CanMEDS Proficiencies / Roles & Key Competencies, Addiction Psychiatry - Medical Expert

For addiction psychiatry core competencies, the psychiatry specialist (by the end of PGY V) must be able to:

1. Ability to conduct a comprehensive clinical evaluation of the patient with substance use disorders with and without concurrent disorders

Which includes the skills to gather specific personal and family history information, both from the patient and from relevant collateral informants; to elicit the symptoms and recognize the signs of substance - dependent conditions; to recognize the clinical manifestations of acute intoxication and withdrawal states; to utilize and interpret the appropriate ancillary tests and laboratory examinations; to identify substance-specific neuro-psychiatric complications; to produce a differential diagnosis between substance-induced and independent psychiatric disorders; to establish the presence of concurrent disorders and functional relationship between conditions, as well as the context in which they arise; to assess suicidal risk, loss of behavioural control and potential for violence; to look for and recognize the presence of physical complications specific to separate substances and drug-using practices; to assess the patient's degree of disability and functional impairment; and the capacity to make appropriate use of all such information in deciding clinical management and treatment approach.

2. Ability to provide direct care to patients with substance use disorders with and without concurrent disorders

Including the ability to predict the occurrence of sever clinical complications and to decide proper setting for treatment i.e. from outpatient to day therapy to residential to inpatient care; the skills to treat acute intoxication and withdrawal states, both in hospital and on an ambulatory basis; the handling of overdose situations in emergency settings; an adequate familiarity with detoxification protocols in order to conduct elective drug discontinuation treatments; the knowledge of drug interactions, drug cross-tolerance, potentiation risks and abuse liability; the awareness of specific contraindications in the pharmacotherapy of psychiatric disorders in patients who are also substance abusers; the familiarity with addiction pharmacotherapies and with drug maintenance regimes; the skill to engage in the patient and conduct motivation enhancement interventions; the capability to assume a continuing care role and offer individual or group psychotherapies of proven value for addictive disorders (e.g: supportive-expressive, individual or cognitive behavioural, modified-dynamic, skills training and behavioural desensitization), and a familiarity with intervention strategies involving the family and social network.

3. Ability to provide concurrent psychiatric care / consults to patients who are receiving addiction treatment elsewhere

Including an adequate familiarity with local community resources and addiction centers, their admission criteria, type of services and treatment curricula, the referral procedures and key contact persons; an adequate knowledge of the self help programs, their philosophy and established practices; the ability to communicate with and work alongside other therapists (often non-psychiatric or even non-professional); an awareness of possible misconceptions about psychiatric disorders and pharmacotherapy in such addiction therapy programs; and the skill to provide appropriate psychiatric advise and influence the clinical management without undermining the addiction treatment effort.

4. Ability to attend to legal / ethical issues

Including the decisions concerning legal competence, the operation of motor vehicles, the ability to care for dependent persons and occupational disability (see also Advocacy Role below).

The knowledge and skills will be obtained via:

1. Exposure to a wide variety of generalist and specialist rotations in PGY I and blended experiences in PGY II-V

1. The development of skills in addiction and concurrent disorder assessment and treatment
2. The development of skills necessary for the development of an integrated differential diagnosis and a treatment plan for the patient, with the understanding of the difficulties and time-length to obtain accurate diagnoses in concurrent disorder patients
3. The use of evidence-based literature for helping guide assessment and treatment
4. The learning of a variety of core procedures (e.g. withdrawal management) pertaining to the practice of addictions and concurrent disorders
5. Adequate exposure to inpatients in hospital-based rotations and outpatients in hospital-based and community-based ambulatory rotations
6. The integration of basic and clinical sciences and how they apply to addiction issues of patients
7. The understanding of epidemiological principles and how they apply to addiction issues of patients

The knowledge and skills will be taught in the following ways:

1. Assignment to appropriate clinical services with in-patient and/or ambulatory components
2. Attendance at academic hospital-based rounds and other educational activities
3. Learning about evidence-based medicine as it applies to addiction psychiatry
4. The teaching of assessment and treatment knowledge and skills through formal supervision, and the monitoring of competency possibly through a log-mechanism.  Each teaching site would have an Addictions Coordinator to help insure that the resident is able to have addiction psychiatry training opportunities

Evaluation:

1. Via the supervisor of the resident, and the monitoring of competency through a log-mechanism
2. In-training Evaluations and the meeting of expectations
3. Successfully passing any Addiction Psychiatry exam questions / OSCE type evaluations that are already built into the resident evaluation of their overall progress through the Psychiatry PGY I-V.

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