Addiction Medicine
Addiction Medicine Elective
Overview
This elective in Addiction Medicine is developed for senior (R2) Family Medicine residents who have an interest in practicing in the field of addiction medicine and/or would like to incorporate addiction medicine into a comprehensive primary care practice. An introduction of assessment, treatment and advocacy for various substance use disorders will be the foundation of the elective.
The elective will take place over one month and be offered between October and May. During the initiation phase of the program only one resident will be placed per month.
Competencies and Objectives
Medical Expert
Knowledge:
Demonstrate knowledge of the signs and symptoms of alcohol, sedative, GHB, opioid, and other drug withdrawal syndromes, as well as their neurobiology and pathophysiology.
Describe the medical/psychiatric conditions that can mimic intoxication or withdrawal.
Describe the risks and benefits of the use of clonidine, buprenorphine/naloxone, methadone in the management of opioid withdrawal.
Demonstrate an understanding of the theories supporting the use of various other pharmacotherapies for other drug withdrawal syndromes, e.g. stimulant and cannabis withdrawal.
Medical Assessment:
Perform an assessment using the diagnostic criteria for substance use disorders and various intoxication and withdrawal states according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Use definitions of a “standard drink” when calculating a patient's quantity/frequency of consumption and trying to determine the level of tolerance of the likelihood of developing alcohol withdrawal.
Use the Clinical Opioid Withdrawal Scale to assess readiness for buprenorphine/naloxone initiation.
Clinical Judgment and Management:
Appropriately choose treatment options for the patient with alcohol withdrawal.
Manage sedative tapers for benzodiazepine detoxification.
Manage poly-substance withdrawal appropriately.
Use nicotine replacement therapies and other approaches in the management of nicotine withdrawal
Manage inpatient rotation from methadone to buprenorphine/naloxone.
Counsel a patient on the risk of opioid overdose following detoxification and provide counselling on the use of naloxone
Communicator
Communicate effectively to clients and their families information regarding the risks and
benefits of treatment alternatives.
Collaborator
Demonstrate knowledge of the importance and beneficial nature of team-based health care practices which involve multiple clinicians from multiple disciplines to create the best care experience and the optimum clinical outcomes for patients and their family members.
Participate in clinical team huddles and where appropriate, to be an effective leader of clinical teams.
Communicate to family physicians the plan for ongoing support of clients discharged from hospital.
Leader
Carry out appropriate clinical services in the context of limited medical resources, limited social support and limited time available for the resident.
Demonstrate time management skills to reflect and balance priorities for patient care, sustainable practice, and personal life.
Health Advocate
Demonstrate knowledge of community-based resources which address the needs of persons with SUD.
Advocate effectively for mental health care, social service, family medicine and residential treatment for patient effected by SUD.
Scholar
Facilitate the learning of students or junior residents when appropriate.
Demonstrate that they have pursued self-directed learning around cases seen.
Professional:
Exhibit professional behaviours such as being punctual for clinical and educational activities and being available to administrative and clinical staff.
Recognize the limits of his/her knowledge and skills and consult with attending staff to request assistance in patient management where appropriate
Professional
Exhibit professional behaviours such as being punctual for clinical and educational activities and being available to administrative and clinical staff.
Recognize the limits of his/her knowledge and skills and consult with attending staff to request assistance in patient management where appropriate
Structure of the Elective
Students will attend RAAM clinics to learn assessments and treatment of OUD with suboxone.
Students will attend the supervised injection site(s) run by HIV /Aids London.
Students will visit the MLHU dispensary for safe injection supplies.
Students will attend consultations and rounds for in-patients at LHSC being treated by Addiction Services and may attend the withdrawal management (detoxification) service.
Students will attend a Methadone Maintenance clinic to learn about OUD assessments and methadone treatment guidelines and management.
Students will attend infectious disease clinics to further understand the assessment, treatment and impact of living with hepatitis C and HIV.
Students will learn about the services at Thames Valley Addiction Services and how to access these programs.
Sample for Addiction Medicine Elective
|
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|
Weeks 1 and 3 |
Woodstock Methadone Clinic All Day |
CMHA RAAM Clinic All Day |
AM Supervised Injection Site
PM Academic Half Day |
AM MLHU Dispensary Safe Supplies
PM Primary Care Addiction Management |
AM Centre of Hope Detoxification Program
PM Protected Time for Reading and Reflective Learning |
|
Weeks 2 and 4 |
Strathroy Methadone Clinic |
CMHA RAMM Clinic All Day |
AM Supervised Injection Site
PM Academic Half Day |
AM Infectious Disease Clinic
PM Primary Care Addiction Mangement |
AM John Gordon Home
PM Protected Time for Reading and Reflective Learning |
Evaluation Process
Residents will be evaluated by one assigned primary supervisor for the one month elective, who will collate feedback from the professionals the resident has interacted with and collaborated with. A mid-month evaluation session will assist in ensuring residents meet their learning objectives.
Evaluations will be based on daily field notes and written feedback from physician supervisors from each clinical setting.
If a clinical setting is not available for the resident to attend they will spend this time reviewing educational resources on the topic area.
Residents will also be required to submit a reflective essay on their experience over the month, with detailed summaries of their learning in each area of competency.
