Background: Substance use disorders represent a significant social and economic burden globally. Accurate diagnosis and treatment by early career professionals in addiction medicine (ECPAM) falls short, in part, due to a lack of training programmes targeting this career stage. Prior research has highlighted the need to assess the specific training needs of ECPAM. Therefore, this focused review assessed self-reported training needs of ECPAM. Methods: Medical and medical education databases (Medline, EMBASE, CINAHL, ERIC, PSYCHInfo, BEI, and AEI) were searched to June 2018 for studies reporting self-reported training needs of ECPAM (trained at most five years before assessment occurred). Retrieved citations were screened for eligibility; two independent researchers reviewed included studies, assessed quality and extracted data. Experts reviewed study findings. Results: Of 1364 identified records, three cross-sectional studies were included, originating from China, USA and England. All studies surveyed ECPAM using self-reported questionnaires, with one study including face-to-face interviews. Participants included residents, physicians and social workers. All studies had a low risk of bias, and reported a wide range of training needs including rehabilitation, relapse prevention, buprenorphine treatment and risk assessment. Conclusions: There is little evidence for and substantial heterogeneity of training needs of ECPAM found in this review, particularly at the level of skills and knowledge. Study quality varies greatly. ECPAM training needs assessments are a priority. Klimas J, Kelly D, Adam A, Arya S, Ruiz B, Krupchanka D, Hamilton M, Dennehy T, Wood E, Cullen W MedEdPublish https://doi.org/10.15694/mep.2020.000062.1 Page | 2

https://researchrepository.ucd.ie/bitstream/10197/11717/2/Klimas-et-al_MededPublish_2020.pdf

What Are the Self-Assessed Training Needs of Early Career Professionals in Addiction Medicine? A BEME Focused Review

Education as drug policy: A realist synthesis of continuing professional development for opioid agonist therapy.

Abstract Introduction Substance use disorders (SUD) are increasing in prevalence, and most physicians will encounter patients with SUD (PWSUD). As a result, the training of the global addiction workforce requires expansion. Two primary barriers to improving the quality and quantity of the global addiction workforce are healthcare providers' negative attitudes toward PWSUD and a lack of qualified addiction physicians. The authors are unaware of any published research on the association between these two barriers: a study that could help inform us about how to strengthen global addiction services through targeted medical training. Methods . The MCRS, measuring professionals' attitudes towards patients with SUD, and the AM-TNA, measuring perceived training needs and competence gaps, were used to study the association between attitudes and competence. We used Pearson correlation, multiple regression, and PROCESS path analysis in a cross-sectional study design in a convenience sample of addiction physicians trained in The Netherlands (Dutch)(N = 70) and in Lithuanian (Lithuania) (N = 75) to explore this association and a possible moderation effect of the Gender and Country of Origin variables among addiction caregivers. Results. We found a significant positive correlation between the total score of both scales: R = 0.537, p &lt; 0.001. The MCRS predicted the three AM-TNA subscales significantly p &lt; 0.001, and Gender did not influence the association between the two scales. The Country of Origin variable and its combination with the MCRS total score did strengthen the association between the MCRS and two AM-TNA subscales: medical- ( p &lt; 0.001) and practical aspects of perceived addiction competence ( p &lt; 0.05 ). Conclusions. Attitudes predict perceived training needs, meaning addiction physicians with positive attitudes are likelier to have and want better-developed addiction knowledge and skills. To improve addiction services, the in-tandem use of the MCRS and the AM-TNA could reveal specific SUD competence gaps and model the design of an integrated addiction training or intervention approach. Future research should focus on the longitudinal use of the combined scales, assess individual professionals’ progress, and compare and combine self-reported competencies and attitudes with validated external assessments of learning, attitudes, and self-efficacy. 

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Physicians’ attitudes towards patients with substance-related disorders predict training needs in addiction medicine: challenges and opportunities for strengthening the global addiction medicine workforce

Australia has one of the highest rates in the world of the use of the crystalline form of methamphetamine, a highly addictive stimulant that is often associated with a chronic, relapsing dependency. Methamphetamine use is associated with both acquisitive and violent offending, which cause substantial personal and societal costs. Whilst the short-term euphoria and stimulation provide a positive reinforcement to methamphetamine use, the aversive states of withdrawing from methamphetamine and the associated craving, which may last up to five weeks into abstinence, underlie the negative reinforcement to continued methamphetamine use. Although many methamphetamine-dependent users experience high levels of psychological distress, it is likely that less than half engage with treatment or support services, and current intervention and treatment programmes have high discontinuation rates. Stigma and discrimination, even from paramedics and health clinicians, are prominent barriers to methamphetamine-dependent users accessing treatment in Australia. 

Methamphetamine dependence in Australia–why is ‘ice’ (crystal meth) so addictive?

Abstract Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 – August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.

Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting

Substance use disorders pose a significant global social and economic burden. Although effective interventions exist, treatment coverage remains limited. The lack of an adequately trained workforce is one of the prominent reasons. Recent initiatives have been taken worldwide to improve training, but further efforts are required to build curricula that are internationally applicable. We believe that the training needs of professionals in the area have not yet been explored in sufficient detail. We propose that a peer-led survey to assess those needs, using a standardised structured tool, would help to overcome this deficiency. The findings from such a survey could be used to develop a core set of competencies which is sufficiently flexible in its implementation to address the specific needs of the wide range of professionals working in addiction medicine worldwide.

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Victoria Cock

Papers

Closing the gap between training needs and training provision in addiction medicine.