Enhanced Skills Program: Addiction Medicine Medical Withdrawal Service Rotation Goals and Objectives

Medical Expert

By the end of the rotation, the Addiction Medicine resident will be able to:

Knowledge:

Demonstrate knowledge of the signs and symptoms of alcohol, sedative, GHB, opioid, and other drug withdrawal syndromes, as well as their neurobiology and pathophysiology.
Describe the medical/psychiatric conditions that can mimic intoxication or withdrawal.
Describe the risks and benefits of the use of clonidine, buprenorphine/naloxone, methadone in the management of opioid withdrawal.
Demonstrate an understanding of the theories supporting the use of various other pharmacotherapies for other drug withdrawal syndromes, e.g. stimulant and cannabis withdrawal.
Demonstrate an understanding of the use of sedative tolerance tests and sedative substitution approaches for benzodiazepine and other sedative withdrawal syndromes.

Medical Assessment:

Perform an assessment using the diagnostic criteria for substance use disorders and various intoxication and withdrawal states according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Use definitions of a “standard drink” when calculating a patient's quantity/frequency of consumption and trying to determine the level of tolerance of the likelihood of developing alcohol withdrawal.
Use the Clinical Opioid Withdrawal Scale to assess readiness for buprenorphine/naloxone initiation.

Clinical Judgment and Management:

Appropriately choose “symptom-triggered detox” versus “Benzodiazepine loading” in the treatment of the patient with alcohol withdrawal.
Manage sedative tapers, with and without augmentation with anticonvulsants, for benzodiazepine detoxification.
Manage polysubstance withdrawal appropriately.
Use nicotine replacement therapies and other approaches in the management of nicotine withdrawal
Demonstrate the use of anticonvulsants and other agents for alcohol withdrawal management and the rationale/indications for use of each.
Manage inpatient rotation from methadone to buprenorphine/naloxone.
Counsel a patient on the risk of opioid overdose following detoxification and provide counselling on the use of naloxone

By the end of the rotation, the Addiction Medicine resident will be able to:

Communicate effectively to clients and their families information regarding the risks and benefits of treatment alternatives.

By the end of the rotation, the Addiction Medicine resident will be able to:

Demonstrate knowledge of the importance and beneficial nature of team-based health care practices which involve multiple clinicians from multiple disciplines to create the best care experience and the optimum clinical outcomes for patients and their family members.
Participate in clinical team huddles and where appropriate, to be an effective leader of clinical teams.
Coordinate management with members of the Emergency Department staff who are receiving and conducting the initial triage and stabilization of acutely intoxicated or withdrawing patients.
Communicate to family physicians the plan for ongoing support of clients discharged from the medical withdrawal service.

By the end of the rotation, the Addiction Medicine resident will have increased proficiency in their ability to:

Carry out appropriate clinical services in the context of limited resources, limited expected lengths of stay, and limited time available for the resident.
Demonstrate time management skills to reflect and balance priorities for patient care, sustainable practice, and personal life.

By the end of the rotation, the Addiction Medicine resident will be able to:

Demonstrate knowledge of community-based resources which address the needs of persons admitted to the Medical Withdrawal Service, especially community-based residential facilities, clinics and agencies for aftercare.
Advocate effectively for transitions to mental health care, social service, family medicine and residential treatment following admission to the medical withdrawal service.

By the end of the rotation, the Addiction Medicine resident will be able to:

Facilitate the learning of students or junior residents.
Demonstrate that they have pursued self-directed learning around cases seen on the ward.

By the end of the rotation, the Addiction Medicine resident will be able to:

Exhibit professional behaviours such as being punctual for clinical and educational activities and being available to administrative and clinical staff.
Recognize the limits of his/her knowledge and skills and consult with attending staff to request assistance in patient management where appropriate