Enhanced Skills Program: Addiction Medicine Outpatient Medicine and Concurrent Disorders (AMS) Rotation Goals and Objectives

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

Medical Expert

Medical Assessment

• Complete a comprehensive addiction assessment and make an appropriate diagnosis of all substance use disorders present (as well as document 'pertinent negatives') according to DSM5
• Assess the presence of non-addictive but unhealthy alcohol and other drug use in order to initiate brief intervention and motivational enhancement activities or, as indicated, refer to another member of the healthcare team to provide brief intervention, Motivational Enhancement Therapy, or referral to other addiction care
• Perform a physical exam that evaluates the patient's general medical status as well as signs/symptoms of withdrawal, intoxication and complications associated with their substance use
• Perform a mental status exam and collect a psychiatric review of systems to rule out or rule in the presence of significant co-morbid psychiatric conditions that should be addressed along the individual's substance use disorder; this includes assessment of self-harm, suicide, and harm-to-other risk
• Review recent collateral information from the patient's primary care provider or from a recent hospitalization, emergency room encounter, urgent care center encounter, detox encounter and incorporate that information into an assessment
• Use rating scales (CAGE, AUDIT, QIDS etc.) to assist in the formulation of a diagnosis
• Assess patients with chronic non-cancer pain who are using opioid analgesics, and assist in their care, making an appropriate assessment for the presence/absence of co- morbid addiction along with their underlying pain medicine condition; and demonstrate the ability to consult bi-directionally with pain medicine physicians and pain clinics.

Clinical Judgement and Management

• Evaluate impaired health care professionals in an outpatient practice including communication with licensing boards, hospital/clinic medical staff, and other entities regarding the professional's ongoing fitness for duty.
• Demonstrate competence in assessing and managing withdrawal syndromes as they appear in the ambulatory setting.
• Form a relationship with the patient that includes non-judgmental acceptance of the patient, regardless of the severity of his or her primary disease or its complications, and which may include the patient’s inability to adhere to recommendations regarding abstinence from alcohol or drug use.
• Initiate, continue, and discontinue addiction pharmacotherapies, as indicated including pharmacotherapies for alcohol use disorder, tobacco use disorder, opioid use disorder, cannabis use disorder
• Identify proper patient candidates for office-based opioid treatment, to perform outpatient inductions onto methadone or buprenorphine maintenance treatment, and manage patients over time with maintenance therapies
• Determine appropriateness for discontinuation of methadone or buprenorphine maintenance and advise patients of the safest mode of buprenorphine/methadone discontinuation
• Appropriately triage clients to either outpatient or inpatient detoxification as required
• Identify what constitutes an addiction medicine emergency as it presents in the outpatient setting.
• Lead or facilitate group meetings and family sessions
• Perform office-based psychosocial interventions such as motivational interviewing, and cognitive behavioural therapy for substance use disorders
• Develop and carry out a management plan, both for the immediate need or intervention, and for long-term, chronic disease management, for any primary addictive illness, and its medical and psychiatric co-occurring disorders
• Offer support, patient education, and psychotherapy, as needed, using individual, group, or family therapy modalities, to children and other family members of persons with addiction or another substance use condition when that condition has affected the health, well-being and functional status of that family member
• Use laboratory tests, including urine drug testing, and other diagnostic procedures and consultations to appropriately provide ongoing monitoring of the patient's addictive disease and/or general medical complications of chronic drug/alcohol use/addiction.

Communicator

• Effectively set boundaries with patients and their families
• Communicate with patients and families the diagnosis of a substance use disorder and provide education regarding the natural history of the disease as chronic and relapsing in nature

Collaborator

• Appropriately consult physicians from other specialities and other health care professionals as indicated during general outpatient addiction medicine care.
• Request assistance from the pharmacist to verify the patient's substance use history during the history-taking process via Ontario Drug Benefit dispensing records or directly from the patient’s pharmacy.
• Communicate with other care providers to obtain previous health care records, contact family members and other relevant collateral to confirm or refute patient self-reports and come to the most accurate diagnosis

Leader

• Demonstrates time management skills to reflect and balance priorities for patient care, sustainable practice, and personal life
• Makes cost-effective use of health care resources based on sound judgement, balancing resources to maximize benefits to all patients, including managing waiting lists

Health Advocate

• Demonstrate an understanding of the purpose of drug court and diversion programs from the criminal justice system
• Assist patients in navigating admission to provincially-funded residential programs

Scholar

• Locate, appraise and assimilate scientific evidence on an ongoing basis and incorporate it into medical practice.
• Strive to improve patient care based on constant self-evaluation and life-long learning.
• Set learning and improvement goals and discuss these with a preceptor
• Incorporate formative evaluation feedback into daily practice
• Use information technology to optimize learning.

Professional

• Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
• Understanding of issues related to assessment and caring for physician colleagues with addictive disorders.