Introduction: Despite how often medical trainees witness the spectrum of unhealthy substance use, disproportionately little curricular time is devoted to this topic. This lack of curricular time and shortage of actionable skills often leads to feelings of hopelessness and cynicism when caring for affected patients. Towards the goals of helping medical residents learn practical skills and gain confidence in detecting, diagnosing, and managing patients with unhealthy substance use, we developed this 4-week, 16-hour SBIRT (Screening, Brief Intervention, Referral, and Treatment) curriculum. SBIRT is a public health approach to the delivery of early intervention and treatment services for people with, or at risk of developing, substance use disorders. Methods: The curriculum is intended for second or third-year postgraduate primary care residents during a 1-month ambulatory block. Teaching elements include traditional didactics, experiential and case-based learning, skills-based practice with feedback, and peer-peer feedback. Slide decks, handouts for reflection exercises and skills practice, educational posters, individual pocket-cards, and instructor guides for each module are provided. For skills reinforcement, this curriculum also includes content for “booster” sessions that can be offered later in the year. Results: This curriculum has been a core component of our ambulatory training for a track of internal medicine residents at the University of California, San Francisco. This 4-week curriculum has been very well-received by our residents, and we have demonstrated significant improvements in knowledge and confidence in the management of substance-use disorders from self-administered survey data. Discussion: SBIRT is a public health approach to the delivery of early intervention and treatment services for people with or at risk of developing substance-use disorders. Evidence for SBIRT's efficacy in persons with non-dependent, unhealthy alcohol use has led to universal screening recommendations from the United States Preventive Services Task Force for use in primary care settings.
- Describe the rationale and evidence of SBIRT (Screening, Brief Intervention, Referral, and Treatment).
- Self-assess ability and interest in effectively identifying substance use in their patients.
- Self-assess barriers and facilitators to effectively screening and providing an intervention for substance use in clinical settings.
- Identify ways that risky substance use and substance-use disorders present among their clinical population and list common challenges in assessing/managing care in these situations.
- Demonstrate the ability to use the one-question screeners for alcohol and substance-use disorders.
- Demonstrate the ability to use one patient-centered communication strategy for discussing behavior change with patients.
- Describe how patients fit within the spectrum of low-risk use, risky use, use disorder (mild, moderate, severe) and how that affects triage/intervention.
- Identify resources within their care system for patients with alcohol/substance use disorders.
- Distinguish their role as providers within their care teams for patients with alcohol/substance use disorders.
- Consider themselves less frustrated and more confident in working with patients with alcohol/substance disorders.
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Azari S, Siegel J, Jain S, Capps L, Rich C. How to teach residents about vulnerable populations. Workshop presented at: Society for General Internal Medicine (SGIM) Conference; April 2014.
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