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Klimas J, Gorfinkel LR, Hamilton M, Lail M, Krupchanka D, Cullen W, Wood E, Fairbairn N. Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting. Subst Use Misuse 2022; 57:2134-2141. [PMID: 36315582 PMCID: PMC9970042 DOI: 10.1080/10826084.2022.2137815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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.
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Affiliation(s)
- J. Klimas
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Addictology, First Faculty of Medicine, Charles University, Czech Republic
| | - Lauren R. Gorfinkel
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - M.A. Hamilton
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - M. Lail
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Ireland
| | - D. Krupchanka
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic; Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - W. Cullen
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Ireland
| | - E. Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
| | - N. Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC, Canada
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Raine G, Evans C, Uphoff EP, Brown JVE, Crampton PES, Kehoe A, Stewart LA, Finn GM, Morgan JE. Strengthening the clinical academic pathway: a systematic review of interventions to support clinical academic careers for doctors and dentists. BMJ Open 2022; 12:e060281. [PMID: 36691216 PMCID: PMC9462120 DOI: 10.1136/bmjopen-2021-060281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/21/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Evaluate existing evidence on interventions intended to increase recruitment, retention and career progression within clinical academic (CA) careers, including a focus on addressing inequalities. DESIGN Systematic review. DATA SOURCES Medline, Embase, Cochrane Controlled Register of Trials, PsycINFO and Education Resource Information Center searched October 2019. STUDY SELECTION Eligible studies included qualified doctors, dentists and/or those with a supervisory role. Outcomes were defined by studies and related to success rates of joining or continuing within a CA career. DATA EXTRACTION AND SYNTHESIS Abstract screening was supported by machine learning software. Full-text screening was performed in duplicate, and study quality was assessed. Narrative synthesis of quantitative data was performed. Qualitative data were thematically analysed. RESULTS 148 studies examined interventions; of which 28 were included in the quantitative synthesis, 17 in the qualitative synthesis and 2 in both. Studies lacked methodological rigour and/or were hindered by incomplete reporting. Most were from North America. No study included in the syntheses evaluated interventions aimed at CA dentists.Most quantitative evidence was from multifaceted training programmes. These may increase recruitment, but findings were less clear for retention and other outcomes. Qualitative studies reported benefits of supportive relationships, including peers and senior mentors. Protected time for research helped manage competing demands on CAs. Committed and experienced staff were seen as key facilitators of programme success. Respondents identified several other factors at a programme, organisational or national level which acted as facilitators or barriers to success. Few studies reported on the effects of interventions specific to women or minority groups. CONCLUSIONS Existing research is limited by rigour and reporting. Better evaluation of future interventions, particularly those intended to address inequalities, is required. Within the limits of the evidence, comprehensive multifaceted programmes of training, including protected time, relational and support aspects, appear most successful in promoting CA careers. SYSTEMATIC REVIEW REGISTRATION Open Science Framework: https://osf.io/mfy7a.
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Affiliation(s)
- Gary Raine
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Connor Evans
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Jennifer Valeska Elli Brown
- Centre for Reviews and Dissemination, University of York, York, UK
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Paul E S Crampton
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Amelia Kehoe
- Health Professions Education Unit, Hull York Medical School, York, UK
| | | | | | - Jessica Elizabeth Morgan
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Haematology & Oncology, Leeds Children's Hospital, Leeds, UK
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Klimas J, Dong H, Hamilton MA, Cullen W, Samet JH, Wood E, Fairbairn N. Impact of the international collaborative addiction medicine research fellowship on physicians' future engagement in addiction research. Subst Abus 2022; 43:809-814. [PMID: 35130132 PMCID: PMC8963348 DOI: 10.1080/08897077.2021.2010256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: To evaluate how an international one-year intensive research training program for addiction medicine physicians contributed to subsequent research involvement and productivity. Methods: We prospectively compared addiction medicine physician fellows admitted to a one-year training program with non-admitted controls, using baseline questionnaire and peer-reviewed publication data. Participants' publication activity was assessed from fellowship application date onwards using biomedical databases (e.g., PubMed, Embase). Results: Between July 2014 and June 2020, which is six years of cohorts, 56 (39 women) physicians, both fellows (n = 25) and non-admitted applicants (n = 31), were observed and included in the study, contributing 261 person-years of observation. At baseline, in the fellows' cohort: 76% of participants (19/25) reported past research involvement, 24% (6/25) had one or more advanced graduate degrees (e.g., MPH), and the median number of peer-reviewed, first author publications was one (Interquartile Range [IQR] = 0-2). At baseline, in the controls' cohort: 84% of participants (26/31) reported past research involvement, 39% (12/31) had one or more advanced graduate degrees, and the median number of peer-reviewed, first author publications was zero. The physicians' training included internal medicine (n = 8), family medicine (n = 33), psychiatry (n = 5) and others (n = 4). At follow up, there was a significant difference between fellows (n = 25) and controls (n = 31) in total number of publications (Rate Ratio [RR] = 13.09, 95% Confidence Interval [CI], 5.01 - 34.21, p < 0.001), as well as first author publications (RR = 5.59, 95% CI, 2.23 - 14.06, p < 0.001). Conclusion: In the six-year observation period, fellows' productivity indicates undertaking this fellowship was associated with significant research outputs in comparison to controls, signaling successful training of addiction physicians to help recruit addiction medicine physicians to participate in addiction research.
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Affiliation(s)
- Jan Klimas
- British Columbia Centre on Substance Use, Vancouver, BC, Canada;,School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | | | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Jeffrey H. Samet
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, BC, Canada;,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, BC, Canada;,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Klimas J, Small W, Ahamad K, Cullen W, Mead A, Rieb L, Wood E, McNeil R. Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors. Addict Sci Clin Pract 2017; 12:21. [PMID: 28927448 PMCID: PMC5606021 DOI: 10.1186/s13722-017-0086-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships. Methods We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.
Results We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training. Conclusions Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.
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Affiliation(s)
- J Klimas
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - W Small
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - K Ahamad
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - W Cullen
- School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - A Mead
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - L Rieb
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Family Practice, University of British Columbia, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.,Department of Family and Community Medicine, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - E Wood
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Medicine, Coombe Healthcare Centre, University College Dublin, Dolphins Barn, Dublin 8, Ireland
| | - R McNeil
- Department of Medicine, B.C. Centre on Substance Use, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Klimas J, McNeil R, Ahamad K, Mead A, Rieb L, Cullen W, Wood E, Small W. Two birds with one stone: experiences of combining clinical and research training in addiction medicine. BMC MEDICAL EDUCATION 2017; 17:22. [PMID: 28114925 PMCID: PMC5260094 DOI: 10.1186/s12909-017-0862-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting. METHODS We interviewed physicians from the St. Paul's Hospital Goldcorp Addiction Medicine Fellowship and learners from the hospital's academic Addiction Medicine Consult Team in Vancouver, Canada (N = 26). They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick's model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software (Nvivo 10). RESULTS We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training. Competing priorities, including clinical and family responsibilities, hindered training. CONCLUSIONS Combined training in addiction medicine and research is feasible and acceptable for current doctors and physicians in training. However, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required to improve curricula and research productivity.
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Affiliation(s)
- J Klimas
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - R McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - K Ahamad
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Family Practice, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - A Mead
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Family Practice, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - L Rieb
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Family Practice, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family and Community Medicine, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - W Cullen
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - E Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - W Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
- Urban Health Research Initiative, B.C. Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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