In this survey of 51 psychiatry residents from various parts of Nigeria, a large proportion of the participants expressed interest in pursuing further specialization in addiction psychiatry. Almost half perceived their training on managing SUD to be inadequate. When asked to rate satisfaction with the SUD training they have received so far, over half of participants were unsatisfied, and the absence of in-house SUD training program was the leading cause of dissatisfaction. However, less than half were satisfied and the most common reasons for satisfaction were SUD training and treatment-related factors. The most frequent suggestions for making addiction psychiatry subspecialty attractive included the provision of SUD treatment units, structured SUD training, and continuity of such training. Equipping treatment units and creating more treatment units were the most common suggestions for improving current SUD training.
In this study, 70.6% expressed interest in the field of addiction psychiatry, which was higher than 44.5% reported in an American study [14]. At 47.1%, the proportion of residents satisfied with their SUD training was lower than 95% reported in a study of residents in the USA [10]. A Canadian study reported a high level of satisfaction with SUD training but data regarding the actual number or proportion of satisfied residents were not provided [9]. Neither of the American and Canadian studies explored dissatisfaction, and as such, we could not compare our results with theirs.
These findings have several implications for Nigeria. Issues related to SUD treatment units/centers were mentioned among the reasons for dissatisfaction with SUD training, and among suggestions for improving SUD training and for making addiction psychiatry attractive to general psychiatry residents. An earlier study [3] highlighted a shortage of and an uneven geographical distribution of SUD treatment centers in Nigeria. Therefore, provision of more SUD treatment centers and equipping existing centers should be a top priority. It is also important to consider SUD treatment units that adopt evidence-based practices within available resources, which would entail keeping abreast of and adopting what works best for various types of SUDs, embracing approaches that produce the most benefits to patients, training and retraining staff as needed, and monitoring and auditing practices [15].
Our findings also highlighted a need to review the structure of SUD training in Nigeria, because participants cited it as one of the ways to improve SUD training and to make addiction psychiatry attractive. Psychiatry residents undertake SUD training during junior residency, and it could be completed at an accredited external site [12]. In this study, absence of in-house SUD training was the predominant reason for dissatisfaction with SUD training; one possible explanation is that residents had to travel or relocate to the training sites. It would be necessary to evaluate resources available at those accredited external training sites to ensure uniformity and quality of training. Such evaluation should also seek to uncover if variations in experiences occur between those who completed their SUD training in-house versus external sites. Concerns about provision of psychotherapy and the availability of staff and resource persons should be addressed to improve training. Some participants suggested continuity of SUD training and continuous assessments/evaluations; online education platform is a cost-effective means of supplementing in-person training and for continuing medical education [16]. Additionally, online platforms should also be considered as flexible and efficient means for providing interventions, thereby improving access to SUD treatment [17].
Strengths and limitations of this study need to be acknowledged. Research studies relating to SUDs are predominantly conducted in high-income countries [18]. Most existing studies on SUD training were conducted in high-income countries, so this study provided insights from a low-/middle-income country. The study was representative, as the participants were drawn from the six regions in Nigeria. The sample size was small, however, which precluded subgroup analysis and limits generalizability of the results. Despite the limitations, this study provides useful information on SUD training and may stimulate further research on evaluating the process of educating psychiatric physicians to treat SUDs. Assessing psychiatry residents’ perceptions of SUD training would offer valuable feedback to program directors regarding the training itself and provide an opportunity to seek suggestions for improvement. It might be worthwhile to conduct multiple research surveys on the same cohort of psychiatry residents to gather feedback at various points during residency training because opinions and attitudes change over time [19]. In this study, the not applicable/no response category in satisfied and dissatisfied groups were likely to be respondents who skipped the question because they were dissatisfied and satisfied, respectively. It, however, highlighted a limitation of understanding why residents may be satisfied/dissatisfied with quality of SUD training and further supports collection of feedback at various points during residency training. Addressing the causes of dissatisfaction and areas suggested for improvement would require the buy-in and support of decision makers. A previous study [20] found that lack of time, lack of institutional support, lack of faculty expertise, and lack of training sites were barriers to SUD training. Therefore, future research should seek feedback from medical/residency directors to identify their opinions, needs, and challenges.