Addiction Psychiatry / Medicine and Motivational Interviewing

Sites: BWH
Director(s): Erik Alexander, David Hathaway, Lisa Vercollone
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month. Except July, August and April.
Location: BWH - Brigham and Women's Hospital (23)
Open to Exclerks: US/Canadian
Description: Students may add themselves to the waiting list for this course during add/drop periods but not during lottery periods. Please contact Dr. David Hathaway,, for approval to enroll. The elective in addiction medicine/psychiatry is designed to provide students with an opportunity to gain knowledge and experience in the assessment and management of substance use disorders with a focus on medical settings. Students will have the opportunity to gain proficiency in a range of addiction treatment that may include the following: � Addiction consultation-liaison (BWH): As part of the medical-psychiatry consultation service, students will evaluate patients in the inpatient medical and surgical floors, emergency room, and intensive care units. Students will gain experience in a variety of clinical issues such as managing intoxications, overdoses and withdrawals, buprenorphine/methadone dosing, pain management in addicted patients, and managing pregnant patients. Students will also have the opportunity to experience outpatient addiction consultation-liaison practice in primary care, OB, and HIV clinics. � Inpatient detoxification (BWFH): Under supervision of the Addiction Recovery Team, students will follow patients on hospital-based level 4 inpatient detoxification unit. � Dual diagnosis intensive outpatient program (BWFH): Students will work closely with the Addiction Recovery Program staff in treating dually diagnosed patients participating in an intensive outpatient program. Opportunities to co-facilitate group therapy are available. � Buprenorphine maintenance treatment (BWH and BWFH): Students will gain experience in buprenorphine treatment, including induction and stabilization. Students can participate in innovative models of care: collaborative care management at a primary care clinic, or a shared visit model at an outpatient addiction clinic. Students will have the opportunity to co-facilitate groups. � Motivational Interviewing (BWH and BWFH): Students interested in gaining proficiency in motivational interviewing (MI) will learn the basics and will be given ample opportunity to practice this skill under supervision from trainers who are members of the Motivational Interviewing Network of Trainers (MINT). � Students are expected to complete a scholarly project in collaboration with the course director.
Incorporation of Basic Science Content and Evidence-Based Medicine:
Discussion of findings from relevant basic science and clinical studies are incorporated into weekly rounds. For selected cases, students review relevant articles and summarize them in rounds. Topics that are covered include pathophysiology of addiction, pharmacology of substances of abuse, agonist maintenance treatment, and behavioral therapies for substance use disorders.
Grade Criteria:
Honors with Distinction:
Student demonstrates all the competencies listed for a Honors grade. In addition, student shows an exceptional capacity for empathy, communication, diagnostic acumen, clinical judgment and treatment planning. Student consistently acquires substantial evidence-based background information relevant to clinical cases seen, and asks questions that indicate an in-depth analysis of this information and of the case. Student's scholarly project reflects original thought, including an ability to figure out next steps for research about the chosen topic.
Student demonstrates all the competencies listed for a �Pass� grade. In addition, student's evaluations of patients include thorough, detailed, nuanced histories and accurate, descriptive mental status examinations. Student can develop comprehensive differential diagnoses and biopsychosocial formulations. Student proactively finds relevant evidence-based information and shares it with the treatment team. Student communicates with patients in a nuanced, empathic way that is matched with patients� varied communication styles and capabilities. Student's scholarly project is well organized and effectively delivered, and reflects an accurate, up to date synopsis of the evidence base for the chosen topic.
Student's evaluations of patients consistently include key elements of history, mental status examination, risk assessment, and multiaxial diagnosis or differential diagnosis. Student demonstrates ability to form a treatment plan that has defined goals and treatment modalities and is consistent with clinically effective and cost-effective care. Student demonstrates ability to explain risks and benefits of recommended treatments to patients. Student demonstrates ability to find evidence-based information and apply it to clinical situations. Student communicates effectively with patients, family members, other clinicians and supervisors. Student performs assigned tasks, consistently exhibits professional behavior, and works effectively as part of a health care team. Student completes a scholarly project. Unsatisfactory:
Unsatisfactory: Student does not demonstrate one or more of the competencies listed for a �pass� grade.