1. Use of Mentored Residency Teams to Enhance Addiction Medicine Education Maureen Strohm, MD, Ken Saffier, MD, Julie Nyquist, PhD, Steve Eickelberg, MD MERF Champions Project April 26, 2015

2. Disclosures All presenters and authors have nothing to disclose.

3. MERF Champions Project Medical Education and Research Foundation for the Treatment of Addiction 501c organization Associated with the California Society of Addiction Medicine Funding from Open Society Foundation 22 months, from 8/2012 – 5/2014

4. Purpose Primary care residents and faculty do not feel confident about caring for patients with substance use disorders or teaching about SUDs. By developing mentored residency teams, our goal was to encourage and guide SUD curriculum development. 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;154:56-59 Isaacson, J.H., 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, 912-915

5. Rationale: A Significant Gap Clinical services: SUD and unhealthy use of alcohol and drugs affects 120 million in US –More than all DM, CAD and cancer. –Missed diagnoses –Inappropriate or no treatment offered Residents feel less prepared than for other chronic medical diseases. Faculty need more support and expertise. Blumenthal,D; et al., Preparedness for clinical practice: reports of graduating residents at academic health centers. JAMA. 2001;286(9) The National Center on Addiction and Substance Abuse at Columbia University, Addiction Medicine: Closing the Gap between Science and Practice, June 2012.

6. Educational Objectives To develop faculty and resident competence in: SBIRT (screening, brief intervention and referral to treatment) for unhealthy drug and alcohol use. Motivational interviewing applied to primary care behavioral interventions.

7. Educational Objectives (cont’d.) The science and treatment of substance use disorders (SUD). Leadership skills to advocate for SUD education and access to care.

8. Methods 2 faculty and 1-2 residents from each program with each program having a mentor. 4 family medicine programs 120 family medicine residents Planning Committee: –2 FPs, 1 Addiction Psychiatrist –Educational consultant –Administrator

9. Methods (cont’d) Personal and programs’ needs assessments were done before meeting in San Francisco. 14 hours of onsite faculty and curriculum development combined didactics with structured small group exercises. 48 hours onsite SUD education including extensive use of case discussions throughout, including an 8 hour workshop on motivational interviewing.

10. Methods Methods (cont’d) Mentored meetings online every 8 - 10 weeks on Blackboard Collaborate. –Plan interventions and track progress. –4 journal clubs discussing 2 articles each session. Planning committee meetings every 4 - 6 weeks inviting individual educational consultations. Evaluation of the project and all local curricular innovations.

11. Evaluation questions 1.How well is the program accomplishing its planned activities (accountability)? 2.What types of changes are being made in each of the “champion” programs (impact)? 3.How much knowledge, skill and confidence are being demonstrated by “champions” and by their learners (learning)? 4.What are champions doing at the end of the program, that they were not doing at the beginning (behavior)?

12. Process Results n All formal training sessions were delivered (Question 1) n Community of learners built (Question 1) n Frequent interchanges among sites (Question 4) n Collaboration among champions (Question 4)

13. Site Activities - Educational

14. Site Activities - Clinical

15. Project and Site Scholarly Activities

16. Confidence and Knowledge No significant change in confidence Physicians’ Competence in Substance Abuse Test: “n” was too small for teams and residents to provide meaningful analysis. Harris, JM, Sun, H, The Physicians’ Competence in Substance Abuse Test (P-CSAT): A multidimensional educational measurement tool for substance abuse training programs. Drug and Alcohol Dependence. 2012, 122(3):236-40

17. Discussion – Lessons Learned Mentored teams promote: –SUD education, clinical services and scholarship. –Faculty development –Regional SUD workshops –Leadership and advocacy to innovate curricula Less leadership support slowed progress

18. Limitations Data collection is difficult for Champions, faculty and especially residents due to competing demands and limited time. Although clinical and teaching confidence trended positively, tools for measuring competence were not employed.

19. Importance/conclusions The MERF Champions’ Project can serve as a model for successful integration of SUD education into residencies to: Eliminate current educational and practice gaps, Enhance prevention, screening, diagnosis and treatment of SUDs.

20. Special Thanks to: STFM Open Society Foundation Kerry Parker, CEO, California Society of Addiction Medicine USC Keck School of Medicine, Department of Medical Education

21. Please evaluate this session at: stfm.org/sessionevaluation