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. 2024 Jul 12;15(3):73-96.
doi: 10.36834/cmej.75973. eCollection 2024 Jul.

Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies

Christine Ausman  1 , Dawoud Almatar  1 , Niki Kiepek  1
Affiliations

Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies

Christine Ausman et al. Can Med Educ J. .

Abstract
in English, French

Background: The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion.

Objectives: The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients.

Results: Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum.

Conclusion: To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé.

Contexte: Il incombe à tous les médecins de répondre aux besoins en matière de soins de santé des consommateurs de substances psychoactives. Au sein du système de santé, les recherches révèlent régulièrement des expériences inéquitables en matière de soins de santé, les consommateurs de substances faisant état de stigmatisation, de marginalisation et d'un manque de compassion.

Objectifs: L'objectif de cette étude exploratoire était de trouver et de décrire les compétences enseignées, développées et encouragées dans le cadre de la formation médicale, puis de formuler des recommandations pour améliorer les soins prodigués à ces patients.

Résultats: Au total, 19 articles ont été inclus. Les compétences recommandées en matière de connaissances tendent à promouvoir la compréhension des changements neurophysiologiques causés par les substances, ainsi que la connaissance de l'évaluation des comportements « à risque ». Les compétences couramment recommandées concernent le dépistage et la gestion des troubles liés à l'usage de substances. Les compétences recommandées en matière d'attitude comprennent l'identification des préjugés personnels et l'instauration d'une culture centrée sur le patient au sein des équipes de praticiens. Tous les articles s'appuient sur le modèle pathologique de la toxicomanie et ne reconnaissent pas les expériences potentiellement bénéfiques ou non problématiques de la consommation de substances. Pour améliorer les compétences en matière de connaissances, il est conseillé aux programmes de formation médicale d'inclure des spécialistes de la toxicomanie en tant qu'éducateurs et de prévenir la stigmatisation par le biais d'un programme d’études caché.

Conclusion: Pour réduire les expériences de stigmatisation et de marginalisation parmi les patients qui consomment des substances illicites et pour améliorer la qualité des soins, les connaissances, les aptitudes et les attitudes peuvent être enseignées plus efficacement dans les programmes de formation médicale.

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Conflict of interest statement

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