Scutti (2019) and Young et al. (2019) confirm that less than 4,000 of the more than one million actively licensed physicians in the U.S. are specially trained in addiction medicine and psychiatry. With more than 40 million people being diagnosed with a substance use disorder between 2020 and 2021 and only 4 million receiving any substance use treatment (SAMHSA, 2021), the addiction epidemic in the US requires a holistic approach to increase the healthcare workforce overall and addiction specialists in particular.
Many medical schools offer traditional curricula based on a passive learning style (McPhail, 2021), with students completing separate pre-clinical and clinical courses. Medical students’ introduction to medical school is generally through lectures and laboratory work in subjects such as biochemistry, anatomy, pharmacology, and psychology. This tends to be followed, in the third and fourth years, by a combination of lectures and clinical placements in various medical departments – general surgery, obstetrics and gynecology, psychiatry, pediatrics, general surgery, etc. Students are then required to take board exams and spend between three and seven years in a residency program at a teaching hospital in order to gain specific experience in a chosen specialty.
Research has shown the flaws of this approach to education. Gaddam et al. (2015) posit that the knowledge gained from the pre-clinical courses tends to be inadequate for students as they move on to the clinical aspect of the program, resulting in a lack of motivation, limited retention, and poor performance in exams. Additionally, this type of learning prevents students from seeing the relevance of the individual courses, thus limiting their ability to apply their knowledge to clinical practice (Quintero et al., 2016). Consequently, many medical programs have tried to alter their approach by using an integrated curriculum.
While the term tends to be “loosely defined in the literature” (Brauer & Ferguson, 2015, p. 313), an integrated curriculum can be described as one which uses “a constructivist learning perspective mainly based on the concept of teaching for understanding” (Quintero et al., 2016), incorporating specific innovative approaches to teaching medical students. These include incorporating topics as threads into courses (horizontal), adding relevant content to a unit, or integrating clinical experience early in the program (vertical).
A louder call for reform of the medical education curriculum came in 2010 when the Carnegie Foundation for the Advancement of Teaching reported its research on the direction medical school education should take. The report insisted that “Fundamental change in medical education will require new curricula, new pedagogies and new forms of assessment.” One of the main goals identified is the integration of knowledge with clinical skills through the achievement of competencies (Cooke et al., 2012). The 2010 Lancet Commission on Education of Health Professionals for the 21st Century also proposed that reform was required in the education systems that train health professionals so that they would be better able to meet the needs of the populations they serve (Bhutta et al., 2010).
Similarly, Frenk et al. (2022) argue that health professional education or HPE “should strive to evolve as a humane and effective creator of lifetime learners who are prepared…to meet changing health needs of individuals and populations” (p. 34). Quintero et al. (2016) argue that the move to an integrated curriculum mimics the change in the health-illness process, which no longer sees health and illness as a biological construct but rather an anthropological one. They also posit that the benefits far outweigh the disadvantages or barriers because the approach focuses on improving student outcomes, thus resulting in better-prepared physicians.
The Addiction Training for Health Professionals (ATHP) program agrees with this view and uses this approach to achieve its goal of exposing all medical students to Addiction Medicine throughout their medical school training. Our approach uses threading or horizontal integration. All of our clinical courses ensure that students, regardless of their areas of specialization, receive training in the knowledge, attitudes, behaviors, and skills they need to provide evidence-based and compassionate care to those with substance use disorders. Each course incorporates SUD content in at least one lesson, and students engage in activities that require them to demonstrate the skills learned. From early in their career, students become familiar with the needs and challenges experienced by patient populations with substance use disorders, along with state-of-the-art recommendations for research and policy to lessen the burden of disease.
This type of integration not only ensures that all graduates have basic training in Addiction Medicine, but it can work to encourage more physicians to specialize in Addiction Medicine. This approach will aid in addressing the shortage of physicians trained in addiction medicine and, consequently, increase the number of persons with substance use disorders who receive treatment. ATHP is able to bridge the gap between the shortage of physicians and the availability of training and addresses this need by developing an integrated medical school curriculum that trains all physicians to treat substance use disorders and encourages specialization in addiction medicine and psychiatry.
In our next blog, we discuss the importance of residency training in the fight against substance use disorders and its impact on increasing the number of physicians trained to treat SUDs and reducing stigma.
Visit our website at https://athp.nextgenu.org/ for more information on the work of the Addiction Training for Health Professionals program.
Dr. Glenda Niles
Author
