1. ABAM/CNHF Project FELLOWSHIPS FELLOWS TRAINING EVENTS

2. SUMMARY Context: Addiction is a major health problem with a suboptimal response from the health care system and with a shortage of trained physicians to provide needed care Objective: Develop a physician workforce trained to provide care and teach screening, brief intervention and refferal to treatment (SBIRT) to other physicians Design: Observational educational study Setting: North American academic graduate medical education (GME) training programs on addiction medicine Participants: Directors of addiction medicine fellowship programs and the fellows Intervention: Standardized national SBIRT curriculum for addiction medicine GME Main outcome measures: Number of fellowships established, fellows trained, SBIRT training events delivered, and primary care providers trained in SBIRT Results: More programs are training more fellows who can teach adolescent-oriented SBIRT during their fellowship and in the year following completion of training Conclusion: A new work force of addiction medicine physicians is beginning to have an impact on the health care response to the epidemic of adolescent substance use disorders

3. CONTEXT What’s the problem? How will it be fixed?  BACKGROUND: The substance use disorders are a major health problem  Health system response is treatment focused  We can’t treat our way out of this problem  OBJECTIVE: Expand the focus of the health system beyond the treatment of addiction  Include a focus on early disease  Include a focus on young people  PROBLEM: Lack of addiction medicine physician workforce with vision and skills  SOLUTION: Establish fellowships, develop curricula, train future leaders  EXPECTED OUTCOMES: Specific and measurable  Fellows will be expert educators as shown by progression through “Milestones” during training  Fellows will be become agents of system change by continuing training events after graduation

4. GOALS & OBJECTIVES Change the Health Care System  Establish Fellowships  Seek out potential sites for fellowship  Work with the ABAM certified champion  Develop Curricula  Compile lists of available materials  Develop the skills of existing faculty  Develop curricula for training fellows  Train Future Leaders  Use the “see one, do one, teach one” model  Aspire for skills needed to effect system change

5. EVALUATIVE STRATEGY Data Collection & Management  Design/setting: Observational study/fellowship  Participants: Program directors & fellows  Baseline data: Program chacteristics & demographics of the fellows  Intermediate process measures  Quantitative: Number and type of training events, number of trainees  Qualitative: Evaluations by faculty, fellows and trainees  Main outcome measures:  Total number of training events in the year after graduation  Number of training events designed to change a health care system  Data management: Systematically collected, use of statistical software (SPSS)

6. Fellowships: More Programs are Training More Fellows

7. Fellows: Background and Milestone Progress Internal Med Psych

8. Fellows as Teachers: More Physicians Trained in Adolescent SBIRT

9. 2014 Training Events: Who was trained? How were they trained? Physicians

10. Fellows’ Training Events: Fellows Continue to Train after Graduation

11. CONCLUSIONS: 2013-2017  Number of ADM fellowships has more than doubled (19 to 43)  Over 100 ADM fellows have entered the workforce  These clinical physicians have been taught to train others in SBIRT  They have continued to train other physicians after graduation  Their efforts are changing the health care system

12. Publications  Doe JD, Roe RA, Smith H, Wesson DB. Establishing fellowship for physicians on addiction medicine: barriers encountered and lessons learned. Grad Med Educ 2018;12:34-45.  Doe JD, Roe RA, Smith H, Wesson DB. Filling a workforce need: the training of physicians on addiction medicine. J Med Educ 2018;12:34-45.  Doe JD, Roe RA, Smith H, Wesson DB. Changing the American healthcare system: addiction medicine physicians as agents of change. Am J Health Policy 2018;12:34-45.

13. Acknowledgements  Funding provided by:  NIAAA R25  Conrad N. Hilton Foundation  With additional support from:  Society of Teachers of Family Medicine  Blue Cross/Blue Shield of Western New York