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Revising residents’ addiction experience: a 1‐week intensive course

What problem was addressed? Medical residents are not adequately prepared to address substance use (SU) disorders despite the substantial and increasing contribution to mortality, disability and health care costs. Insufficient training contributes to low levels of confidence and increased frustration. These attitudes and a lack of skills then result in general discomfort and avoidance of counselling and treating patients with SU disorders. What was tried? We developed a week-long intensive course for primary care internal medicine interns (WAM! Week of Addiction Medicine). The curriculum was based in a learner-centred, experiential education model. Interns participated in lectures, patient interviews, a journal club, discussion of the literature on addiction and clinical site visits. Sessions covered neurobiology of addiction, opiates, alcohol, motivational interviewing, brief interventions, harm reduction and policy. Motivational interviewing training included theory, skills-based practice and coaching sessions. We utilised preand post-tests to measure both knowledge and attitudes. The organisation of the week was championed by the chief resident, with support and teaching from core primary care faculty members and addiction specialists. What lessons were learned? Overall, this innovative curriculum on addiction medicine increased knowledge of and improved attitudes towards substance use. The mean test score for clinical knowledge improved from 50% to 70% (p < 0.0005). The mean confidence score increased from 2.7 to 4.2 (p < 0.0005) on a 5-point Likert scale. At baseline, 69% of participants somewhat or strongly agreed that treating SU is rewarding; this increased to 94% at the end of the week. Likewise, 57% somewhat or strongly believed at baseline that they could make a difference for their addicted patients, compared with 88% after the course. Qualitative feedback was strongly positive. We believe that the success of this programme can be attributed to several factors. The consolidated learning during the week allowed a deeper dive into the topic, compared with having multiple experiences spread out over time. We utilised specialists and resources within our medical system and provided myriad experiences through interactive sessions. The learners left the classroom to visit different clinical settings (in-patient detox, intensive out-patient treatment or methadone clinic) to which they could refer patients. We hypothesise that first-hand exposure will lead to a more sustained impact compared with having representatives from those sites come to them, creating an active learning experience. Finally, we believe that incorporating a focus on patients in recovery and outpatient settings was a positive contrast to experiences residents may have had on the in-patient wards, and may have contributed to the increase in positive attitudes towards treating patients with SU. In conclusion, there is a knowledge gap and a pervasive negative attitude towards SU disorders. Knowledge, confidence and attitudes towards SU improved after this intensive week of addiction medicine. Future studies will need to determine if the effects persist and lead to improved physician satisfaction, patient counselling, treatment and health outcomes. There is a possibility that primary care residents have a different level of interest in or baseline motivation to learn about SU. Going forward we will continue to set aside one week each spring for this course. We plan to expand the programme to a larger cohort of trainees.