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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2017

Open Access 01-12-2017 | Research

Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors

Authors: J. Klimas, W. Small, K. Ahamad, W. Cullen, A. Mead, L. Rieb, E. Wood, R. McNeil

Published in: Addiction Science & Clinical Practice | Issue 1/2017

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Abstract

Background

Although 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.

Methods

We 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.

Results

We 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.

Conclusions

Implementation 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.
Literature
1.
Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379:55–70.CrossRefPubMed
2.
3.
US Burden of Disease Collaborators. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591–608.CrossRefPubMedCentral
4.
Kaner E, Bland M, Cassidy P, Coulton S, Deluca P, Drummond C, Gilvarry E, Godfrey C, Heather N, Myles J, et al. Screening and brief interventions for hazardous and harmful alcohol use in primary care: a cluster randomised controlled trial protocol. BMC Public Health. 2009;9:287.CrossRefPubMedPubMedCentral
5.
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207.
6.
Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. Reducing the health consequences of opioid addiction in primary care. Am J Med. 2013;126:565–71.CrossRefPubMed
7.
Fiellin DA, O’Connor PG, Chawarski M, Pakes JP, Pantalon MV, Schottenfeld RS. Methadone maintenance in primary care: a randomized controlled trial. JAMA. 2001;286:1724–31.CrossRefPubMed
8.
Kaner EFS, Brown N, Jackson K. A systematic review of the impact of brief interventions on substance use and co-morbid physical and mental health conditions. Mental Health Subst Use. 2011;4:38–61.CrossRef
9.
Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Myles J, et al. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. Br Med J. 2013;346:e8501.CrossRef
10.
Cullen W, Stanley J, Langton D, Kelly Y, Staines A, Bury G. Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines’ implementation. Br J Gen Pract. 2006;56:848–56.PubMedPubMedCentral
11.
Ries RK, Miller SC, Fiellin DA. Principles of addiction medicine. Philadelphia: Lippincott Williams & Wilkins; 2009.
12.
Mullen L, Barry J, Long J, Keenan E, Mulholland D, Grogan L, Delargy I. A national study of the retention of irish opiate users in methadone substitution treatment. Am J Drug Alcohol Abuse. 2012;38:551–8.CrossRefPubMed
13.
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.CrossRefPubMed
14.
National Center on Addiction and Substance Abuse at Columbia University. Missed opportunity: CASA national survey of primary care physicians and patients on substance abuse. Columbia: National Center on Addiction and Substance Abuse at Columbia University; 2000.
15.
16.
Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Subst Abuse. 2011;32:84–92.CrossRef
17.
Columbia C. Addiction medicine: closing the gap between science and practice. New York: The National Center on Addiction and Substance Abuse (CASA) at Columbia University; 2012. p. 1–573.
18.
19.
Haber PS. International Perspectives in postgraduate medical training in addiction medicine. Subst Abuse. 2011;32:75–6.CrossRef
20.
el-Guebaly N, Violato C. The international certification of addiction medicine: validating clinical knowledge across borders. Subst Abuse. 2011;32:77–83.CrossRef
21.
Carroll J, Goodair C, Chayor A, Notley C, Ghodse H, Kopelman P. Substance misuse teaching in undergraduate medical education. BMC Med Educ. 2014;14:34.CrossRefPubMedPubMedCentral
22.
O’Brien S, Cullen W. Undergraduate medical education in substance use in Ireland: a review of the literature and discussion paper. Ir J Med Sci. 2011;180:787–92.CrossRefPubMed
23.
Wood E, Sakakibara T, McIver G, McLean M. A UBC, Vancouver Coastal Health and St. Paul s hospital strategy for education in addiction medicine. UBC Med J. 2013;5:5–7.
24.
Small W, Rhodes T, Wood E, Kerr T. Public injection settings in Vancouver: physical environment, social context and risk. Int J Drug Policy. 2007;18:27–36.CrossRefPubMed
25.
McCann E, Temenos C. Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policy. Health Place. 2015;31:216–23.CrossRefPubMed
26.
Rieb L, Wood E. The evolution of addiction medicine education in British Columbia. Can J Addict. 2014;5:17–20.
27.
Klimas J, McNeil R, Ahamad K, Mead A, Rieb L, Cullen W, Wood E, Small W. Two birds with one stone: experiences of combining clinical and research training in addiction medicine. BMC Med Educ. 2017;17:22.CrossRefPubMedPubMedCentral
28.
Strathdee SA, Palepu A, Cornelisse PG, Yip B, O’Shaughnessy MV, Montaner JS, Schechter MT, Hogg RS. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280:547–9.CrossRefPubMed
29.
Wood E, Hogg RS, Bonner S, Kerr T, Li K, Palepu A, Guillemi S, Schechter MT, Montaner JS. Staging for antiretroviral therapy among HIV-infected drug users. JAMA. 2004;292:1175–7.CrossRefPubMed
30.
Kerr T, Small W, Johnston C, Li K, Montaner JS, Wood E. Characteristics of injection drug users who participate in drug dealing: implications for drug policy. J Psychoact Drugs. 2008;40:147–52.CrossRef
31.
Klimas J, Fernandes E, deBeck K, Hayashi K, Milloy M-J, Kerr T, Cullen W, Wood E. Preliminary results and publication impact of a dedicated addiction clinician scientist research fellowship. J Addict Med. 2017;11:80–1.CrossRefPubMed
32.
Klimas J, Ahamad K, Fairgrieve K, McLean M, Mead A, Nolan S, Wood E. Impact of a brief addiction medicine training experience on knowledge self-assessment among medical learners. Subst Abuse. 2017;38:141–4.CrossRef
33.
Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No 90: Part II. Med Teach. 2014;36:838–48.CrossRefPubMed
34.
Morse JM. What is qualitative health research. Chapter 24. In: Denzin NK, Lincoln YS, editors. The SAGE handbook of qualitative research. 2011. p. 401–14.
35.
Neale J, Hunt G, Lankenau S, Mayock P, Miller P, Sheridan J, Small W, Treloar C. Addiction journal is committed to publishing qualitative research. Addiction. 2013;108:447–9.CrossRefPubMed
36.
37.
Klimas J, Muench J, Wiest K, Croff R, Rieckman T, McCarty D. Alcohol screening among opioid agonist patients in a primary care clinic and an opioid treatment program. J Psychoact Drugs. 2015;47:65–70.CrossRef
38.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.CrossRef
39.
Elliott R, Timuľák L. Descriptive and interpretative approaches to qualitative research. In: Miles J, Gilbert P, editors. A handbook of research methods in clinical and health psychology. Oxford: Oxford University Press; 2005.
40.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.CrossRefPubMedPubMedCentral
41.
42.
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.CrossRefPubMed
43.
Roche AM. Drug and alcohol medical education: evaluation of a national programme. Br J Addict. 1992;87:1041–8.CrossRefPubMed
44.
Ewan CE, Whaite A. Training health professionals in substance abuse: a review. Int J Addict. 1982;17:1211–29.CrossRefPubMed
45.
El-Guebaly N, Toews J, Lockyer J, Armstrong S, Hodgins D. Medical education in substance-related disorders: components and outcome. Addiction. 2000;95:949–57.CrossRefPubMed
46.
Rasyidi E, Wilkins JN, Danovitch I. Training the next generation of providers in addiction medicine. Psychiatr Clin North Am. 2012;35:461–80.CrossRefPubMed
47.
Kashiwagi DT, Varkey P, Cook DA. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med. 2013;88:1029–37.CrossRefPubMed
48.
Kusurkar RA, Croiset G. Autonomy support for autonomous motivation in medical education. Med Educ Online. 2015;20:27951.CrossRef
49.
50.
The Standards of Reporting Trials Group. A proposal for structured reporting of randomized controlled trials. JAMA. 1994;272:1926–31.CrossRef
51.
Rosier RN. Institutional barriers to the orthopaedic clinician-scientist. Clin Orthop Relat Res. 2006;449:159–64.CrossRefPubMed
52.
Berk M, Hallam K, Lucas N, Hasty M, McNeil CA, Conus P, Kader L, McGorry PD. Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust. 2007;187:S11–4.PubMed
53.
54.
Hauser SL, McArthur JC. Saving the clinician-scientist: report of the ANA long range planning committee. Ann Neurol. 2006;60:278–85.CrossRefPubMed
55.
O’Connor PG, Nyquist JG, McLellan AT. Integrating addiction medicine into graduate medical education in primary care: the time has come. Ann Intern Med. 2011;154:56–9.CrossRefPubMed
56.
Childers JW, Broyles LM, Hanusa BH, Kraemer KL, Conigliaro J, Spagnoletti C, McNeil M, Gordon AJ. Teaching the teachers: faculty preparedness and evaluation of a retreat in screening, brief intervention, and referral to treatment. Subst Abuse. 2012;33:272–7.CrossRef
57.
58.
Christison GW, Haviland MG. Requiring a one-week addiction treatment experience in a six-week psychiatry clerkship: effects on attitudes toward substance-abusing patients. Teach Learn Med. 2003;15:93–7.CrossRefPubMed
59.
60.
Alford D, Bridden C, Jackson A, Saitz R, Amodeo M, Barnes H, Samet J. Promoting substance use education among generalist physicians: an evaluation of the chief resident immersion training (CRIT) program. J Gen Intern Med. 2009;24:40–7.CrossRefPubMed
61.
Guest G, Bunce A, Johnson L. How many interviews are enough? an experiment with data saturation and variability. Field Methods. 2006;18:59–82.CrossRef
62.
Strang J, Hunt C, Gerada C, Marsden J. What difference does training make? A randomized trial with waiting-list control of general practitioners seeking advanced training in drug misuse. Addiction. 2007;102:1637–47.CrossRefPubMed
Metadata
Title
Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors
Authors
J. Klimas
W. Small
K. Ahamad
W. Cullen
A. Mead
L. Rieb
E. Wood
R. McNeil
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2017
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-017-0086-9

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