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Promoting substance use education among generalist physicians: an evaluation of the Chief Resident Immersion Training (CRIT) program.

ABSTRACT: Education about substance use (SU) disorders remains inadequate in medical training.To describe the Chief Resident Immersion Training (CRIT) program in addiction medicine and to evaluate its impact on chief resident (CR) physicians' substance use knowledge, skills, clinical practice, and teaching.A controlled educational study of CRIT programs (2003, 2004, and 2005) for incoming CRs in generalist disciplines. Intervention CRs were trained to diagnose, manage, and teach about SU. The control CRs sought but did not receive the intervention.Eighty-six CR applicants to the CRIT program.Baseline and 6-month questionnaires assessing substance use knowledge, skills, clinical practice, and teaching. Outcomes were compared within groups from baseline to follow-up and between groups at follow-up.The intervention (n = 64) and control (n = 22) CRs were similar demographically. At 6-month follow-up, the intervention CRs reported a significant increase in SU knowledge, confidence, and preparedness to diagnose, manage, and teach and an increase in SU clinical and teaching practices compared to their baseline and control CRs.This intensive training for chief residents (CRs) improved knowledge, confidence, and preparedness to diagnose, manage, and teach about substance use (SU), affecting both the CRs' SU clinical and teaching practices. The CRIT program was an effective model for dissemination of SU knowledge and skills to educators in a key position to share this training with a broader audience of medical trainees. This model holds potential to address other high priority medical, yet under-addressed, content areas as well.

SUBMITTER: Alford DP

PROVIDER: S-EPMC2607502 | biostudies-other | 2009 Jan

REPOSITORIES: biostudies-other

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Project description:BACKGROUND: Little is known about the factors that influence applicants' decisions to select a graduate medical education training program. Programs may improve their recruitment by better understanding that process. METHODS: Following the Match for the years 2008 though 2010, an electronic survey was sent to 664 applicants to 15 Duke University graduate medical education programs. Those individuals were ranked high enough to match to Duke University but chose to match at another institution. We used quantitative and qualitative analyses to explore factors influencing candidates' decisions and to identify program and institutional improvements to better attract top candidates. RESULTS: Response rate was 63% (417/664). The quantitative analysis identified factors that were "very important" to applicants (current resident satisfaction, relationship between faculty and residents, collegiality of current residents, quantity and quality of faculty content/mentoring, faculty teaching expertise, diversity of patients and types of procedures, and location), and those that were "not important" to applicants (child care or education opportunities for children, salary, United States Medical Licensing Examination requirements, part-time training options, favorable environment for minorities or women). There were statistically significant differences among specialties. Qualitative analysis identified 3 themes as most influential in their choice: location, program relationships, and the interview experience. CONCLUSION: The collection of 3 years of data across specialties identified factors that are important to applicants' choice of a training program. Some factors can be addressed quickly and with little effort, such as the format of the interview day. Others require programs and institutions to revisit their mission, priorities, and training culture to improve relationships between residents and faculty. Programs may wish to be more tactical in selecting the residents and faculty who meet with applicants and be more focused in planning how the interview time is used.

Project description:BackgroundPatient death is an inevitability during medical training, with subsequent psychologic distress, decreased empathy and worse learning outcomes. We aimed to explore resident experiences with patient death early in training, including the immediate and delayed impacts of these experiences, preparedness of trainees for these events and coping strategies used, potentially identifying gaps and opportunities to further support trainees during difficult or traumatic events.MethodsWe performed a qualitative study using phenomenology methodology to understand trainees' personal experiences with patient death. Resident physicians who had completed an internal medicine rotation at McMaster University, Hamilton, Ontario, were invited to participate from December 2020 to April 2021. Semistructured interviews were conducted to understand circumstances, emotional responses, support, coping mechanisms and preparedness regarding the patient death experience. Interviews were transcribed and coded to identify emerging themes with the use of thematic and interpretive analysis.ResultsEighteen participants were interviewed. On average, the interviews were 40 minutes in length. The participants' mean age was 27 years. The majority of trainees (10 [56%]) were in their first year of residency, with 5 (28%) from family medicine and 4 (22%) from internal medicine. Most participants (13 [72%]) had experienced their first patient death during medical school. Three themes were identified: patient death circumstances, immediate and delayed emotional impact, and preparedness and coping mechanisms. Unexpected death, pronouncing death, cardiopulmonary resuscitation and communicating with families were common challenges. Feelings of guilt, helplessness and grief followed the events. Feeling underprepared contributed to emotional consequences, including difficulties sleeping, intrusive thoughts and emotional distancing; however, these experiences were consistently normalized by participants.InterpretationPatient death during medical training can be traumatic for trainees and may perpetuate loss of empathy, changes to practice and residual emotional effects. Educational initiatives to prepare trainees for patient death and teach adaptive coping strategies may help mitigate psychologic trauma and loss of empathy; further research is required to explore these strategies.

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Promoting substance use education among generalist physicians: an evaluation of the Chief Resident Immersion Training (CRIT) program.

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