ADDICTION MEDICINE IS MEDICINE: A REQUIRED TWO-WEEK CLINICAL ROTATION FOCUSED ON SUBSTANCE USE FOR INTERNAL MEDICINE RESIDENTS

ABSTRACT

SETTING AND PARTICIPANTS: Montefiore Health System is the largest health care provider in Bronx, New York, a community that is disproportionately impacted by substance use disorders (SUDs). To better prepare resident physicians to care for patients with SUDs, we developed a novel addiction medicine rotation required for internal medicine residents. DESCRIPTION The 2-week rotation includes inpatient and outpatient clinical experiences. During the inpatient week, residents rotate on the Addiction Consult Service, staffed by an addiction medicine attending, a fellow, and a peer navigator. Residents attend a weekly interdisciplinary meeting with the Psychiatry Consult Service to discuss cases. During the outpatient week, residents rotate through an opioid treatment program, an intensive outpatient substance use treatment program, and an addiction medicine “Bridge” clinic, which links patients with SUDs to primary care post- hospitalization. Residents also complete a self-study curriculum that includes addiction-focused readings and podcasts as well as the 8-hour online buprenorphine waiver training. All residents participate in Addiction Medicine Rounds, a weekly case conference and journal club led by addiction medicine faculty and trainees. EVALUATION Between July and November 2021, 22 internal medicine residents participated in the rotation and 12 (55%) completed formal evaluations. All residents rated the overall rotation to be valuable for their education, with 33% in strong agreement based on a 4-point scale from strongly disagree to strongly agree. All residents also agreed (with 42% strongly agreed) that the rotation increased their knowledge and skills in diagnosing SUDs, and managing medication treatment for SUDs. One resident summarized “This rotation is one of the best rotations I have experienced during my time as a resident. After completing this rotation, I felt very confident in my ability to diagnose, navigate, and manage the complexities of addiction related illness.” DISCUSSION / REFLECTION / LESSONS LEARNED The Addiction Medicine Rotation was well-received in its first months of implementation. The experience on the Addiction Consult Service stood out as high-yield training, building on residents' familiarity with hospital-based care and leveraging multidisciplinary partnerships with psychiatry, pharmacy, and nursing departments. Providing rigorous inpatient training in addiction medicine is a unique feature of this rotation, as addiction consult services are not the mainstay in most hospitals. The “Bridge” clinic has also been valuable in training residents to provide medication treatment for SUDs within primary care. However, the outpatient experience in specialty care settings faced many scheduling challenges related to the COVID-19 pandemic, with reduced availability of preceptors, decreased number of in-person visits, and suspended group treatment. Optimizing outpatient addiction medicine training will be an ongoing goal in future rotation iterations. ONLINE RESOURCE URL Rotation document https//tinyurl.com/ MontefioreAddMedRotation.