Postresidency Impact of Alcohol and Drug Screening and Intervention Training.

BACKGROUND AND OBJECTIVES: Many residency programs provide alcohol and drug screening, brief intervention (BI), and referral to treatment (SBIRT) training, hoping to impact residents' future practice activities. Little is known about postresidency use of these skills. This study assesses postresidency impact of SBIRT training. METHODS: Over 3 years, physicians who participated in SBIRT training in four residency programs were recruited for follow-up. Participants chose between a paper and online questionnaire 12-24 months after graduation; participants received $20 gift cards. We first analyzed postresidency responses only (n=74), then compared pre- and posttraining results of those completing both surveys (n=50). RESULTS: Of 182 enrolled graduates, 74 (41%) completed questionnaires. In paired comparisons to their pretraining responses, graduates increased endorsement of statements that BIs can reduce risky use and reduced endorsement of statements that they do not have adequate training or time to address patients' alcohol use, or that discussing alcohol use with patients is uncomfortable. While most barriers to providing interventions were endorsed less frequently by SBIRT-trained clinicians in postresidency surveys, ongoing concerns included poor reimbursement, little time, low success rates, and some discomfort with interventions. Seventy percent of graduates felt motivational interviewing techniques created stronger doctor-patient relationships; 16% reported colleagues in their practices had increased SBIRT activities after they joined the practice. CONCLUSIONS: SBIRT trainees reported high levels of SBIRT activity 12-24 months after graduation and increased SBIRT activities by their colleagues. While some barriers remain, residency training appears to be a promising approach for disseminating SBIRT into clinical practice.

Clavicular Osteomyelitis Secondary to Candida Parapsilosis Infection.

Candida parapsilosis osteomyelitis is a rare diagnosis. Candidal infection can occur via hematogenous or local spread. A localized swelling around a bony structure should raise clinical suspicion. Diagnosis is made by a combination of imaging modalities and biopsy. Anecdotal case reports have been reported in medical literature and treatment guidelines are very limited. Treatment modality includes a combination of surgical debridement and antifungal therapy.