Friday, Oct. 20
14:30 – 15:30 (1 hr)
Meeting Room: Port Alberni (4th floor – North Tower)
David Crockford*, MD, FRCPC; Anees Bahji, MD, FRCPC; David Crockford, MD, FRCPC
Supported by the Addiction Psychiatry Section

CanMEDS Roles:

1. Medical Expert
2. Health Advocate
3. Leader

At the end of this session, participants will be able to: 1) Recognize the changes in the updated Canadian Psychiatric Association position papers on substance use disorders; 2) Apply the knowledge, skills, and attitudes required to manage patients with primary and comorbid substance use disorders in psychiatric practice; and 3) Recognize the Entrustable Professional Activities applicable to substance use disorders and be able to evaluate and (or) meet them.

There are patients with substance use disorders (SUDs) in all psychiatric practice settings. Concurrent disorders are the norm rather than the exception. Despite the prevalence and consequences of SUDs and their frequency of presentation for potential intervention, most people with or without a comorbid psychiatric disorder do not receive any treatment. If they do, they often report unmet needs. Psychiatrists are crucial in treating people with concurrent psychiatric symptoms and SUDs. All psychiatrists need the knowledge, skills, and attitudes necessary to identify and help manage primary and comorbid SUD in the patients they see. Clinical practices have rapidly evolved and training requirements have shifted with Competence By Design, necessitating the update of the 2015 Canadian Psychiatric Association position paper on SUDs due to be published this year. Dr. Bahji will review Part 1, describing the knowledge, skills, and attitudes of current practising psychiatrists necessary to competently assess and manage people with SUDs in their psychiatric practice. Dr. Crockford will review Part 2, identifying psychiatry residency training program requirements for SUD training, Entrustable Professional Activities (EPAs) applicable to SUD, how staff should evaluate the EPAs, and how residents can meet each EPA’s requirements.

W18a – Training in Substance Use Disorders, Part 1: Overview of Clinical Practice Recommendations
Anees Bahji, MD, FRCPC

At the end of this session, participants will be able to: 1) Recognize the updated Part 1 of the CPA position paper on substance use disorders (SUDs), addressing an overview of clinical practice recommendations; 2) Review key clinical concepts, knowledge, and skills in addiction psychiatry for clinicians currently in psychiatric practice; and 3) Review treatment modalities for SUDs, including psychosocial and pharmacological treatments.

Substance use disorders (SUD) are common in the Canadian population and psychiatric practice and can predispose people to other psychiatric disorders. Clinical guidelines have been published for treated SUDs by several organizations. Still, there are new developments in treating SUDs and approaches to managing patients with concurrent disorders that practising psychiatrists need to know. Since many psychiatrists received minimal training in addictions during residency, it can be difficult to upgrade when foundational knowledge is rudimentary. Through the Canadian Psychiatric Association (CPA) and the Royal College of Physicians and Surgeons of Canada, the psychiatric profession must ensure that practising psychiatrists have the knowledge, skills, and attitudes to manage SUDs effectively. In this session, attendants will become familiar with the updated Part 1 of the CPA position statement on training in SUDs, which provides an overview of clinical practice recommendations. Specifically, Dr. Bahji will review the key clinical concepts, knowledge, and skills in addiction psychiatry, including attitudinal skills; screening, assessment, and diagnosis; and how this differs by clinical settings, including emergency department, inpatient psychiatric units, outpatient/community, consultation-liaison, and specialized addiction centres. Finally, Dr. Bahji will review treatment modalities for SUDs, including psychosocial/behavioural treatments; pharmacological treatment of alcohol, opioid, and tobacco use disorders; other SUDs; and concurrent disorders.

References:

1. Bahji A, Crockford D, Schutz C, et al. Training in substance use disorders, part 1: overview of clinical practice recommendations. Can J Psychiatry 2023. In press.
2. Fleury G, Milin R, Crockford D, et al. Training in substance-related and addictive disorders, part 1: overview of clinical practice and general recommendations. Can J Psychiatry 2015;60(12):1–9.

W18b – Training in Substance Use Disorders, Part 2: Updated Curriculum Guidelines and Entrustable PAs
David Crockford, MD, FRCPC

At the end of this session, participants will be able to: 1) Recognize the updated Part 2 of the CPA position paper on substance use disorders (SUDs) addressing training requirements and entrustable professional activities (EPAs); 2) Identify the EPAs applicable to SUDs for psychiatric training; and 3) Evaluate and (or) meet the EPAs applicable to SUDs for psychiatric training.

Training in the management of substance use disorders (SUD) in psychiatry remains disproportionately limited in psychiatric residency training programs, compared to other major psychiatric disorders, despite SUDs becoming increasingly common in all psychiatric care settings. Given the high prevalence of SUDs in psychiatric practice and unmet treatment needs for people with comorbid psychiatric and SUDs, it is imperative that all psychiatry residents develop the requisite knowledge, skills, and attitudes for managing people with SUDs. In 2020, Canadian psychiatry training programs began the transition from a traditional time-based training model to Competence by Design (CBD), with promotion in the program linked to successfully completing Entrustable Professional Activities (EPAs). The publication of the new psychiatry competencies and training experiences ended the requirement of the one-month rotation in SUDs; instead, the EPAs for SUDs were embedded within multiple EPAs, occurring during the Foundations of Discipline and Core of Discipline stages of training. Dr. Crockford will review the clinical content based on the Royal College of Physicians and Surgeons of Canada psychiatry competencies, delineating areas of knowledge in SUDs that residents need to acquire, means for training programs to develop a skill-based interactive curriculum, EPAs applicable to SUDs, how staff should evaluate the EPAs, and how residents can meet each EPA’s requirements.

References:

1. Crockford D, Bahji A, Schutz C, Brasch J, Buckley L, Danilewitz M, Dubreucq S, Mak M, George TP. Training in Substance Use Disorders, Part 2: Updated Curriculum Guidelines. CPA Position Paper, Can J Psychiatry 2023, in press.
2. Crockford D, Fleury G, Milin R, et al. Training in Substance-Related and Addictive Disorders, Part 2: Updated Curriculum Guidelines. CPA Position Paper, Can J Psychiatry 2015;60(12):1-12.