Sociometric Assessment of Leadership Status in Substance Abuse Training

Abstract

A learner-centered clinical faculty development program in substance abuse, conducted at an urban medical school, was evaluated using a sociometric approach. This fellowship program was based upon the premise that faculty fellows would become academic opinion leaders in the sense that other clinical faculty, as well as residents and students, would seek them out for their knowledge and expertise on substance abuse. A survey instrument designed to test this hypothesis was distributed to all full-time clinical faculty in the fellows' departments (General Internal Medicine, Pediatrics, Psychiatry, and Family Medicine) at the beginning and upon conclusion of training. Significant pre-post differences were observed on the dimensions of advice/consultation, clinical management, teaching, and research. In all but one case, the changes in perception were positive, and specific to the subject of substance abuse, and represented all of the dimensions. Posttraining perceptions were extremely favorable compared with those of established leaders. The exceptional case in which a negative change in perception occurred after the fellowship appeared to be influenced by a radical change in the fellow's administrative role. These findings suggest that a faculty development program of this kind can generate academic opinion leaders. It remains to be seen whether or not this position can be translated into a persistent academic presence.     

Interdisciplinary Service-Learning Substance Abuse Projects

Abstract

The purpose of this paper is to describe the development and implementation of community-based, service-learning field projects by 30 health professional faculty fellows of Project MAINSTREAM, a faculty development program on substance abuse. The fellows worked together for two years in 10 Interdisciplinary Faculty Learning Groups (IFLGs), which consisted of three academics of different disciplines. The ten projects are viewed within the context of service-learning and are based on a balance between the provision of services to the community and furthering the learning objectives of Project MAINSTREAM.     

Interdisciplinary service-learning substance abuse projects: processes and outcomes.

The purpose of this paper is to describe the development and implementation of community-based, service-learning field projects by 30 health professional faculty fellows of Project MAINSTREAM, a faculty development program on substance abuse. The fellows worked together for two years in 10 Interdisciplinary Faculty Learning Groups (IFLGs), which consisted of three academics of different disciplines. The ten projects are viewed within the context of service- learning and are based on a balance between the provision of services to the community and furthering the learning objectives of Project MAINSTREAM.     

Baylor Pediatric SBIRT Medical Residency Training Program: Model Description and Evaluation

ABSTRACT. Background: The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment methods for alcohol and substance use problems. Methods: This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first-year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. Results: The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program, self-reported improvement in SBIRT skills, observed proficiency in SBIRT skills, and utilization of SBIRT skills in clinical practice. Conclusions: SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.     

Implementing Adolescent Screening,Brief Intervention,and Referral to Treatment (SBIRT) Education in a Pediatric Residency Curriculum

Background: Screening, brief intervention, and referral to treatment (SBIRT) is recommended as part of routine health care for adolescents as well as adults. In an effort to promote universal SBIRT, the Substance Abuse and Mental Health Services Administration awarded funding to residency programs to develop and implement SBIRT education and training. Our project focused on creating scientifically based, developmentally appropriate strategies and teaching materials for the adolescent age range. This paper describes curriculum development and implementation and presents evaluation data. Methods: Pediatric and child psychiatry residents were trained. The training consisted of 4 activities: (1) case-based teaching modules, (2) role-play of motivational interviewing and brief interventions, (3) mock interviews with trained adolescents, and (4) supervised “hands-on” screening and brief interventions. Main outcome measures included trainee satisfaction, and SBIRT knowledge, perceived self-efficacy, and self- and observer report of use of the SBIRT algorithm. Results: Among 150 total participants completing the SBIRT training modules, nearly all (92.3%) were satisfied/very satisfied with the training modules. Knowledge accuracy immediately post training was high, but declined significantly by the end of the first residency year, with little change across subsequent years of residency. Confidence ratings also declined over time. Use of the SBIRT algorithm during the Adolescent Medicine rotation was high according to trainee self- and faculty observer report. Conclusions: We found evidence of training satisfaction, increased confidence in talking to adolescents about substance use, and widespread use of recommended practices immediately following training. Use of a highly structured algorithm to guide practice, and simple, highly structured brief interventions was a successful training approach, as residents self-reported accurate use of the SBIRT algorithm immediately after training. Knowledge and self-confidence declined over time. It is possible that “booster” sessions and ongoing opportunities to review materials could help residents retain knowledge and skills.     

Multispecialty screening,brief intervention,and referral to treatment (SBIRT) training in an academic medical center: Resident training experience across specialties

ABSTRACT

Background: The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently begun to fund programs that train medical residents on how to utilize an evidence-based validated system known as screening, brief intervention, and referral to treatment (SBIRT) for providing early detection and brief treatment of unhealthy substance use. This paper investigates training outcomes of multispecialty SBIRT training at one such program at Albany Medical Center (AMC), one of the initial SAMHSA grantees. Methods: Training outcomes were measured across 3 domains of learning: trainee satisfaction, acquired knowledge, and perceived usefulness. The authors explored differences in learning experience by postgraduate year and by specialty. Results: Overall, residents were highly satisfied with the training, and learning outcomes met objectives. Residents' ratings of usefulness did not vary by program year. However, the results indicate that relative to residents in other programs, residents in psychiatry and pediatrics found the training components significantly more useful, whereas emergency medicine residents found training components to have less utility. Residents who found the training relevant to their daily work were more satisfied and more receptive to SBIRT training overall, which may help explain difference scores by program. Conclusions: Residents were highly satisfied with SBIRT skills training, although ratings of usefulness varied by residency program. Specialization by program and on-site modeling by senior faculty may enhance trainee satisfaction and perceived usefulness.     

基于实践能力培养的药学实验教学体系构建

目的 构建基于实践能力培养的药学实验教学体系.方法 通过推进实验教学改革、实验中心建设、大学生创新性实验计划、创业实践训练以及举办全国大学生"药苑论坛"、大学生实验技能大赛等系列活动构建基于实践能力培养的药学开放性实验教学体系.结果与结论 通过构建基于实践能力培养的药学实验教学体系来培养学生基本知识和专业技能,促进专业素质和综合素质协调发展,有利于培养具有创新意识、创新思维、创新能力的高素质药学专门人才.     

A Buprenorphine Education and Training Program for Primary Care Residents: Implementation and Evaluation

ABSTRACT. Background: Although substance use disorders are highly prevalent, resident preparation to care for patients with these disorders is frequently insufficient. With increasing rates of opioid abuse and dependence, and the availability of medication-assisted treatment, one strategy to improve resident skills is to incorporate buprenorphine treatment into training settings. Methods: In this study, esidency faculty delivered the BupEd education and training program to 71 primary care residents. BupEd included (1) a didactic session on buprenorphine, (2) an interactive motivational interviewing session, (3) monthly case conferences, and (4) supervised clinical experience providing buprenorphine treatment. To evaluate BupEd, the authors assessed (1) residents’ provision of buprenorphine treatment during residency, (2) residents’ provision of buprenorphine treatment after residency, and (3) treatment retention among patients treated by resident versus attending physicians. Results: Of 71 residents, most served as a covering or primary provider to at least 1 buprenorphine-treated patient (84.5 and 66.2%, respectively). Of 40 graduates, 27.5% obtained a buprenorphine waiver and 17.5% prescribed buprenorphine. Treatment retention was similar between patients cared for by resident PCPs versus attending PCPs (90-day retention: 63.6% [n = 35] vs. 67.9% [n = 152]; P = .55). Conclusion: These results show that BupEd is feasible, provides residents with supervised clinical experience in treating opioid-dependent patients, and can serve as a model to prepare primary care physicians to care for patients with opioid dependence.     

Evaluation of clinical research knowledge and interest among pharmacy residents: survey design and validation.

PURPOSE: The development and validation of a survey to describe the research knowledge, attitudes, and skills of pharmacy practice residents are described. SUMMARY: A survey was drafted to determine if pharmacy practice residency experience and the American Society of Health-System Pharmacists (ASHP)-required project improve the residents' objectively and subjectively assessed research knowledge, to determine if the residency experience and the ASHP-required project affect the residents' attitudes regarding research as a component of their future professional practice, and to subjectively assess the effect of the residency experience and the ASHP-required project on other essential skills, such as problem solving, critical thinking, and time management. An initial questionnaire was developed and underwent content validation testing by clinical pharmacists and faculty, residents, and research fellows. Following content validation, the questionnaire underwent construct validity testing (for discriminative validity and responsiveness) in students, residents, and clinical pharmacists and faculty. Reliability was tested in a subgroup of subjects who completed the questionnaire twice within two to four weeks. From the content validation phase, average scores for individual questions ranged from 1.00 to 2.00. Discriminative validity testing of the revised questionnaire demonstrated the instrument's ability to discriminate between groups expected to differ. Effect-size and mean-knowledge score differences indicated high levels of responsiveness, signifying the instrument's ability to detect change over time or after an intervention. CONCLUSION: A survey questionnaire developed to measure research knowledge and interest among pharmacy practice residents demonstrated its validity and reliability with significant sensitivity and responsiveness.     

An examination of an interactive substance abuse prevention program for high school students

Abstract

Since research shows that interactive prevention programs are more effective than didactic-based lectures, the current study examined the efficacy of an interactive substance abuse prevention program for adolescents. Participants completed pre- and post-surveys examining their substance use knowledge and program perceptions. The program included small groups led by near-peer health care professional trainees as facilitators and interactive, hands-on activities, such as the examination of diseased human organs due to substance use. Results demonstrated statistically significant increases in knowledge of substance use risks on mental and physical health. Findings highlight effective methods that can be implemented by health care professionals to increase awareness of the harmful effects of substance use.     

An assessment of house staff's knowledge of alcohol and substance abuse utilizing standardized patients

Utilizing standardized patients (SPs), house staff knowledge of alcohol and substance abuse was assessed in residents just prior to their starting their first graduate year of training. A total of 345 residents from 13 different residencies in eight institutions participated in this program. Each resident was assigned four SP cases. The reliability of these encounters ranged from 0.63 to 0.74. Of the participating residents, 22% were United States medical graduates (USMGs) and 78% were international medical graduates (IMGs). A considerable proportion of both USMGs and IMGs failed to ask appropriate questions concerning alcohol and drug use or identify the presence of risk factors associated with such use. Residents’ scores on cases primarily dealing with general medical issues, as compared to those dealing with substance abuse, were consistently higher. Knowledge of basic information concerning substance abuse and opioids was deficient in over 50% of those tested. These findings suggest that residents about to start their clinical training are not sufficiently prepared to address patients presenting with alcohol and other drug problems.     

Alcohol Medical Scholars Program—A Mentorship Program for Improving Medical Education Regarding Substance Use Disorders

ABSTRACT

The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in their medical schools, professional development, and networking. Results are reported from an anonymous survey of self-reported changes in educational involvement by 28 of 33 AMSP graduates. Participation was associated with a 4-fold increase in yearly SUD lecture time and topics, increased numbers of medical disciplines taught and trained in clinical rotations, design of new SUD-related electives and journal clubs, and membership on medical education committees. Sixty percent of scholars reported promotion since involvement in AMSP, with the majority endorsing the organization's contribution to professional development. AMSP is a useful mentorship model for junior faculty and is associated with increasing SUD-related medical education.     

Internal Medicine Residents’ Training in Substance Use Disorders: A Survey of the Quality of Instruction and Residents’ Self-Perceived Preparedness to Diagnose and Treat Addiction

ABSTRACT

Background: Resident physicians are the direct care providers for many patients with addiction. This study assesses residents’ self-perceived preparedness to diagnose and treat addiction, measures residents’ perceptions of the quality of addictions instruction, and evaluates basic knowledge of addictions. Methods: A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May 2012. Results: Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a substance use disorder (SUD). Twenty-five percent of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across postgraduate year (PGY) level. Fifty-five percent rated the overall instruction in addictions as poor or fair. Seventy-two percent of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all 6 knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. Nine percent of residents responded that someone had expressed concern about the respondent's substance use. Conclusions: Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUDs. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.     

Creating Change Agents

Abstract

Objective: This study evaluated the effects of a national interdisciplinary faculty development program, Project MAINSTREAM, on creating curriculum enhancement in health professional education.

Method: Thirty-nine faculty completed a two-year, part-time fellowship program featuring interdisciplinary collaboration, mentoring, training meetings, and Internet-based instructional materials. The main vehicle for curricular change was a required collaborative education project to develop trainees' core competencies in substance abuse prevention services.

Results: Fellows used a variety of approaches to implement 123 curricula and provide 66,995 hours of training to 10,170 trainees. Ninety percent of the training hours occurred in required courses, a potential indication of sustainability. Fellows indicated that a majority of the offerings would be sustained beyond the fellowship.

Conclusion: Project MAINSTREAM shows promise as a model for achieving durable curriculum change in response to the public health crisis associated with a workforce untrained to deliver substance abuse services.     

Assessment of factors influencing community pharmacy residents' pursuit of academic positions

Objectives

To determine the percentage of residents accepting faculty positions following completion of a community pharmacy residency program (CPRP) and identify influences to pursue/not pursue an academic career.

Methods

CPRP directors and preceptors across the United States were contacted and 53 community pharmacy residents were identified. The residents were invited to participate in surveys at the beginning and end of the 2005-2006 residency year.

Results

Forty-five residents (85%) completed the preliminary survey instrument and 40 (75%) completed the follow-up survey instrument. Of these, 36 completed both survey instruments. Initially, 28 (62%) respondents indicated a faculty position as one of their potential job preferences. After completing their residency program, 3 (8%) residents accepted faculty positions; and 3 (8%) others were awaiting offers at follow-up. Reasons for accepting a faculty position were positive teaching experiences and the influence of a mentor or preceptor. Reasons for not pursuing a faculty position included lack of interest, geographic location, disliked teaching experiences, lack of preparedness, and non-competitive salary.

Conclusion

Many community pharmacy residents consider faculty positions early in their residency but few pursue faculty positions. CPRPs and colleges of pharmacy should work together to enhance residents'' experiences to foster interest in academia.     

An Asynchronous Learning Approach for the Instructional Component of a Dual-Campus Pharmacy Resident Teaching Program

Objective. To describe the shift to an asynchronous online approach for pedagogy instruction within a pharmacy resident teaching program offered by a dual-campus college.Design. The pedagogy instruction component of the teaching program (Part I) was redesigned with a focus on the content, delivery, and coordination of the learning environment. Asynchronous online learning replaced distance technology or lecture capture. Using a pedagogical content knowledge framework, residents participated in self-paced online learning using faculty recordings, readings, and discussion board activities. A learning management system was used to assess achievement of learning objectives and participation prior to progressing to the teaching experiences component of the teaching program (Part II).Assessment. Evaluation of resident pedagogical knowledge development and participation in Part I of the teaching program was achieved through the learning management system. Participant surveys and written reflections showed general satisfaction with the online learning environment. Future considerations include addition of a live orientation session and increased faculty presence in the online learning environment.Conclusion. An online approach framed by educational theory can be an effective way to provide pedagogy instruction within a teaching program.     

1例帕金森病伴部分精神障碍患者的用药分析和药学监护

目的 探讨临床药师在帕金森病伴部分精神障碍患者治疗过程中的作用。方法 临床药师结合患者疾病特点、用药史、药物相互作用及药品不良反应等情况,对患者进行药学监护并提出优化治疗方案的建议。结果 临床药师参与患者治疗方案的制订,进行用药指导和出院教育,促进合理用药。结论 临床药师可利用自身专业知识,积极参与临床药物治疗工作,协同医师优化临床给药方案。     

Development of innovative teaching materials: clinical pharmacology problem-solving (CPPS) units: comparison with patient-oriented problem-solving units and problem-based learning--a 10-year review

The First Teaching Clinic in Clinical Pharmacology, sponsored by the American College of Clinical Pharmacology in September 1992, was designed for the preparation and development of new clinical pharmacology problem-solving (CPPS) units. CPPS units are case histories that illustrate pertinent principles in clinical pharmacology. Each unit consists of the following sections: introduction, learning objectives, pretest, four clinical pharmacology scenarios, posttest, answers to pre- and posttest questions, and selected references. The clinical pharmacology content of the CPPS units place greater emphasis on clinical information, drug selection, and risk/benefit analyses, and thus they complement the basic pharmacology presented in the patient-oriented problem-solving (POPS) units. In general, the CPPS units are intended for use by students more advanced in clinical pharmacology than first- and second-year medical students. The CPPS unit "Clinical Pharmacology of Antiepileptic Drug Use: Clinical Pearls about the Perils of Patty" was developed for use by third- and fourth-year medical students doing rotations in neurology or clinical pharmacology; advanced pharmacy students; residents in neurology, pediatrics, internal medicine, and family practice; fellows in clinical pharmacology, and those taking the board examination in clinical pharmacology. The CPPS unit titled "Geriatric Clinical Psychopharmacology" was written for third- and fourth-year medical students; residents in psychiatry, family practice, and internal medicine;fellows in clinical pharmacology; and those studying for boards in clinical pharmacology. The CPPS unit "Anisocoria and Glaucoma" was written for more advanced students of clinical pharmacology. The CPPS unit titled "Antiepileptic Drugs" was intended for second-year medical students. The second teaching clinic was held in November 1993 and focused on the development and editing of the CPPS units and their evaluations by faculty and students from academic centers. Evaluations by faculty and students have been overwhelmingly positive. Requests to use the CPPS units in various clinical pharmacology teaching programs were received from numerous schools within the United States and from abroad. The third teaching clinic in September 1995 included a follow-up focused on the uses of drug information databases in case problem exercises. These examples are presented to demonstrate the variety of educational activities the American College of Clinical Pharmacology is sponsoring to fulfill its strategic initiative dedicated to offer innovative teaching programs and to develop new teaching materials in clinical pharmacology. Collectively, all of the teaching clinics, symposia, and workshop efforts, sponsored by the various academic professional societies alone or together over the past decade, are necessary if new and innovative teaching materials in the field of basic science and in the fields of pharmacology and clinical pharmacology are to be continuously developed to keep pace with the new, rapidly changing developments in medicine to provide the best treatment for patients in the 21st century.     

The use of speech disfluency as an indicant of paradigm development in pharmacy's academic subdisciplines

BackgroundParadigm development among disciplines has implications for faculty productivity, quality of work life, turnover, organizational rewards, and scholarly progress. Although studied in basic fields, paradigm development has not been measured in professional programs, such as pharmacy.ObjectiveThe objective of this study was to compare speech disfluency rates in lectures of entry-level pharmacy courses within 5 subdisciplines of pharmacy as a measure of paradigm development.MethodsDisfluency rates were observed in randomly selected courses in 4 schools of pharmacy. Disfluency rates among course faculty in personal interviews controlled for subjects' inherent disfluency rates. Lecturers completed a modified version of the Brief Fear of Negative Evaluation survey and a self-rated anxiety measure. Correlates of disfluency patterns were determined using analysis of covariance procedures.ResultsThe overall mean disfluency rate in lectures was 2.11 disfluencies per minute. Average disfluency rates among the 5 subdisciplines ranged from 1.28 to 2.74. The subdiscipline under study, the lecturers' self-rated anxiety, fear of negative evaluation, or any alternative factors were not associated with disfluency rates in the classroom.ConclusionsAlthough study results corroborate previous evidence that pharmacy's academic subdisciplines exhibit similar paradigm development, the use of speech disfluency as a measure of paradigm development may have limited utility in the study of disciplinary progress within professional domains.