Towards competency-based medical education in addictions psychiatry: a systematic review

Abstract

Background: Current curriculum guidelines for addiction training in psychiatry need to be adapted to the competency by design framework to integrate clinical skills in addiction.
 Objective: We conducted a systematic review to identify curricular and educational interventions to build competency among psychiatry residents and fellows in addiction psychiatry.
 Methods: We followed the PRISMA guidelines, searching five databases from inception to August 2020 for relevant evaluation-type studies exploring addiction psychiatry competency among psychiatry residents and fellows. We appraised study quality using the Joanna Briggs Institute's risk of bias tool for observational designs.
 Results: From 1600 records, 17 studies met inclusion criteria. Addiction psychiatry competencies spanned themes involving core knowledge development; attitudinal, communication and leadership skills; screening, assessment, diagnosis; management; and special populations. Examples of effective educational interventions to enhance addiction competency include specific modules for substance use disorders and integrated clinical rotations that simultaneously combine multiple types of skills. Lived experience improved trainee attitudes towards addiction psychiatry.
 Conclusions: While there is current evidence supporting strategies for developing competency in addiction psychiatry, the lack of studies measuring sustained competence over a longer-term follow-up period and the absence of randomized controlled trials limit the overall strength of evidence in this review. Current psychiatry entrustable professional activities (EPAs) involving addiction only partly overlap with curriculum training guidelines and studies identified in this review. These EPAs need to be better identified for training programs, competence in those EPAs better delineated for residents and preceptors, and evaluations should be done to ensure that adequate competence in addictions is attained and sustained.

Training in Substance Use Disorders, Part 2: Updated Curriculum Guidelines

“…The core goals and objectives of this second part of the position paper are to review and describe the psychiatric competencies as they apply to SUDs, and to identify the EPAs related to SUD with a rubric for their evaluation to promote more uniform knowledge, skill and attitude development for residents nationally. The recommendations for EPA evaluation are based on the prior CPA position papers, 1,10 practice guidelines, 14–18 research papers and book chapters published on medical and postgraduate education in addictions 2,8,18–21 and major textbooks. 8,22,23 This position paper aims to provide guidance to residency training programs in Canada to facilitate the training of general psychiatrists to competently manage patients with concurrent or primary SUD in psychiatric practice using evidence-based practices with appropriate optimism for improvement.…”

“…Les principaux buts et objectifs de cette deuxième partie de l’énoncé sont d’examiner et de décrire les compétences psychiatriques comme elles s’appliquent aux TUS, et d’identifier les APC liées au TUS avec une grille d’évaluation pour promouvoir le développement de connaissances, compétences et attitudes plus uniformes pour les résidents à l’échelle nationale. Les recommandations pour l’évaluation d’une APC sont basées sur les énoncés précédents de l’APC 1, 10 , les lignes directrices de la pratique 14–18 , les documents de recherche et les chapitres de livres publiés pour l’éducation médicale et diplômée en toxicomanie 2, 8, 18–21 et les principaux manuels 8, 22, 23 . Le présent énoncé de principe vise à offrir un guide aux programmes de formation de résidence au Canada pour faciliter la formation des psychiatres généraux en vue de prendre en charge avec compétence les patients avec un TUS primaire ou concomitant dans la pratique psychiatrique à l’aide de pratiques fondées sur des données probantes et avec un optimisme approprié quant à l’amélioration.…”