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Even At Mass. General, Medical Training On Addiction Deemed Lousy

Massachusetts General Hospital. (Steven Senne/AP)
Massachusetts General Hospital. (Steven Senne/AP)

Even at the lofty institution that bears the nickname Man's Greatest Hospital, most medical residents think they're not taught well enough about addiction and substance abuse, a 2012 survey found.

The hospital itself, Massachusetts General Hospital, sent over word of the study today, and says it has since increased addiction training for medical residents, who estimate that one-quarter of the inpatients they see have a substance abuse problem. From its press release:

BOSTON – A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation's leading teaching hospitals – found that more than half rated the training they had received in addiction and other substance use disorders as fair or poor.

Significant numbers felt unprepared to diagnose or treat such disorders, results similar to surveys of practicing physicians. In response to the findings, published online in the journal Substance Abuse, the MGH has increased residents' training in addiction medicine.

"Our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease prevalence similar to that of diabetes," says Sarah Wakeman, MD, chief medical resident at MGH and lead author of the report. "Finding that the majority of residents feel unprepared to treat addiction and rate the quality of their education so low represents a tremendous disparity between the burden of disease and the success of our current model of training."

The study's authors note that residents provide most direct medical care in teaching hospitals and often find caring for patients with addictions to be troublesome – possibly due to a lack of training and faculty role models – which can lead to a lack of trust between patients and physicians.

Several previous studies have pointed out deficiencies in addictions education for primary care and internal medicine residents, with some programs offering none at all. Wakeman explains, "Our findings are in line with previous data from training programs that reported limited addictions training and with studies of medical residents showing low satisfaction in caring for addicted patients. It is unlikely that MGH is unique in this educational deficiency, but rather these findings may demonstrate a critical failure in medical education as a whole."

Also:

At the time the survey was taken, formal addiction training for most residents was confined to a single noontime conference on alcohol withdrawal and three highly rated lectures on addiction-related topics during ambulatory rotations. The primary care residency, however, included an intensive two-week outpatient rotation in addictions, which was available as an elective to other residents.

One quarter of survey respondents indicated feeling unprepared to diagnose addiction, and 62 percent felt unprepared to treat it. Addictions training in the outpatient setting was rated fair to poor by 72 percent of respondents, and 56 percent rated inpatient addictions training as fair to poor. In contrast, 95 percent of participants in the primary care addictions rotation rated it as good or excellent.

...

James Morrill, MD, PhD, an MGH internist and core faculty member of the outpatient addictions elective rotation, says, "It's time to bring the level of addictions education in elite medical training programs like MGH's up to the same high level that residents receive in areas such as cardiology. We need to help our residents recognize the great potential of primary care to stem the tide of morbidity and mortality due to addiction and keep addicted patients in treatment and out of the hospital."

...

In response to the survey's findings, the MGH has expanded resident education on addictions – adding another ten noontime conferences and including addiction case histories in 25 percent of ambulatory intern reports. Wakeman and her co-authors are now repeating the survey to assess the impact of those changes. They also hope to expand the survey to a national sample of residents to determine whether their findings can be broadly applied to programs nationwide.

This program aired on May 22, 2013. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.

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