and medical students, with varied success [8]. Psychiatry residents can subspecialize in addiction psychiatry by training in an Accreditation Council on Graduate Medical Education (ACGME)-certified addiction psychiatry fellowship program. In addition, physicians from psychiatry and other specialties can become certified by the American Board of Addiction Medicine (ABAM). There are two pathways: (1) a 1-year fellowship training similar to addiction psychiatry programs but administered by the American Board of Addiction Medicine Foundation or (2) to qualify to take the ABAM exam after completing 50 h of addiction-related continuing medical education (CME) courses and practicing in the field of addiction medicine for 1 year. The first pathway requires an additional year of training, which can be difficult for many physicians with large amounts of medical education debt. The second pathway does not provide much structure, making it difficult to physicians to stay motivated. To encourage physicians to complete the second pathway, we developed the Rutgers New Jersey Medical School Executive Fellowship in Addiction Medicine (Exec-FAM). In addition to providing structure for ABAM exam requirements, we hope this fellowship will increase a practitioner’s confidence and accuracy in assessing and diagnosing addictive disorders, and raise her or his comfort level in providing evidence-based treatment for addicted patients.

Editorial introductions.

Editorial introductions.

Editorial introductions

Editorial introductions.

Research Training in Psychiatry Residency: Strategies for Reform

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

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