Enhanced Skills Program: Addiction Medicine_ Inpatient Addiction Medicine (SMH) Rotation Goals and Objectives

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

Medical Expert

Medical Assessment

Know the effects of the substance use on the medical condition and its treatment, as well as the impact of medical conditions on the treatment of the substance use condition.
Understand the pharmacology of addiction medications particularly as they relate to specific medical co-morbidities.
Recognize the spectrum of presentation of withdrawal syndromes in the presence of concomitant medical complications.
Recognize common psychiatric conditions as they occur among patients with substance use conditions, and know when to seek appropriate psychiatric consultation.
Recognize the relationship between the psychiatric diagnosis and the substance use condition.
Recognize and treat substance use conditions (e.g. intoxication, withdrawal, use disorders) in the setting of acute and chronic medical and psychiatric conditions.
Complete a comprehensive addiction assessment, and make a complete diagnosis of all substance use disorders present, and note pertinent negatives in medically/surgically/obstetrically hospitalized patients or in the Emergency Department.
Conduct an appropriate risk management assessment of each patient, including suicide and self-harm risk and risk to others, and refer to a higher level of care if indicated.

Clinical Judgement and Management

Make appropriate recommendations for the initiation or continuation of addiction pharmacotherapies during the inpatient encounter.
Utilize principles of dialectical behavioural therapy to manage patients with co-occurring substance use and borderline personality disorder where indicated
Medically manage withdrawal from alcohol and other drugs, appropriate to the level of care provided, or refer for a higher level of care if indicated by appropriately using and interpreting standard withdrawal assessment scales.
Demonstrate competence in rotation from buprenorphine to methadone during an inpatient admission and understand when such a rotation is indicated.

Demonstrate the ability to develop a comprehensive or complex plan for the patient that incorporates the input of the patient
Communicate a succinct clinical impression and plan in a consultation note, including clear delineation of responsibilities between the consultant and the referring physician in the ongoing care of the patient.

Work collaboratively with the attending addiction medicine physician in chairing treatment planning meetings of the multidisciplinary clinical team, reviewing continuing care and discharge criteria.
Communicate with the patient’s family physician to ensure continuity of care on discharge

Lead a health care team including junior learners to provide addiction medical care.
Set agenda and provide structure to team huddles. Take on extra tasks if necessary.
Effectively lead or contribute to the health care team; delegates and distributes tasks fairly; uses time wisely.

Recognize when end-stage liver disease is present, and arrange for appropriate palliative care when further active interventions have no reasonable possibility of benefit.
Intervene on behalf of patients or the community with respect to the social, economic and biologic factors that may impact on their health.

Demonstrate an understanding of the principles of adult learning and helps others learn by providing guidance, teaching and by giving constructive feedback.
Critically evaluate medical information and its sources, and applies this appropriately to practice domains.
Effectively use evidence in day to day clinical work. Reads around cases and is knowledgeable about own patients.
Demonstrate an ability to teach others.