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ACGME Policies and Procedures (2008) Pages one to five (the table of contents) give a detailed list of everything covered in this 110-page document. For example, the section "Procedures for the Develoment and Approval of Requirements" shows that changes originate with the Residency Review Committees and proceed through specific steps itemized here, including notifying the "communities of interest." -------------------------------------------------------------------------------- ACGME program requirements for residents in Addiction Psychiatry -------------------------------------------------------------------------------- ACGME program requirements for residents in Family Medicine -------------------------------------------------------------------------------- ACGME program requirements for residents in Internal Medicine -------------------------------------------------------------------------------- The RRC proposed these revisions “to match the intent of the Outcomes Project and base the residency training on the competencies, rather than on curriculum or process.” This 6-page impact statement discusses the intended impact of the changes. -------------------------------------------------------------------------------- The RRC for Internal Medicine revises its requirements about every two years and posts them for comment. The comment period ended May 2008. This 25-page document shows the revisions, which will become effective July 2009. -------------------------------------------------------------------------------- This paper by Daniel P. Alford, M.D. et. al. describes the Chief Resident Immersion Training (CRIT) program in addiction medicine and evaluates its impact on chief resident (CR) physicians' substance use knowledge, skills, clinical practice, and teaching. The CRIT program in addiction medicine effectively transferred evidence-based SU knowledge and practice to 64 CRs in generalist disciplines and more importantly, enhanced the substance use curriculum in 47 residency programs. CRIT is designed to capitalize on the potential to shift the values and culture of a residency program to include more substance use training. J Gen Intern Med DOI: 10.1007/s11606-008-0819-2 -------------------------------------------------------------------------------- This document contains the most commonly cited list of core competencies (starting on page 207) in the chapter written by David Fiellin, MD, Gail D’Onofrio, MD, Richard Brown, MD, Patrick O’Connor, MD, Richard Butler, DO. -------------------------------------------------------------------------------- Commentary by Stephan Arndt and Pat Taylor from the special "Recovery" issue of the Journal of Substance Abuse Treatment. J Subst Abuse Treat 2007; 33: 275. -------------------------------------------------------------------------------- Julia H. Arnsten et. al. wrote case scenarios for OSCE stations based on their clinical experience and the core competencies described by Fiellin et. al., in the AMERSA "Strategic Plan." This article describes the process and the results. The immediate feedback provided during an OSCE helped teach needed skills for assessing and managing substance abuse disorders. J Gen Intern Med 2006; 21(5): 453-459. -------------------------------------------------------------------------------- Medical education shapes student attitudes toward substance-abusing patients,often in negative ways. Curricular interventions to foster more positive attitudes toward such patients and their treatment can have lasting effects on clinical practice. The nature and duration of such interventions, however, requires clarification. To test the hypothesis that spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site would improve attitudes toward substance-abusing patients without reducing the clerkship benefits on attitudes toward, and knowledge about, psychiatry patients. Conclusions: Spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site increased regard for patients with alcoholism without adversely affecting measures of attitudes toward, and knowledge about, psychiatric patients. Teach Learn Med 2003; 15(2): 93-97. -------------------------------------------------------------------------------- Two groups in a Level 1 trauma center were studied: the intervention group and a control group. The intervention was a 4-hour didactic, a video and a skills-based workshop. Change was measured by record review before and after intervention. Ann Emerg Med July 2002; 40:50-62. -------------------------------------------------------------------------------- Research published in Addiction by Nady El-Guebaly et. al. Aims. To analyze the process of acquisition by physicians of a body of knowledge and skills in the management of substance abuse. Design. A comprehensive search of English-speaking literature was conducted over 20 years. Articles assessing the outcome of educational strategies in undergraduate, graduate and continuing medical education were examined to determine the targeted sample, the educational strategies involved and the outcomes assessed. Findings. Nine studies in undergraduate education, 11 in graduate and 11 in continuing education met the inclusion criteria. They were generally difficult to compare in design, strategy and outcome analysis. Cognitive knowledge and behavioral skills appear to be easier to obtain compared to more complex attitudinal shifts. Conclusions. There is growing consensus in the selection of a combined didactic and interactive educational strategy but few empirical data as to the more cost-effective learning interventions. Training must be reinforced at regular intervals. While the expanding panoply of interventions available to physicians should enhance the perceptions of role legitimacy and treatment optimism, cohort studies across levels of education, specialty groups and across-substance and other addictive behaviors are required to determine cost-effective educational strategies. Addiction 2000; 95(6): 949-957. -------------------------------------------------------------------------------- 1999 national survey by Michael F. Fleming and others, via telephone interviews, of the faculty who taught residents about substance use disorders. J Fam Pract 1999; 48(9):725-9. -------------------------------------------------------------------------------- The authors, Marc Galanter et. al., developed a six-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and demonstrated its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. Three treatment settings were used: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities. J Subst Abuse Treat 2007; 33: 257-264. -------------------------------------------------------------------------------- Research by Marc Galanter published in the special "Recovery" issue of the Journal of Substance Abuse Treatment. Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal. A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioral norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives. The mechanisms underlying the attribution of new meaning in AA are considered by recourse to the models of positive psychology and social network support; both models have been found to be associated with constructive health outcomes in a variety of contexts. By drawing on available empirical research, it is possible to define the diagnosis of addiction and the criteria for recovery in spiritually oriented terms. J Subst Abuse Treat 2007; 33: 265-272. -------------------------------------------------------------------------------- Commentary by Stuart Gitlow from the special "Recovery" issue of the Journal of Substance Abuse Treatment. J Subst Abuse Treat 2007; 33: 277-278. -------------------------------------------------------------------------------- To determine the amount of formal training in substance use disorders that occurs in selected residency programs and to identify the perceived barriers to such training, a national survey was conducted (by Isaacson JH, Fleming M, Kraus M, Kahn R) of program directors in emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic medicine, pediatrics and psychiatry. J Stud Alcohol 2000; 61: 912-915. -------------------------------------------------------------------------------- Research by Alexandre Laudet Ph.D. from the special "Recovery" issue of the Journal of Substance Abuse Treatment. Recovery is a ubiquitous concept but remains poorly understood and ill defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness. This study examines recovery definitions and experiences among persons who self-identify as “in recovery.” Two questions are addressed: (a) Does recovery require total abstinence from all drugs and alcohol? (b) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well? Inner-city residents with resolved dependence to crack or heroin were interviewed yearly three times (N = 289). Most defined recovery as total abstinence. However, recovery goes well beyond abstinence; it is experienced as a bountiful “new life,” an ongoing process of growth, self-change, and reclaiming the self. Implications for clinical and assessment practice are discussed, including the need to effect paradigmatic shifts from pathology to wellness and from acute to continuing models. J Subst Abuse Treat 2007; 33: 243-256. -------------------------------------------------------------------------------- This is the report from the first national leadership conference convened by the White House Office of National Drug Control Policy (ONDCP) in 2004. It includes findings, recommendations and action plans about undergraduate, graduate and continuing medical education. These leadership conferences were repeated in 2006 and 2008. -------------------------------------------------------------------------------- The report from the second national leadership conference (2006) convened by the White House Office of National Drug Control Policy (ONDCP). It contains sections called "Goals and Strategies" for these areas: undergraduate, graduate and continuing medical education; licensing, accreditation and certification standards; and for payers. -------------------------------------------------------------------------------- This is an early working draft (incomplete in some areas) of the report of the third ONDCP conference held in January 2008. That meting was designed to share information about what had been accomplished since the first and second national leadership conferences and to focus on SBIRT (Screening, Brief Intervention, Referral to Treatment) and getting screening and brief intervention incorporated broadly into clinical practice. -------------------------------------------------------------------------------- Commentary by Jim Ramstad, congressman from Minnesota's third district, from the special "Recovery" issue of the Journal of Substance Abuse Treatment. J Subst Abuse Treat 2007; 33: 273. -------------------------------------------------------------------------------- Substance use disorders constitute one of the most significant public health issues in the United States, and, in addition, there is solid evidence of an unmet need for care among those with these disorders. Although physicians are well placed to address this unmet need, there is also evidence that they frequently do not appropriately screen, diagnose, provide treatment interventions, or make referrals to specialists for those with these disorders. -------------------------------------------------------------------------------- This is the lead article in a special "Recovery" issue of the Journal of Substance Abuse Treatment that also includes four background papers and three commentaries on defining and measuring recovery. Recovery is defined with three elements–sobriety, personal health, and citizenship–with rationale and research implications for each. This landmark work is the consensus of a group of researchers, treatment providers, recovery advocates, and policymakers convened in 2006 by the Betty Ford Institute. J Subst Abuse Treat 2007; 33: 221-228. -------------------------------------------------------------------------------- Research by William L. White from the special "Recovery" issue of the Journal of Substance Abuse Treatment. The addiction field's failure to achieve consensus on a definition of “recovery” from severe and persistent alcohol and other drug problems undermines clinical research, compromises clinical practice, and muddles the field's communications to service constituents, allied service professionals, the public, and policymakers. This essay discusses 10 questions critical to the achievement of such a definition and offers a working definition of recovery that attempts to meet the criteria of precision, inclusiveness, exclusiveness, measurability, acceptability, and simplicity. The key questions explore who has professional and cultural authority to define recovery, the defining ingredients of recovery, the boundaries (scope and depth) of recovery, and temporal benchmarks of recovery (when recovery begins and ends). The process of defining recovery touches on some of the most controversial issues within the addictions field. J Subst Abuse Treat 2007; 33: 229-241. |
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