Closing the gap between training needs and training provision in addiction medicine

Adapting, Implementing, and Maintaining a Group Cognitive Behavioral Therapy Program at an Inpatient Addiction Treatment Facility

Background

Quality training is an oft-cited barrier to effective implementation and ongoing delivery of high-quality evidence-based practice (EBP) across fields. This is especially true in the addiction field, but there is little cited evidence for optimal methods to improve EBP in inpatient addiction facilities with minimal resources.

Objective

The current paper focuses on evaluating the state of our facility's group CBT manual and clinical training on the manual in a "realistic" (ie, non-RCT, non-grant-funded) inpatient addiction treatment setting.

Methods

Five full-time clinicians volunteered to take part in the study (woman = 60%; Mage = 36.20 years). The study involved a mix of semi-structured interviews and surveys designed to measure seven outcomes (barriers, feasibility, useability, appropriateness, acceptability, burden, trialability).

Results

Three themes emerged from the data that impacted the group CBT manual: training, timing, and functionality. Addressing these themes allowed for a new, optimal manual and training procedure to be put into place.

Conclusion

The current study highlights that under-resourced inpatient addiction facilities can still methodically utilize implementation approaches to study their EBP, namely CBT. Such an approach will ensure that the highest quality care is being delivered to patients and actively addresses known training barriers that prevent proper EBP delivery.

Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting

Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 - August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.

Education as drug policy: A realist synthesis of continuing professional development for opioid agonist therapy

BACKGROUND

Continuing professional development (CPD) for opioid agonist therapy (OAT) has been identified as a key health policy strategy to improve care for people living with opioid use disorder (OUD) and to address rising opioid-related harms. To design and deliver effective CPD programs, there is a need to clarify how they work within complex health system and policy contexts. This review synthesizes the literature on OAT CPD programs and educational theory to clarify which interventions work, for whom, and in what contexts.

METHODS

A systematic review and realist synthesis of evaluations of CPD programs focused on OAT was conducted. This included record identification and screening, theory familiarization, data collection, analysis, expert consultation, and iterative context-intervention-mechanism-outcome (CIMO) configuration development.

RESULTS

Twenty-four reports comprising 21 evaluation studies from 5 countries for 3373 providers were reviewed. Through iterative testing of included studies with relevant theory, five CIMO configurations were developed. The programs were categorized by who drove the learning outcomes (i.e., system/policy, instructor, learner) and their spheres of influence (i.e., micro, meso, macro). There was a predominance of instructor-driven programs driving change at the micro level, with few policy-driven macro-influential programs, inconsistent with the promotion of CPD as a clear opioid crisis policy-level intervention.

CONCLUSION

OAT CPD is challenged by mismatches in program justifications, objectives, activities, and outcomes. Depending on how these program factors interact, OAT CPD can operate as a barrier or facilitator to OUD care. With more deliberate planning and consideration of program theory, programs more directly addressing diverse learner and system needs may be developed and delivered. OAT CPD as drug policy does not operate in isolation; programs may feed into each other and intercalate with other policy initiatives to have micro, meso, and macro impacts on educational and population health outcomes.

Internet-Based Learning for Professionals in Addiction Psychiatry: A Scoping Review

BACKGROUND AND AIM

Distance learning techniques are gaining popularity as the internet today is a faster and more convenient source of spreading exhaustive information. We aim at conducting a scoping review on the utility of internet-based learning in addiction psychiatry.

METHODS

We performed a systematic search of databases such as Google Scholar, PubMed, and Cochrane using the following keywords: Distance education, substance related disorder, teaching, internet, along with the MeSH terms ("Internet" AND "Teaching" AND "Substance Related Disorders") OR ("Distance Education" AND "Substance Related Disorders"). The reference lists of articles were searched for other relevant literature.

RESULTS

A total of 34 studies were included. Most of the courses offered online were on specific therapies, for example, training on motivational interviewing, twelve-step facilitation, cognitive behavioral therapy, alcohol screening, and brief intervention. They were based on various aspects of distance learning such as the acquisition of knowledge or skills, feasibility, level of satisfaction of the trainees/students, the cost-effectiveness of the techniques, and the type of trainees who have access to the course. The majority of the studies showed positive findings in terms of the parameter being studied. However, the level of satisfaction among the students is questionable.

CONCLUSION

Internet-based teaching programs provide a good alternative to traditional educational methods in terms of effectiveness, feasibility, and acquisition of knowledge and skills. We emphasize the use of internet-based training in addiction psychiatry reinforced by actual practical experiences.

Education and training on addiction psychiatry in low and middle income countries: Observations from existing literature and recommendations going ahead

BACKGROUND

Addictive disorders are a significant contributor to the global burden of disease. The burden of addictive disorders in LMIC is expected to grow further over the coming years.

AIMS

In this article we present the observations from the existing literature on the current status of education and training on addiction psychiatry in LMIC and provide recommendation on way forward for this specialized field of psychiatry.

MATERIALS AND METHODS

We searched electronic databases of PubMed to access the literature on the current status of education and training on addiction psychiatry. Additional searches were also conducted in other database of Google Scholar for potential 'grey' literature.

RESULTS

We were able to identify a total of 11 relevant articles.

DISCUSSION

Currently there is limited published literature on education and training on addiction psychiatry from the LMICs.

CONCLUSIONS

Strengthening of the training on addictive disorders shall not only help bridge the gap of the unmet need for the evidence-based interventions of addictive disorders across these countries it shall also help enhance the research capacity on addictive disorders in these countries.