Primary Addiction Training for Hospice and Palliative Medicine Fellows: A National Survey of Program Directors

Outcomes 1. Describe the current landscape of learning opportunities on substance use, misuse, and use disorder integrated into Hospice and Palliative medicine fellowship training across the country.2. Examine high priority gaps in educational resources that support teaching relevant primary addiction medicine knowledge and skills to specialty Hospice and Palliative medicine fellows. Key Message Primary addiction medicine skills training is critical for the modern practice of hospice and palliative medicine (HPM). This national survey of HPM program directors reveals wide variation, gaps in training opportunities, and limited resources. Results highlight the need to support the design and wide dissemination of educational curricula on critical and relevant primary AM skills for HPM trainees. Introduction Patients with opioid use disorder (OUD) have high rates of serious illness, co-existing pain, and risk for substandard medical care. Over half of HPM specialists report regular management of opioid misuse/OUD, yet the overwhelming majority do not feel comfortable or well-trained in managing OUD or concurrent pain. Teaching core primary addiction medicine (AM) skills has been shown to increase fellows’ self-reported competency and satisfaction in caring for patients with addiction. ACGME requires fellowship training on ‘recognizing the signs of addiction,’ however there is little guidance on what this entails. Thus, little is known about the national variation in primary AM education for HPM specialty fellows, and which topics would be prioritized for curricular development if resources were available. Objectives To describe current training opportunities, educational implementation challenges, and curricular gaps in core primary AM skills for HPM fellows nationwide. Methods Anonymous Qualtrics surveys were sent to program directors (PD) at all 163 HPM ACGME accredited fellowships. Results 84 (52%) of HPM PDs responded, representing adult/ pediatric physician (83%), nurse practitioner (8%), social work (4%), and pharmacy (3%) trainees. A mean of 3.6 hours was spent on formal education around OUD and misuse. 39% felt their trainees were ‘not so confident’ or ‘not at all confident’ in caring for patients with OUD. Three priority learning objectives for curricular development include: identifying appropriate patients and plans for buprenorphine (17%), managing pain and OUD (16%), and managing prescription medication misuse (9%). The most common challenges include lack of faculty with addiction training (22%), limited faculty with experience using buprenorphine (20%), and lack of available curricula (19%) or faculty to deliver training (19%). Conclusions Wide gaps in training highlight the need to support the design and dissemination of educational curricula on critical and relevant primary AM skills for HPM trainees. Keywords Workforce / Career Development / Scientific Research