Medical Student Resources

 

Goals and Objectives for Medical Student Education in Addiction

APA Committee on Training and Education in Addiction Psychiatry (Draft 9/6/01)

Please address feedback, comments or suggestions to jritvo@dhha.org or richard.schottenfeld@yale.edu. 
  1. KNOWLEDGE BASE
    1. Drug Classes
    2. Pharmacology
    3. Neurobiology
    4. Epidemiology (use, abuse, dependence)
    5. Pathophysiology
    6. Physical and mental status findings and medical complications (including intoxication, withdrawal and neonatal/obstetrical issues.)
    7. Pharmacological interventions (including detoxification, agonist, antagonist, aversive and anti-craving medications.)
    8. Psychosocial interventions (overview of modalities including 12-step programs and skills training and awareness of the increased efficacy of pharmacological approaches supplemented by counseling.)

 

II. CLINCIAL COMPETENCIES

These competencies should be rated using the following anchors. The rating should be based on the presence of the skill, NOT specific expectations for each training level.

Anchors:

  • Skill Not Apparent: The student has not demonstrated any ability to implement the skill.
  • Skill Emerging: The student has shown partial ability to meet the competency requirement. The student may only show that he/she has the skill only intermittently or to a limited extent. Nevertheless, the student clearly has shown at least the beginning of applying the skill.
  • Skill Apparent: The student consistently shows an ability to implement the skill.
  • Skill Highly Developed: The student shows an ability to implement the skill consistently and comprehensively.

Skill Not Apparent

Skill Emerging

Skill Apparent

Skill Highly Developed

Not Applicable

(Please complete for medical students at all levels)

A. Assessment
1) Ability to obtain a substance use history in an empathic manner with a non-judgmental attitude
2) Ability to obtain a substance use history that identifies patterns of use over time, covers major drug classes (sedatives, stimulants, opiates, nicotine, hallucinogens, etc) and identifies the applicable routes of administration (oral, intranasal, smoking, injecting, etc) and features of tolerance, withdrawal and loss of control.

3) Ability to obtain a substance use history that identifies psychosocial (relationship, marital, parental, work, school, legal, housing, financial) problems related to regular or episodic use
4) Ability to obtain a substance use history that identifies co-morbid medical and psychiatric disorders
5) Ability to obtain a substance use history that identifies previous attempts to reduce use or quit, the past treatment history and the current interest in reducing or stopping using

6) Ability to use laboratory and diagnostic test in the assessment of a patient’s substance use

Potential mechanisms for teaching: Simple screening tools (.e.g. MAST, DAST, AUDIT, CAGE, TWEAK, RAFFT, Fagerstrom Tolerance Test for Tobacco, CIWA-Ar for Alcohol) ; demonstration interviews, role playing. For Objective 1 see motivational interviewing resources under section C. below.

Potential mechanisms for assessing: Observed interview

B. Diagnosis:
1) Ability to verbally present the information obtained from substance use history
2) Ability to write up the details of information obtained from a substance use history
3) Ability to identify and discuss the relationships between past or current patterns of substance use and associated problems (e.g. insomnia, anxiety, elevated blood pressure, aggression, weight loss,) and other comorbid medical/psychiatric conditions.
4) Ability to identify and discuss the relationships between past or current patterns of substance use and psychosocial complications (see II.A.3 above)

5) Ability to diagnose a substance related disorder and provide an appropriate differential diagnosis from the information obtained from a the substance use history

6) Ability to identify potential dangerousness (homicide, suicide, child abuse)

Potential mechanisms for teaching:

Videotapes, Sample case histories.

 

Potential mechanisms for assessing: Case presentation

C. Brief Motivational Interventions & Referral:
1) Ability to conduct an interview that minimizes the development of resistance and defensiveness.
2) Ability to facilitate the patient talking openly and freely about the pros and cons of continued substance use and the pros and cons of reducing or quitting use.
3) Ability to elicit self-motivating statements, ask open ended questions and exchange information about substance related problems and solutions
4) Ability to summarize key aspects of the substance use history, facilitate a discussion of the future consequences of continued use, and give feedback on the differential diagnosis, the recovery process and possible treatment options
5) Ability to effect an appropriate referral for further diagnostic evaluation and/or treatment

Potential mechanisms for teaching: video "The Emergency Physician and the Problem Drinker: Motivating Patients for Change", Gail D’Onofrio, Edward Bernstein and Judith Bernstein, Marino & Co. Productions, 1997 available at 800-548-9481.( further bibliography appended)

Potential mechanisms for assessing: Observed interview with real or standardized patient in primary care or emergency setting.

D. Other:

Comments: Please include in this section your written comments as to areas of strength and those areas in need of further development. Comments for areas rated as "skills not apparent" should be made here.

Strengths:

Areas in Need of Further Development:

 

 

 

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