Index

Technical Report Documentation Page

Executive Summary

Background

Methods and Outcomes

Conclusions

References

Appendix

University of Washington School of Medicine Curriculum Development:

The first two years of medical school at the University of Washington consist of formal course work. We believed that it is important for students to become exposed to information concerning alcohol abuse and counseling during this period as well as during clinical clerkships. To increase the amount of substance abuse training in this curriculum, we surveyed all UW School of Medicine Human Biology Course Coordinators who teach our Human Biology curriculum courses, asking for descriptions of any substance abuse content offered by them or anybody lecturing as part of their courses. The results of this survey are shown below in Table 2.

Table 2: 
Current Substance Abuse (SA) Content in Human Biology Curriculum: Results of Survey of all Classroom Medical School Instructors

Title

Qtr

Substance Abuse (SA) Content

Micro Anatomy (Histology)

A1

no SA content

Anatomy & Embryology

A1

SA mentioned in context of living anatomy of the liver & portal circulation

Mechanisms in Cell Physiology

A1

discusses synaptic mechanism of cocaine

ICM I

A1

lecture on interviewing patients about use of alcohol and drugs

Biochemistry I-A

A1

no SA content

Human Behavior I-A

A1

lecture on fetal alcohol syndrome

Cell & Tissue/Injury

W1

Mechanism of alcohol-induced cell death & pathogenesis of liver disease

Nat History Infectious Diz I-A

W1

covers problems associated with AIDS, bacteremia, endocarditis, and hepatitis with alcohol/drugs

ICM I

W1

lecture on SA, patients in recovery describe experiences

Introduction to Immunology

W1

No SA content

Biochemistry I-B

W1

No SA content

Human Behavior I-B

W1

No SA content

Epidemiology

S1

Not specifically addressed, but research methods taught apply to SA research

Head, Neck, EN & T

S1

No SA content

Nervous System

S1

No SA content

Natural History Infec Diz I-B

S1

Discusses wound botulism associated w/ cocaine inhalation

S1

Lecture/discussion on topic similar to A1 and W1 quarters

Cardiovascular System

A2

No SA content

Respiratory System

A2

20 minutes on smoking, no other substances covered

ICM II

A2

Making and giving SA diagnosis: interview and write HPI on a patient w/SA problem

Principles of Pharmacology I A2 Pharmacology of alcohol, toxicity, dependence, tolerance, abuse potential
Endocrine System A2 No SA content
Systemic Pathology A2 Discusses liver disease: dose & cirrhosis
Genetics A2 No SA content
Skin System A2 No SA content
ICM II W2 Visit AA mtg, interview an AA member, hand in write-up of HPI on their SA
Gastrointestinal System W2 Seminar on liver disease w/case discussion on liver transplant
Hematology W2 Discussed as part of sickle cell disease lecture:
Musculoskeletal System W2 No SA content
Medicine, Health & Society W2 No SA content
ICM II S2 Interviewing styles demonstrated, panel discussion, attend AA meeting
Urinary System S2 No SA content
Human Behavior II S2 1 hr. alcohol abuse and 1 hr. substance abuse
Principles of Pharmacology II S2 Stimulants: mech. of action, clinical use, side effects, psychotomimetics
Reproduction S2 Nothing in syllabus, passing remarks on steroid abuse effects on males
Nutrition for Physicians S2 Consequences of alcohol abuse covered in one of the lectures

Note: A= autumn, W= winter, S= spring. 
"1" and "2" refer to first and second years of medical school, when all course work is taken.

This survey demonstrated that teaching on alcohol abuse can be done in many courses throughout the curriculum. It is more effective to include discussions in many different courses rather than confining it to one short period during medical school.

We surveyed all Clinical Clerkship Coordinators who are responsible for developing curriculum for the clinical rotations constituting the second two years of medical school. These results are shown below in Table 3.

Table 3: 
UW Substance Abuse Training Content in 6 Required Clerkships: Survey of Clinical Clerkship Coordinators.

Clerkship

Substance Abuse Training Experiences Provided

Psychiatry
(Ries, Dunn)

 

Advanced assessment of substance use/abuse/dependence
2-hr. lecture and demonstration of a brief intervention
Treatment models and recovery taught
Structured intervention work-up with Psychiatry patient with SA problem
Perform brief intervention with that patient
Visit different Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous meetings other than those visited in ICM II course

Surgery
(Dunn)

90-minute lecture on alcohol abuse, trauma, and brief interventions has been cancelled

Pediatrics
(Robertson)

Students given syllabus of 36 case scenarios (at least one case addresses substance abuse).
Most students have contacts with Fetal Alcohol Syndrome, cocaine babies, and teens abusing substances, but not guaranteed
Occasional lecture on adolescent substance abuse
Adolescent substance abuse lecture seldom given anymore

Family
(Stern)

19 common problems in Family Practice are focused on; Substance abuse is subsumed under only one of these topics, "depression"
Alcoholism not focused on as common problem ("too many others to do")
One chapter to read on alcoholism and drug abuse
May include SA among required web site references for students

Medicine
(Paauw)

There is an alcohol abuse section in the student syllabus that is required reading
Most students take care of alcohol and drug-abusing patients in clinic, but not specifically mandated

All the rotations above are required of all medical students. The results indicate that students are exposed to information about substance abuse at a number of times during their clinical training. This repeat exposure is very useful in changing behavior and instilling skills and a sense of self-efficacy.

  • We presented the results of the two surveys to the UW Substance Abuse Theme Committee that included the Assistant Dean of the Medical School. This presentation included our recommendations for including many more substance abuse training topics. These recommendations were derived from the International Medical Education Model, and we believe are generalizable to other schools of medicine across the U.S. They represent a strategy for training future physicians in screening for and management of patients with problem drinking. These recommendations are summarized in Table 4 below.

Table 4: 
Recommended Substance Abuse (SA) Training Topics 
(from International Medical Education Model, Fleming & Murray):

Topic

Topic Description

1

Epidemiology & Phenomenology

Continuum of SA problems (low-risk, hazardous, abuse/dependence)
Natural history of SA disorders
Prevalence of SA disorders vs. other medical disorders
Special populations w/special SA problems
Stages of change readiness

2

Etiology & Prevention

Risk & buffer factors
Clinically-based prevention opportunities

3

Special Populations

Adolescents, women, elderly
Age & gender physiological differences
Screening & assessment issues
Patients with psychiatric disorders

4

All drugs of abuse

Trends in use, availability, preparations of, routes of administration of all drugs of abuse
Behavioral effects of all drugs of abuse
Biopsychosocial consequences of acute & chronic abuse of all drugs
Clinical signs & symptoms of each

5

Clinical Research

Research methods used for epidemiological & clinical studies
Outcomes of various SA treatment modalities
SA treatment outcomes vs. outcomes for other chronic disorders

6

Screening & Assessment

Standardized screening & assessment techniques
Interviewing skills

7

Brief intervention

Learn how non-specialists can treat SA
Listening to patients and giving them feedback and advice
How to do brief interventions across numerous medical specialties

8

Alcohol-related Medical Problems

Medical conditions caused or exacerbated by SA: perinatal & FAS, HTN, cardiac, stroke, GI, pancreatitis, malabsorption, liver, cancers, sexual dysfunction, HA, sleep problems, peripheral neuropathy, organic brain disorders, hematological problems

9

Specialized Treatment

Continuum of treatment modalities: what they are and what they do
The art of referring patients for treatment

10

AA & Self-help Groups

Know basics of AA and other self-help groups
Referring to and visiting meetings
Meet successfully recovering people

11

Pharmaco-therapy

Neurobiology of drug actions and craving

12

Medical Detoxification

Neurobiology and clinical treatment of withdrawal for all drugs of abuse
Withdrawal & co-morbid conditions

13

Management of Anxiety & Pain

Abuse potential of commonly prescribed drugs
Breathalyzer/drug testing
Assessment of pain & psychiatric symptoms
Pharmacological & non-pharmacological treatment of pain
Pain contracts, informed consent procedures

14

Tobacco Cessation

Screening & brief intervention procedures
Pharmacotherapy
Office-based systems

15

Harm Reduction Methods

Pregnancy
IV drug users
Sexually transmitted disease prevention

16

Psychiatric Comorbidity

Psychiatric problems caused, complicated, exacerbated by substance abuse

17

Legal & Ethical Issues

Patient autonomy
Confidentiality and charting issues around SA
Protection of records, liability, child abuse

  • We provided to the UW Substance Abuse Theme committee copies of the National Institute of Alcoholism and Alcohol Abuse’s (NIAAA) "An International Model for the Prevention and Treatment of Alcohol Use Disorders." This material contains a comprehensive substance abuse knowledge base that teaches evidence-based medical treatment for substance abuse. The intent is that information in this model would be incorporated into the curriculum.

  • Recommendations were made to the School of Medicine on how the UW curriculum could further comply with NIAAA’s training recommendations, such as including topics listed in table 4 in the Human Biology course curriculum.

  • Key faculty members were identified in General Internal Medicine, Family Medicine, Pediatrics, and Obstetrics and Gynecology who would become future "substance abuse champions," thereby promoting the inclusion of more substance abuse training experiences into the clinical clerkships.

  • We revised the UW Substance Abuse Theme Committee’s "Substance Abuse Roadmap," a document summarizing the substance abuse training experiences our medical students receive from year 1 through year 4 of their education in the School of Medicine.