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"Addressing the Crisis: Helping Graduate Medical Education to Integrate Addiction Medicine and Science into Primary Care"

This Critical Issues/Consensus Conference, which was held in Los Angeles December 4-6, 2008, drew attention to the virtual absence of formal graduate medical education for primary care physicians in the recognition and treatment of addictive disease. The ultimate aim of the Conference was to reduce and prevent the harm being done to patients by physicians who, in the absence of adequate training, lack the skills and competencies to diagnose and treat addicted patients in their practices.

Fourteen faculty members, all nationally and internationally known experts in the field of training for primary care physicians, participated in debate and discussions about the critical nature of the deficiency that exists in graduate medical education that will continue to give us generations of unprepared and unqualified physicians who have never acquired the core clinical skills and competencies that are essential for the diagnosis and treatment of alcoholics and other addicts. Worse still, these physicians will be practicing medicine without insight or knowledge about the negative, and often fatal, ways in which alcohol and drug abuse and dependence can influence the course of other chronic diseases commonly seen in all arenas of medical practice. The corollary of this statement is, of course, also true; there is now evidence to suggest that long-term stable recovery from addiction in the context of good medical care can improve and enhance the overall prognosis for many chronic diseases.

A primary purpose of the "GME" Conference was to speculate about reasons for the critical situation outlined above, and to devise a strategy designed to bring about mandatory inclusion of addiction medicine training at all levels and in all aspects of graduate medical education. This strategy is designed to increase the likelihood that organizations such as the Accreditation Council on Graduate Medical Education and other relevant bodies will be willing to include this vital element as a mandatory component in their required curricula for training.

A very satisfactory consensus was achieved by the Conference faculty concerning the nature and causes of the problem. A preliminary plan was outlined for implementation of the Strategy for Change that is based on the findings and recommendations of the Conference. A summary paper has been published in the Annals of Internal Medicine.  

During the past 20 years, numerous Conferences have been held under various auspices on the topic of GME in addiction for physicians. However, despite the energies and labors of many individuals and organizations the results have been disappointing, to say the least. As a way of avoiding a repeat of this outcome, this BFI GME Conference will be followed by a Phase II Conference to evaluate the success of the Strategy for Change by measuring; (1), policy changes in the regulatory agencies; (2), the extent to which addiction medicine is a required element in residency training curricula; (3), the actual number of Primary Care Residency Training Programs that include mandatory training in addiction medicine, and (4) the increase (if any) of Faculty Members dedicated to teach addiction medicine to Residents.

Resources

ACGME Description
ACGME Policies and Procedures (2008)
ACGME Program Requirements for Addiction Psychiatry (2003)
ACGME Program Requirements for Family Medicine (2007)
ACGME Program Requirements for Internal Medicine (2007)
ACGME Program Requirements for Internal Medicine—Impact Statement (2008)
ACGME Program Requirements for Internal Medicine—Proposed Revisions (2008)
Alford: An Evaluation of the Chief Resident Immersion Training (CRIT) (2008)
AMERSA Strategic Plan: A New Approach to Substance Use Disorders (2002)
Arnsten: Teaching About Substance Abuse with Objective Structured Clinical Exams–OSCE (2006)
Christison: Requiring a One-Week Addiction Treatment Experience (2003)
D'Onofrio: Improving Emergency Medicine Residents' Approach to Patients With Alcohol Problems (2002)
El-Guebaly: Medical Education in Substance-Related Disorders—Components and Outcome (2000)
Fleming: Who Teaches Residents About the Prevention and Treatment of Substance Use Disorders? (1999)
Isaacson: National Survey of Training Substance Use Disorders in Residency Programs (2000)
ONDCP Leadership Conference on Medical Education in Substance Abuse: Working Groups Reports (2004)
ONDCP Second Leadership Conference on Medical Education in Substance Abuse (2006)
ONDCP Third Leadership Conference on Medical Education in Substance Abuse (2008)
Report of the AMA Council on Medical Education (2007)

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