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Improving Health Professions Education to Treat Addiction: The Time Has Come
New Haven, CT
Of the 23 million Americans currently suffering from addiction, only 11% receive treatment. Increasing attention has been paid to this treatment gap with improved recognition of the opioid epidemic in the U.S., with opioid overdose rates now exceeding motor vehicle accidents as the leading cause of injury-related death.
Although addiction has reached epidemic proportions in the U.S., little has been done to address the workforce shortage prepared to care for this population. Although health professions trainees are exposed to increasing numbers of patients with addiction, often presenting late in the disease course, the number of curricular hours dedicated to training in evidence-based approaches to identification, treatment and prevention of addiction are woefully inadequate. In addition, the traditional structure of health professions education has created silos of curricular content that make educational collaboration extremely challenging. The inadequate focus on addiction education has even prompted students from some schools to seek outside training and to request improved curriculum in order to better prepare them to become physicians in the face of the opioid crisis.
Stigma contributes to treatment and education inadequacies
Despite the profound public health impact of addiction and its associated sequelae, it remains one of the most deeply stigmatized and poorly understood chronic diseases by both the public and the medical community. This stigma, in addition to the widening treatment gap, has also contributed to a “hidden curriculum” where some clinicians support the idea that addiction, at its root, is a moral failing that is best treated through exercises in willpower. Without educational reform that is grounded in evidence-based theory and that also addresses stigma, we risk further perpetuating both the treatment gap and the educational inadequacies.
Addiction education should reflect the way addiction treatment is delivered
With our country facing an addiction epidemic, yet addiction remaining so highly stigmatized, it is imperative now, more than ever, to develop comprehensive training programs which educate trainees to approach substance use and addiction like any other chronic disease and to develop educational programs which reflect the way that substance use treatment is delivered to patients—namely in teams of health professionals.
As a Macy Faculty Scholar, my colleagues and I have conducted a comprehensive needs assessment of the medical, nursing, and physician assistant (PA) curricula at Yale University School of Medicine and have developed goals and objectives that provide the scaffolding for an interprofessional curriculum focusing on skill development. Beginning in the fall of 2018, we will train all first-year medical, nursing, and PA students on how to take a substance use history, make an assessment, and work in teams to develop an interprofessional treatment plan.
We will pilot an early, interprofessional, year-long, longitudinal clinical experience focused on addiction, then study the impact it has on trainee skill development and retention. Through these efforts, the goal is to develop a model curriculum that could transform addiction education. Ultimately, through these and other educational efforts, we hope to contribute to the development of a workforce prepared to address addiction as a chronic disease and deliver evidence-based quality care.