Addiction Medicine Elective & Street Medicine

Educational Goals & Objectives

Substance use disorder continues to increase in incidence and prevalence throughout the United States. The goal of this rotation is for residents to be able to recognize, diagnose, and treat substance use disorders. Residents will be able to manage acute withdrawal, develop treatment plans, and utilize motivational interviewing to help develop a positive therapeutic relationship with patient struggling with substance use disorder both in the inpatient and outpatient setting.

Residents will be able to medically manage patients with substance use disorders, help patients navigate barriers to care, understand biopsychosocial contributions to substance use disorders, work with social workers and other team members, and develop an individualized treatment plan for each patient.

Residents participating in Street Medicine also will gain greater insight into daily barriers of care and have an opportunity to work with Substance Use Navigators and other organizations to help patients continue with care. They will learn how to appropriately diagnose and triage common medical illnesses associated with homelessness and practice Motivational Interviewing with a range of patient diagnoses.

Principal Teaching Methods

1. Residents will care for patients with a wide range of substance use disorders including; misuse of prescribed medications, non-prescribed substances, alcohol, and misuse of dietary supplements. Residents will care for patients with substance use disorders in both the inpatient and outpatient setting.

2. Residents will learn to address medical, and psychiatric co-morbidities and complications of substance use disorders.

3. Residents will attend lectures on various aspects of common substance use disorders.

4. Residents may participate in Street Medicine.

Methods of Evaluation

Resident Performance

Faculty will provide verbal feedback mid-rotation.

Faculty will complete competency-based electronic resident evaluation forms in New Innovations. The evaluator will give a formative assessment of core competency performance and share this evaluation with the resident; it is also available for online review by the resident at their convenience.

Program and Faculty Performance

Upon completion of the rotation, residents complete a rotation evaluation form commenting on the faculty, facilities, and service experience. These confidential evaluations are available for the Program Director's review, and the attending faculty physician receives periodic feedback after sufficient residents have completed the elective to maintain anonymity.

Specific Competency Objectives

1. Patient Care

a. The resident will be able to conduct a patient-centered history, utilizing motivational interviewing to obtain the overarching, personal dimensions of the patient’s substance use disorder, as well as the essential details of each substance including amount, frequency, route, first use, duration of use, and last use.

b. The resident will be able to obtain a complete substance use history including: substances used, onset and duration of use, route of use, complications of use physical, mental, and legal, treatment history, prior successes and efforts, withdrawal experiences or complication.

c. The resident will be able to diagnose substance use disorders using DSM-V criteria.

d. The resident will be able to perform a relevant physical examination and identify withdrawal manifestations, and comorbid psychiatric complications.

e. The resident will be able to succinctly summarize and synthesize in the patient’s chart the biopsychosocial aspects of the patient’s addiction.

f. The resident will be able to partner with the patient and utilize motivational interviewing to identify patient’s readiness to change.

g. The resident will be able to identify a harm reduction approach for patients who are pre-contemplative building therapeutic relationships and helping patient increase their overall health and well-being. The resident will be able to meet the patient where they are and help them progress towards their goals of health.

h. The resident will be able to identify a management plan. Work with social workers, groups, counselors, and other physicians on their care team and community organizations like AA to help the patient build a group of sober support.

2. Medical Knowledge

a. The resident will develop the knowledge base in addiction medicine to become proficient within their general specialty practice.
b. The resident should understand the epidemiology and various manifestations of the
spectrum of alcohol and substance use disorders in adults.
c. The resident should become familiar with available multiple treatment modalities,
including pharmacotherapy for the management of alcohol and other substance use
disorders.

3. Interpersonal and Communication Skills

a. The resident will be able to integrate relationship-centered communication skills to gain a biopsychosocial understanding of the patient’s substance use disorder.
b. The resident will be able to effectively communicate with other team members and physicians to help patients navigate the medical system.
c. The resident will practice motivational interviewing and compassionate care with patients.

4. Professionalism

a. The resident will be able to identify stressors, negative past experiences, and how stigma can affect patients with substance use disorder. The resident will utilize this understanding to ensure the patient receives good, respectful care. The resident will also develop a deeper understanding of the patient’s barriers to care, commendable progress, and at times, even the increased frustration patients experience.
b. The resident will be able to become the patient’s ally, provide support and counsel in a primary care setting, and provide information and other resources needed by the patient.
c. The resident will be sensitive to cultural, disability, lifestyle, and gender differences in patients with a substance use disorder.
d. The resident will be able to articulate, understand, and practice in a way consistent with ethically sound, patient-centered practices.

5. Practice-Based Learning and Improvement

a. The resident will be able to critically appraise the literature and apply this knowledge
to the patient.
b. The resident will be able to make self-assessments of his/her impact on addiction patients and also learn to identify their own attitudes and emotions that might interfere with high-quality care.

6. Systems-Based Practice

a. The resident will be able to recognize and address the systems aspect of patients with a substance use disorder and their complex problems in the biological, psychological, and social aspects of their lives.
b. The resident will be able to refer consultations to addiction specialists effectively, including how to introduce and discuss the referral with the patient.
c. The resident will be able to recognize the cost impact of addiction problems as well
as provide cost-effective care for these patients.
d. The resident will be able to help patients identify resources in the community often needed and used by addiction medicine patients, including utilizing social workers, counselors, and substance use navigators.

Street Medicine

Street medicine is designed to be a longitudinal experience throughout residency. All residents rotate through on their ambulatory week on the 4+1 clinic schedule. In addition, PGY2s doing the Addiction Medicine Elective spend additional time weekly.

Street Medicine Rotation Structure

• Street Medicine is 8:45-11:00 AM

• Bring Laptop to connect to Hotspot

• Do not bring white coat (scrubs okay)

• Help with Patient Registration *Pending registration office input*

• Patient history and exam

• Help patient navigate follow up (medications, ECM, SW, Insurance barriers, etc.)