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:
- 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.
- Engage other members of the health care team in a respectful manner.