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The buddy system: Patients as teachers in addiction training for medical residents [Meeting Abstract]

Pace, N A; Ciccaroni, W; Schwartzberg, M Y; Schwartz, C; Parish, S; Brennan, T K
The subtle signs and symptoms of substance use disorder (SUD) often go unrecognized by physicians in training. Many times, this is because primary care physicians are not trained to recognize SUDs as free-standing medical illnesses that can be successfully treated, and require primary care interventions. Physicians-in-training at the residency level may not know what these disorders looks like in their early and active phases, nor in phases of recovery. Most young physicians have never had the opportunity to speak with patients who are actively working to recover or in long-term recovery. In 2008, a major NYC teaching hospital (Lenox Hill Hospital) began to require all first-year primary care internal medical residents to attend a 12-hour Physician Alcohol and Addiction Training Program (PAAT). This innovative program utilizes patients as teachers. Each physician is paired with an alcoholic or addicted patient in recovery and actively involved in AA. In a powerful reversal of the traditional doctor-patient relationship, the patients, or "buddies" act as 1:1 teachers and mentors for the resident physicians, providing a profound and personal window into the experience of alcoholism and addiction, and modeling positive treatment outcomes and recovery. This work with buddies is integrated, in real time, with the training provided by physician faculty. Buddies accompany their resident physicians to an AA meeting and provide them with an understanding of 12-step sober support meetings as a powerful treatment modality. Each Buddy-Resident pair processes their AA experience, dispelling common myths about sober support meetings and dire prognosis of alcoholism and addiction. Residents get to know their buddies as people with expertise to offer them, and not simply as patients. They administer several screening tools (MAST, CAGE, and AUDIT) to their buddies, who are asked to answer both as they would have when actively using, and as they would now, looking backward from their current perches in recovery. This provides residents insight into the defensiveness, minimization and denial that they will face when screening for SUDs, and the critical need for cultivating longitudinal primary care relationships. Residents then take full biopsychosocial histories, and are encouraged to follow their curiosity and ask the questions that they would never ask if their buddies were their patients. The program concludes with resident presentations of their buddies' histories of use and recovery, getting feedback from both faculty and peers. Data about resident ratings of the program, utilizing the Wilcoxon matched-pairs signed-ranks pre-and post-tests, will be presented, as well as results demonstrating robust changes in students' perceptions after buddy mentoring, with the emergence of an understanding that substance use is a chronic relapsing medical disease that can be successfully treated, rather than an irreparable deficiency in moral character
EMBASE:627851777
ISSN: 1935-3227
CID: 3926512

Substance abuse training in medical residency; Altering perceptions and beliefs [Meeting Abstract]

Schwartzberg, M Y; Pace, N A
Many primary care physicians are not properly educated to recognize substance use disease as a separate disease entity that requires legitimate medical care and consideration. Additionally, many physicians do not perceive substance use conditions as being part of their responsibility and that they should remain as case managers throughout the patient's treatment. This primary care Physician Alcoholism/Addiction Training Program (PAAT) serves to train first-year medical residents to properly diagnose, treat, and refer chemical dependent patients. The target physician population is first-year primary care medical residents. The content includes volunteer AA members who serve as teaching buddies, overview of the medical and psychiatric complications, motivational interviewing techniques, and practice sessions. The success of this program was assessed by utilizing the Wilcoxon Matched-Pairs Signed Ranks Pre-/Post-Test. Most primary care physicians fail to perceive drug addiction as a separate disease entity that deserves to be a part of their responsibility to diagnose, treat, and properly refer, while remaining as ongoing case managers. The Physician Alcoholism/Addiction Training Program (PAAT) encourages the outlook for successful long term recovery from addictions by providing information, resources and beginning skills practice for effective screening, intervention, proper referral, counseling and medical treatment of substance use disorders. The curriculum is presented each month for 3 hours over four consecutive sessions, and is anchored by a primary care physician with addiction credentials. The course incorporates AA members into its program where the physician students are individually paired up to an AA Buddy in order to help them understand the complexity of the human component of the disease and the possibility for successful recovery. The physician students are also given the opportunity to utilize the motivational techniques that they learn with the use of professional actors who take on the persona of addicted patients. By doing so, they learn how to develop a rapport with the patient leading to a successful medical screening/diagnosis, helping the patient understand and acceptance the disease model, proper intervention, and treatment. This course also includes a Q&A with a physician in recovery, a group discussion with the AA Buddies panel, information on addiction neurophysiology, medical complications, and psychiatric comorbidity. The centerpiece of the curriculum is having the physician students present their Buddies' histories into recovery. Pre-/post-test mean value analysis using Wilcoxon Matched-Pairs Signed Ranks Test findings show that the PAAT changed the students' perception that rather than a deficiency in moral character, substance use is a chronic relapsing medical disease. Students reported an increase in their ability to recognize common physical signs and symptoms of addiction, more confidence in assessing and accurately diagnosing chemical dependency, increased ability to make an accurate referral, and overall more willing to treat chemically dependent patients. The PAAT is a method to improve physicians' skill sets and clinical abilities to better treat chemically dependent patients by altering negative perceptions. Acceptance of chemical dependency as a medical disease widens the physician students' responsibilities to provide proper case management and overall medical treatment
EMBASE:627851520
ISSN: 1935-3227
CID: 3926522

A Model for a Community-Based, Standardized 12 Hour Resident Physicians Alcoholism Addiction Training Program (PAAT) [Meeting Abstract]

Pace, N. A.; Schwartz, C. E.
ISI:000283304800031
ISSN: 0889-7077
CID: 114205

The effect of Addiction Training on internal medicine residents' perception of addictive diseases [Meeting Abstract]

Pace, NA; Polydorou, S; Rabinowitz, E; Andrieni, J; Meredith, J
ISI:000228614600031
ISSN: 1055-0887
CID: 55931

Adolescent addiction - A physician\'s counseling manual for parental guidance [Meeting Abstract]

Pace, NA
ISI:000221396400034
ISSN: 1055-0887
CID: 46587

Molecular basis of therapeutic properties of Delta-9-tetraphydrocannobinal (THC) [Meeting Abstract]

Pace, N; Sutin, K; Nahas, G
ISI:000168188800056
ISSN: 1055-0887
CID: 55108

The medical use of marihuana and THC in perspective

Chapter by: Pace N; Frick HC; Sutin K; Manger W; Hyman G; Nahas G
in: Marihuana and medicine by Nahas GG [Eds]
Totowa NJ : Humana Press, 1999
pp. 767-780
ISBN: 089603593x
CID: 4596

Alcoholism at the work site

Pace, N A
PMID: 3739133
ISSN: 0066-9598
CID: 112173

Guidelines to safe drinking

Pace, Nicholas A.; Cross, Wilbur
New York : McGraw-Hill, c1984
Extent: xvi, 160 p. ; 22 cm
ISBN: n/a
CID: 5

ALCOHOLISM AS A MODERN PROBLEM [Editorial]

Pace, N
ISI:A1978EH24300002
ISSN: 0001-7094
CID: 29967