Research Article: Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors

Date Published: September 20, 2017

Publisher: BioMed Central

Author(s): J. Klimas, W. Small, K. Ahamad, W. Cullen, A. Mead, L. Rieb, E. Wood, R. McNeil.


Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships.

We interviewed trainees and faculty from clinical and research training programmes in addiction medicine at St Paul’s Hospital in Vancouver, Canada (N = 26) about barriers and facilitators to implementation of physician training in addiction medicine. We included medical students, residents, fellows and supervising physicians from a variety of specialities. We analysed interview transcripts thematically by using NVivo software.

We identified six domains relating to training implementation: (1) organisational, (2) structural, (3) teacher, (4) learner, (5) patient and (6) community related variables either hindered or fostered addiction medicine education, depending on context. Human resources, variety of rotations, peer support and mentoring fostered implementation of addiction training. Money, time and space limitations hindered implementation. Participant accounts underscored how faculty and staff facilitated the implementation of both the clinical and the research training.

Implementation of addiction medicine fellowships appears feasible, although a number of barriers exist. Research into factors within the local/practice environment that shape delivery of education to ensure consistent and quality education scale-up is a priority.

Partial Text

Around the globe, harms stemming from substance use represent a significant social, health, and economic burden [1]. The associated mortality and morbidity stemming from substance use (e.g., HIV, hepatitis C) place considerable demands on healthcare systems [2, 3] and represent an urgent public health priority. Advances in addiction science have helped to identify effective treatments for substance use disorders (e.g. opioid agonist therapies, contingency management) [4, 5]. These treatments are often delivered in general medical settings and are associated with significant improvements in health and social outcomes of people with substance use disorders (SUD) [6, 7], including physical and mental health functioning [8].

We conducted qualitative interviews to explore implementation of the St. Paul’s Hospital Goldcorp Addiction Medicine Fellowship and the Canada Addiction Medicine Research Fellowship, as well as barriers and facilitators to the implementation of these fellowship programmes. We selected the qualitative design specifically because of its capacity to elucidate participants’ experiencing during the implementation of these fellowship programmes and thus deepen understandings of contextual influences on their uptake [34, 35].

Our qualitative analysis of interviews explored how structural, personal and organisational barriers shape the implementation of provider training in addiction medicine. Money, time and space limitations inhibited implementation. Human resources, variety of rotations, peer support and mentoring facilitated training. In summary, our results yield further support for using the Damschroder et al.’s Consolidated Framework for Advancing Implementation Science Research (CFIR) [40] to operationalise and analyse barriers and facilitators of implementing addiction medicine fellowships.

Training in addiction medicine is feasible and acceptable for healthcare providers. Learners experience the training favourably. Its implementation faces barriers like any other innovation. We must understand the barriers and facilitators specific to these types of programmes if we want to develop stronger local implementation strategies and quality standards. These findings can inspire set up, scale up and standardisation of addiction medicine programmes in other countries.




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