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Internal Medicine Resident Addiction Training at the Veteran’s Health Administration: A Qualitative Evaluation of Site Directors’ Response to the 2022 ACGME Requirements

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Substance use disorders (SUDs) are prevalent in the USA yet remain dramatically undertreated. To address this care gap, the Accreditation Council for Graduate Medical Education (ACGME) approved revisions to the Program Requirements for Graduate Medical Education (GME) in Internal Medicine, effective July 1, 2022, requiring addiction medicine training for all internal medicine (IM) residents. The Veterans Health Administration (VHA) is a clinical training site for many academic institutions that sponsor IM residencies. This focus group project evaluated VHA IM residency site directors’ perspectives about providing addiction medical education within VHA IM training sites.

Objective

To better understand the current state, barriers to, and facilitators of IM resident addiction medicine training at VHA sites.

Design

This was a qualitative evaluation based on semi-structured video-based focus groups.

Participants

Participants were VHA IM site directors based at a VHA hospital or clinic throughout the USA.

Approach

Focus groups were conducted using a semi-structured group interview guide. Two investigators coded each focus group independently, then met to create a final adjudicated coding scheme. Thematic analysis was used to identify key themes.

Key Results

Forty-three participants from 38 VHA sites participated in four focus groups (average size: 11 participants). Six themes were identified within four pre-defined categories. Current state of training: most VHA sites offered no formal training in addiction medicine for IM residents. Barriers: addiction experts are often located outside of IM settings, and ACGME requirements were non-specific. Facilitators: clinical champions help support addiction training. Desired next steps: participants desired incentives to train or hire local champions and a pre-packaged didactic curriculum.

Conclusions

Developing competent clinical champions and leveraging VHA addiction specialists from non-IM settings would create more addiction training opportunities for IM trainees at VHA sites. These insights can likely be applied to IM training at non-VHA sites.

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Author information

Authors and Affiliations

  1. VA Puget Sound Healthcare System, University of Washington School of Medicine, Seattle, WA, USA

    Claire Richardson MD, Andrew J. Saxon MD & Amy J. Kennedy MD, MS

  2. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Karin Daniels PhD & Andrea Confer BA

  3. Vulnerable Veteran Innovative Patient-Aligned-Care-Team (VIP) Initiative, Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City Health Care System, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA

    Adam J. Gordon MD, MPH

  4. Office of Mental Health and Suicide Prevention, Substance Use Disorders, Veterans Health Administration, Washington, DC, USA

    Joseph Liberto MD

  5. VA Northern California Healthcare System, UC Davis, School of Medicine, Sacramento, CA, USA

    Anthony P. Albanese MD

  6. VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA

    John Renner MD

  7. VA Connecticut Healthcare System, Yale School of Medicine, New Haven, CT, USA

    Ellen Edens MD

Authors
  1. Claire Richardson MD
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  2. Karin Daniels PhD
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  10. Amy J. Kennedy MD, MS
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Correspondence to Amy J. Kennedy MD, MS.

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Richardson, C., Daniels, K., Confer, A. et al. Internal Medicine Resident Addiction Training at the Veteran’s Health Administration: A Qualitative Evaluation of Site Directors’ Response to the 2022 ACGME Requirements. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08639-4

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  • DOI: https://doi.org/10.1007/s11606-024-08639-4

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