ABAM/CNHF ProjectFELLOWSHIPS

FELLOWS

TRAINING EVENTS

SUMMARYContext: Addiction is a major health problem with a suboptimal response from the health care system and with a shortage of trained physicians to provide needed care

Objective: Develop a physician workforce trained to provide care and teach screening, brief intervention and refferal to treatment (SBIRT) to other physicians

Design: Observational educational study

Setting: North American academic graduate medical education (GME) training programs on addiction medicine

Participants: Directors of addiction medicine fellowship programs and the fellows

Intervention: Standardized national SBIRT curriculum for addiction medicine GME

Main outcome measures: Number of fellowships established, fellows trained, SBIRT training events delivered, and primary care providers trained in SBIRT

Results: More programs are training more fellows who can teach adolescent-oriented SBIRT during their fellowship and in the year following completion of training

Conclusion: A new work force of addiction medicine physicians is beginning to have an impact on the health care response to the epidemic of adolescent substance use disorders

CONTEXTWhat’s the problem? How will it be fixed?

BACKGROUND: The substance use disorders are a major health problem Health system response is treatment focused We can’t treat our way out of this problem

OBJECTIVE: Expand the focus of the health system beyond the treatment of addiction Include a focus on early disease Include a focus on young people

PROBLEM: Lack of addiction medicine physician workforce with vision and skills

SOLUTION: Establish fellowships, develop curricula, train future leaders

EXPECTED OUTCOMES: Specific and measurable Fellows will be expert educators as shown by progression through “Milestones” during training Fellows will be become agents of system change by continuing training events after graduation

GOALS & OBJECTIVESChange the Health Care SystemEstablish Fellowships

Seek out potential sites for fellowship Work with the ABAM certified champion

Develop Curricula Compile lists of available materials Develop the skills of existing faculty Develop curricula for training fellows

Train Future Leaders Use the “see one, do one, teach one” model Aspire for skills needed to effect system change

EVALUATIVE STRATEGYData Collection & ManagementDesign/setting: Observational study/fellowship

Participants: Program directors & fellows

Baseline data: Program chacteristics & demographics of the fellows

Intermediate process measures Quantitative: Number and type of training events, number of trainees Qualitative: Evaluations by faculty, fellows and trainees

Main outcome measures: Total number of training events in the year after graduation Number of training events designed to change a health care system

Data management: Systematically collected, use of statistical software (SPSS)

Fellowships:More Programs are Training More Fellows

2011 2012 2013 2014 2015* 2016* 2017*0

20

40

60

80

100

120

140

Fellowships and Fellows

Fellowships (cumulative) Fellow graduated (annual) Fellow graduates (cumulative)*projected

Fellows:Background and Milestone Progress

Baseline 1st Quarter 2nd Quarter 3rd Quarter Graduate0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Quarterly SBIRT Milestone Achievement by Class Year (Scale 1-

5)

2014 2015* 2016* 2017**projected

Specialty

FM (30%) IM (35%) Psych (25%)Peds (5%) Other (10%)

Fam MedPedsOther

Internal Med

Psych

Fellows as Teachers:More Physicians Trained in Adolescent SBIRT

2014 2015 2016 20170

20

40

60

80

100

120

140

160

Average number of trainees per fellow by graduation year

Average number of trainees per fellow

2014 2015 2016 20170

1000

2000

3000

4000

5000

6000

7000

SBIRT trainees

All trainees Trained in Adolecent SBIRT

2014 Training Events:Who was trained? How were they trained?

55%

20%

10%

10%5%

2014: Type of Training Events (ranked by number of trainees)

DidacticInteractiveDemonstrationWorkshopClinical

DidacticInteractive

Demo

Workshop Clinical

22%

44%

6%

22%

6%

2014: Types of Trainees

PhysiciansResidentsNursesMed StudentsOffice Staff

ResidentsNurses

Medical Students

OfficeStaff

Physicians

Fellows’ Training Events:Fellows Continue to Train after Graduation

2014 (n = 20) 2015 (n = 25) 2016 (n = 30) 2017 (n = 40)0

2

4

6

8

10

12

Average Number of Training Events per Fellow

During Fellowship During the 1 year after graduation

CONCLUSIONS: 2013-2017Number of ADM fellowships has more than doubled (19 to 43)

Over 100 ADM fellows have entered the workforce

These clinical physicians have been taught to train others in SBIRT

They have continued to train other physicians after graduation

Their efforts are changing the health care system

PublicationsDoe JD, Roe RA, Smith H, Wesson DB. Establishing fellowship for physicians on addiction medicine: barriers encountered and lessons learned. Grad Med Educ 2018;12:34-45.

Doe JD, Roe RA, Smith H, Wesson DB. Filling a workforce need: the training of physicians on addiction medicine. J Med Educ 2018;12:34-45.

Doe JD, Roe RA, Smith H, Wesson DB. Changing the American healthcare system: addiction medicine physicians as agents of change. Am J Health Policy 2018;12:34-45.

AcknowledgementsFunding provided by:

NIAAA R25 Conrad N. Hilton Foundation

With additional support from: Society of Teachers of Family Medicine Blue Cross/Blue Shield of Western New York