Top

Published in:

01-01-2009 | Original Article

Promoting Substance Use Education Among Generalist Physicians: An Evaluation of the Chief Resident Immersion Training (CRIT) Program

Authors: Daniel P. Alford, MD, MPH, Carly Bridden, MA, MPH, Angela H. Jackson, MD, Richard Saitz, MD, MPH, Maryann Amodeo, MSW, PhD, Henrietta N. Barnes, MD, Jeffrey H. Samet, MD, MA, MPH

Published in: Journal of General Internal Medicine | Issue 1/2009

ABSTRACT

BACKGROUND

Education about substance use (SU) disorders remains inadequate in medical training.

OBJECTIVE

To describe the Chief Resident Immersion Training (CRIT) program in addiction medicine and to evaluate its impact on chief resident (CR) physicians’ substance use knowledge, skills, clinical practice, and teaching.

DESIGN

A controlled educational study of CRIT programs (2003, 2004, and 2005) for incoming CRs in generalist disciplines. Intervention CRs were trained to diagnose, manage, and teach about SU. The control CRs sought but did not receive the intervention.

PARTICIPANTS

Eighty-six CR applicants to the CRIT program.

MEASUREMENTS

Baseline and 6-month questionnaires assessing substance use knowledge, skills, clinical practice, and teaching. Outcomes were compared within groups from baseline to follow-up and between groups at follow-up.

RESULTS

The intervention (n = 64) and control (n = 22) CRs were similar demographically. At 6-month follow-up, the intervention CRs reported a significant increase in SU knowledge, confidence, and preparedness to diagnose, manage, and teach and an increase in SU clinical and teaching practices compared to their baseline and control CRs.

CONCLUSIONS

This intensive training for chief residents (CRs) improved knowledge, confidence, and preparedness to diagnose, manage, and teach about substance use (SU), affecting both the CRs’ SU clinical and teaching practices. The CRIT program was an effective model for dissemination of SU knowledge and skills to educators in a key position to share this training with a broader audience of medical trainees. This model holds potential to address other high priority medical, yet under-addressed, content areas as well.

Available only for authorised users

Fiellin D, Butler R, D’Onofrio G, Brown R, O’Connor P. The physician’s role in caring for patients with substance use disorders: Implications for medical education and training. Subst Abus. 2002;23:207–12.CrossRef

Michaud CM, Murray CJ, Bloom BR. Burden of disease—implications for future research. JAMA. 2001;285:535–9.PubMedCrossRef

NIAAA. Estimated economic costs of alcohol abuse in the United States, 1992 and 1998. Available at: http://www.niaaa.nih.gov/Resources/DatabaseResources/QuickFacts/EconomicData/cost8.htm. Accessed August 25, 2008.

Office of National Drug Control Policy. The economic cost of drug abuse in the United States, 1992–2000. Available at: http://www.whitehousedrugpolicy.gov/publications/economic_costs/. Accessed August 25, 2008.

SAMHSA. Results from the 2006 national survey of drug use and health: national findings. Available at: http://www.drugabusestatistics.samhsa.gov/NSDUH/2k6NSDUH/2k6results.cfm. Accessed August 25, 2008.

Friedmann PD, Saitz R, Samet JH. Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA. 1998;279:1227–31.PubMedCrossRef

Lewis DC. The role of internal medicine in addiction medicine. J Addict Dis. 1996;15:1–17.PubMedCrossRef

McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689–95.PubMedCrossRef

Saitz R, Horton NJ, Larson MJ, Winter M, Samet JH. Primary medical care and reductions in addiction severity: a prospective cohort study. Addiction. 2005;100:70–8.PubMedCrossRef

10.

Samet JH, Friedmann P, Saitz R. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Arch Intern Med. 2001;161:85–91.PubMedCrossRef

11.

McCormick KA, Cochran NE, Back AL, Merrill JO, Williams EC, Bradley KA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–72.PubMedCrossRef

12.

Kuehn BM. Despite benefit, physicians slow to offer brief advice on harmful alcohol use. JAMA. 2008;299:751–3.PubMedCrossRef

13.

Vastag B. Addiction poorly understood by clinicians: experts say attitudes, lack of knowledge hinder treatment. JAMA. 2003;290:1299–303.PubMedCrossRef

14.

Saitz R, Friedmann PD, Sullivan LM, et al. Professional satisfaction experienced when caring for substance-abusing patients: faculty and resident physician perspectives. J Gen Intern Med. 2002;17:373–6.PubMed

15.

Stimmel B, Cohen D, Colliver J, Swartz M. An Assessment of house staff’s knowledge of alcohol and substance abuse utilizing standardized patients. Subst Abus. 2000;21:1–7.PubMedCrossRef

16.

Institute of Medicine. Improving the quality of health care for mental and substance-use conditions. Washington, DC: The National Academies Press; 2006.

17.

Fleming MF, Barry KL, Davis A, Kropp S, Kahn R, Rivo M. Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992. Acad Med. 1994;69:362–9.PubMedCrossRef

18.

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.PubMedCrossRef

19.

Foley ME, Garland E, Stimmel B, Merino R. Innovative clinical addiction research training track in preventive medicine. Subst Abus. 2000;21:111–9.PubMedCrossRef

20.

Fleming MF, Manwell LB, Kraus M, Isaacson JH, Kahn R, Stauffacher EA. Who teaches residents about the prevention and treatment of substance use disorders? A national survey. J Fam Pract. 1999;48:725–9.PubMed

21.

Kuehn BM. Centers to weave addiction treatment into medical education. JAMA. 2007;297:1763.PubMedCrossRef

22.

Wyatt SA, Vilensky W, Manlandro JJ Jr., Dekker MA. Medical education in substance abuse: from student to practicing osteopathic physician. J Am Osteopath Assoc. 2005;105:S18–S25.PubMed

23.

Project Mainstream: improving substance abuse education for health professionals. Available at: http://www.projectmainstream.net. Accessed March 11, 2008.

24.

Klamen DL, Miller NS. Integration in education for addiction medicine. J Psychoactive Drugs. 1997;29:263–8.PubMed

25.

Alford DP, Richardson JM, Chapman SE, Dube CE, Schadt RW, Saitz R. A web-based Alcohol Clinical Training (ACT) curriculum: is in-person faculty development necessary to affect teaching? BMC Med Educ. 2008;8:11.PubMedCrossRef

26.

Parish SJ, Ramaswamy M, Stein MR, Kachur EK, Arnsten JH. Teaching about substance abuse with objective structured clinical exams. J Gen Intern Med. 2006;21:453–9.PubMedCrossRef

27.

Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996;156:2287–93.PubMedCrossRef

28.

Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144:127–34.PubMed

29.

Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000;61:912–5.PubMed

30.

Abrams-Weintraub T, Saitz R, Samet JH. Education of preventive medicine residents: alcohol, tobacco, and other drug abuse. Am J Prev Med. 2003;24:101–5.PubMedCrossRef

31.

Karam-Hage M, Nerenberg L, Brower KJ. Modifying residents’ professional attitudes about substance abuse treatment and training. Am J Addict. 2001;10:40–7.PubMedCrossRef

32.

Chossis I, Lane C, Gache P, et al. Effect of training on primary care residents’ performance in brief alcohol intervention: a randomized controlled trial. J Gen Intern Med. 2007;22:1144–9.PubMedCrossRef

33.

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.PubMedCrossRef

34.

Marcus MT, Brown RL, Straussner SL, et al. Creating change agents: a national substance abuse education project. Subst Abus. 2005;26:5–15.PubMedCrossRef

35.

Madden TE, Graham AV, Straussner SL, et al. Interdisciplinary benefits in Project MAINSTREAM: a promising health professions educational model to address global substance abuse. J Interprof Care. 2006;20:655–64.PubMedCrossRef

36.

Doughty RA, Williams PD, Seashore CN. Chief resident training. Developing leadership skills for future medical leaders. Am J Dis Child. 1991;145:639–42.PubMed

37.

Levine SA, Caruso LB, Vanderschmidt H, Silliman RA, Barry PP. Faculty development in geriatrics for clinician educators: a unique model for skills acquisition and academic achievement. J Am Geriatr Soc. 2005;53:516–21.PubMedCrossRef

38.

Steel K. The medical chief residency in university hospitals. Ann Intern Med. 1972;76:541–4.PubMed

39.

Alpert JJ, Levenson SM, Osman CJ, James S. Does being a chief resident predict leadership in pediatric careers? Pediatrics. 2000;105:984–8.PubMed

40.

Mygdal WK, Monteiro M, Hitchcock M, Featherston W, Conard S. Outcomes of the first family practice chief resident leadership conference. Fam Med. 1991;23:308–10.PubMed

41.

Bigby J, Barnes HN. Evaluation of a faculty development program in substance abuse education. J Gen Intern Med. 1993;8:301–5.PubMedCrossRef

42.

Rose AJ, Stein MR, Arnsten JH, Saitz R. Teaching internal medicine resident physicians about alcoholics anonymous: a pilot study of an educational intervention. Subst Abus. 2006;27:5–11.PubMedCrossRef

43.

D’Onofrio G, Nadel ES, Degutis LC, et al. Improving emergency medicine residents’ approach to patients with alcohol problems: a controlled educational trial. Ann Emerg Med. 2002;40:50–62.PubMedCrossRef

44.

Nigwekar SU, Morse DS. Educational half day: an innovative way to incorporate substance abuse curriculum into residency training. Subst Abus. 2006;27:1–3.PubMedCrossRef

45.

Institute of Medicine. Broadening the base of treatment for alcohol problems. Washington DC: The National Academies Press; 1990.

46.

Renner JA Jr. How to train residents to identify and treat dual diagnosis patients. Biol Psychiatry. 2004;56:810–6.PubMed

47.

Levine S, Chao S, Brett B, et al. Chief resident immersion training in the care of older adults: an innovative inter-specialty education and leadership intervention. J Am Geriatr Soc. 2008;56:1140–5.PubMedCrossRef

Title: Promoting Substance Use Education Among Generalist Physicians: An Evaluation of the Chief Resident Immersion Training (CRIT) Program
Authors: Daniel P. Alford, MD, MPH
Carly Bridden, MA, MPH
Angela H. Jackson, MD
Richard Saitz, MD, MPH
Maryann Amodeo, MSW, PhD
Henrietta N. Barnes, MD
Jeffrey H. Samet, MD, MA, MPH
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 1/2009
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-008-0819-2

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Promoting Substance Use Education Among Generalist Physicians: An Evaluation of the Chief Resident Immersion Training (CRIT) Program

ABSTRACT

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

MEASUREMENTS

RESULTS

CONCLUSIONS

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

ABSTRACT

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

MEASUREMENTS

RESULTS

CONCLUSIONS

Please log in to get access to this content

Other articles of this Issue 1/2009

Loss of Health Insurance Among Non-elderly Adults in Medicaid

Ethnic Disparities in Coronary Heart Disease Management and Pay for Performance in the UK

Substituted Judgment

Improving Patient Understanding of Prescription Drug Label Instructions

Influence of Caregiving on Lifestyle and Psychosocial Risk Factors Among Family Members of Patients Hospitalized with Cardiovascular Disease

Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page