ABAM/CNHF Project FELLOWSHIPS FELLOWS TRAINING EVENTS
Jan 01, 2016
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