Abstract
BackgroundThis article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse.MethodsThe authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U.S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models.ResultsThis paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice.ConclusionsBroad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.
Highlights
This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse
Increasing numbers of family medicine residents are from other countries [64] where teaching and clinical contact related to substance abuse may be limited or absent
Resident Assessment Strategies In order to demonstrate clinical competence in the management of patients with unhealthy substance use, we propose that each resident be required to demonstrate the core SBIRT competencies listed in Table 1 as a graduation requirement
Summary
This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse. Despite numerous faculty development initiatives related to primary care substance abuse training over the past three decades [1,2,3,4,5,6,7,8,9,10], rates of primary care screening and alcohol counseling remain low [11,12] and many clinicians report a lack of confidence in assessing alcohol use and providing brief advice for alcohol misuse [13]. Of 270 residency directors (58% of a total of 466 residency directors) who completed questionnaires, 203 (75%) reported that their programs offered required substance abuse curriculum, representing an increase of only six programs over the previous 12 years. 78% of respondents reported that faculty development on substance abuse was needed at their institutions Median curriculum time among those reporting curriculum was 8 hours [17]. 78% of respondents reported that faculty development on substance abuse was needed at their institutions
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