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Thursday, May 23, 2013

Internal medicine residents’ training in substance use disorders; a survey of the quality of instruction and resident self-perceived preparedness to diagnose and treat addiction

Resident physicians are the direct care providers for many patients with addiction. This study assesses residents’ self-perceived preparedness to diagnose and treat addiction, measures residents’ perceptions of the quality of addictions instruction, and evaluates basic knowledge of addiction.
A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May, 2012.
Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a SUD. 25% of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across PGY level. 55% rated the overall instruction in addictions as poor or fair. 72% of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all six knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. 9% of residents responded that someone had expressed concern about the respondent's substance use.
Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUD. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.
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