Early Career Training in Addiction Medicine: A Qualitative Study with Health Professions Trainees Following a Specialized Training Program in a Canadian Setting

Abstract

Background: There has been a notable deficiency in the implementation of addiction science in clinical practice and many healthcare providers feel unprepared to treat patients with substance use disorders (SUD) following training. However, the perceptions of addiction medicine training by learners in health professions have not been fully investigated. This qualitative study explored perceptions of prior training in SUD care among early-career trainees enrolled in Addiction Medicine fellowships and electives in Vancouver, Canada. Methods: From April 2015 – August 2018, we interviewed 45 early-career physicians, social workers, nurses, and 17 medical students participating in training in addiction medicine. We coded transcripts inductively using qualitative data analysis software (NVivo 11.4.3). Results: Findings revealed six key themes related to early-career training in addiction medicine: (1) Insufficient time spent on addiction education, (2) A need for more structured addictions training, (3) Insufficient hands-on clinical training and skill development, (4) Lack of patient-centeredness and empathy in the training environment, (5) Insufficient implementation of evidence-based medicine, and (6) Prevailing stigmas toward addiction medicine. Conclusion: Early clinical training in addiction medicine appears insufficient and largely focused on symptoms, rather than etiology or evidence. Early career learners in health professions perceived benefit to expanding access to quality education and reported positive learning outcomes after completing structured training programs.

Keywords:

• Addiction medicine
• medical education
• qualitative research
• clinician scientist

Acknowledgments

We thank the following individuals: Breanne Reel for conducting interviews; Elizabeth Yue, Nicole Fairbairn, Raman Jawanda, and Erin Eydt for their administrative support for this study.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.

Role of authors

All authors contributed to this study’s design, the interpretation of the data, subsequent manuscript drafts (and revisions), and final approval for submission. Three authors (JK, LG, ML) collected and analyzed data. Three authors (LG, MAH, JK) wrote the initial draft of the work and managed revision feedback from all authors.

Additional information

Funding

The study was supported by the US National Institutes of Health (R25DA037756). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine that supports Dr. Evan Wood. This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 701698; from the Canadian Institutes for Health Research (165004); and from the European Commission’s Workforce in Addictions - Valorisation in Europe (Project nr. 101045870 JUST-2020-AG-DRUGS). Dr. Nadia Fairbairn is supported by a Philip Owen Professorship award and Michael Smith Foundation for Health Research/St. Paul’s Foundation Scholar Award.