Vers une éducation médicale axée sur les compétences dans le domaine de la psychiatrie des toxicomanies: une revue systématique

Background: Current curriculum guidelines for addiction training in psychiatry need to be adapted to the competency by design framework to integrate clinical skills in addiction. Objective: We conducted a systematic review to identify curricular and educational interventions to build competency among psychiatry residents and fellows in addiction psychiatry. Methods: We followed the PRISMA guidelines, searching five databases from inception to August 2020 for relevant evaluation-type studies exploring addiction psychiatry competency among psychiatry residents and fellows. We appraised study quality using the Joanna Briggs Institute's risk of bias tool for observational designs. Results: From 1600 records, 17 studies met inclusion criteria. Addiction psychiatry competencies spanned themes involving core knowledge development; attitudinal, communication and leadership skills; screening, assessment, diagnosis; management; and special populations. Examples of effective educational interventions to enhance addiction competency include specific modules for substance use disorders and integrated clinical rotations that simultaneously combine multiple types of skills. Lived experience improved trainee attitudes towards addiction psychiatry. Conclusions: While there is current evidence supporting strategies for developing competency in addiction psychiatry, the lack of studies measuring sustained competence over a longer-term follow-up period and the absence of randomized controlled trials limit the overall strength of evidence in this review. Current psychiatry entrustable professional activities (EPAs) involving addiction only partly overlap with curriculum training guidelines and studies identified in this review. These EPAs need to be better identified for training programs, competence in those EPAs better delineated for residents and preceptors, and evaluations should be done to ensure that adequate competence in addictions is attained and sustained.Contexte : Les directives actuelles du programme d’études pour la formation sur les toxicomanies en psychiatrie doivent être adaptées au cadre de la CPC pour intégrer les compétences cliniques en toxicomanie. Objectif : Nous avons effectué une revue systématique de la littérature afin de repérer les interventions éducatives visant à renforcer les compétences des résidents et des stagiaires post-doctoraux (fellows) en psychiatrie des toxicomanies. Méthodes : Suivant les lignes directrices PRISMA, nous avons effectué une recherche dans cinq bases de données couvrant la période allant de leur création jusqu’à août 2020 pour recenser les études de type évaluation portant sur le développement de compétences en matière de toxicomanie par les résidents et les stagiaires postdoctoraux (fellows) en psychiatrie. Nous avons évalué la qualité des études à l’aide de l’outil d’évaluation du risque de biais de l’Institut Joanna Briggs pour les études observationnelles. Résultats : Dix-sept des 1600 études répertoriées répondaient à nos critères d’inclusion. Les compétences en matière de psychiatrie des toxicomanies couvrent les thèmes de développement des connaissances de base; l’attitude, la communication et les habiletés de leadership; le dépistage, l’évaluation et le diagnostic; la prise en charge; et les populations particulières. Parmi les exemples d’interventions éducatives efficaces visant à améliorer les compétences en matière de toxicomanie figurent les modules portant sur les troubles liés à l’abus de substances et les stages cliniques intégrées qui combinent simultanément plusieurs types d’habiletés. L’expérience concrète vécue semble améliorer l’attitude des apprenants à l’égard de la pratique de la psychiatrie des toxicomanies. Conclusions :  Bien qu’il existe actuellement des preuves à l’appui de stratégies visant à développer les compétences en psychiatrie des toxicomanies, le manque d’étude mesurant le maintien des compétences sur une période de suivi plus longue et l’absence d’essais cliniques randomisés limite la force des preuves de la présente revue.  Les APC qui abordent actuellement la dépendance ne recoupent que partiellement les lignes directrices pour les cursus de formation et le contenu des études recensées dans notre revue. Ces APC doivent être mieux définies pour les programmes d’études et les compétences qu’elles visent doivent être mieux circonscrites pour les résidents et les superviseurs. De surcroît, des évaluations doivent être effectuées pour garantir l’atteinte et le maintien d’une compétence adéquate en matière de toxicomanie

Radioactive Waste Management of Fusion Power Plants

This chapter outlines the attractive environmental features of nuclear fusion, presents an integral scheme to manage fusion activated materials during operation and after decommissioning, compares the volume of fusion and fission waste, covers the recycling, clearance, and disposal concepts and their official radiological limits, and concludes with a section summarizing the newly developed strategy for fusion power plant

Session 2-1-A: A Longitudinal Study of Alberta Electronic Machine Gamblers

Outline of the LLLP What is the LLLP? Launched in 2006 the LLLP is a five age cohort, four data collection wave longitudinal study that examines the incidence and determinants of gambling and problem gambling. The study was guided by four broad research questions: 1.What are the normal patterns of continuity and discontinuity in gambling and problem gambling behavior? 2.What bio-psychological variables and behavior patterns are most predictive of current and future responsible and problem gambling? 3.Are there distinct sub-groupings of gamblers and problem gamblers with different trajectories and predictors? 4.What etiological model of problem gambling is best supported by the longitudinal findings

The Impact of Environmental Factors on Emergency Medicine Resident Career Choice

Objective: To evaluate the impact of environmental factors on emergency medicine (EM) resident career choice. Methods: Program directors of all U.S. EM residencies were surveyed in November 1997. A 22-item questionnaire assessed resources allocated to research, fellowship availability, academic productivity of faculty and residents, and career choices of residency graduates. Results: The response rate was 83%. The program director (mean ± SD) estimates of resident career choice were as follows: 27.8 ± 19.1% pursued academic positions with emphasis on teaching, 5.4 ± 9.8% pursued academic positions with emphasis on research, and 66.8 ± 23.1%, pursued private practice positions. In addition, 5.70 ± 6.13% of the residency graduates were estimated to seek felloship training. Univariate analyses demonstrated that increasing departmental funding for research, having substantial resource availability (defined as having at least two of the following: dedicated laboratory space; support for a laboratory research technician/assistant, a clinical research nurse or study coordinator, a statistician, or an assistant with a PhD degree), a greater number of peer-reviewed publications by residents (r = 0.22; p = 0.08), and a greater number of peer-reviewed publications by faculty (r = 0.26; p = 0.04) positively correlated with the percentage of graduates who pursue academic research careers. Using multiple regression, however, increasing intramural funding and the presence of substantial resource availability were the only variables predictive of resident pursuit of an academic research career. Conclusion: Modification of the EM training environment may influence the career choices of graduates. Specifically, greater commitment of departmental funds and support of resources for research may enhance the likelihood of a trainee's choosing an academic research career.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72940/1/j.1553-2712.1999.tb00387.x.pd

Session 1-3-F: The Alberta Cohorts of Gambling Behaviors An Update

Objectives 1.Experience with recruitment & retention of five cohorts 2.Patterns of continuity & discontinuity in gambling behaviors as well as patterns of recovery from problems? 3. Biopsychosocial variables (risks & resilience) predicting the spectrum of gambling behaviors from responsible to problematic

The critical role of peer reviewers: challenges and future steps

The critical role of peer reviewers in the publishing process is examined. Examples of typical challenges are provided including the relative lack of rewards for this important task. Particular attention is paid to the need to consider diversity of the peer reviewers recruited along with impediments to the selection beyond Areas of Competence, often due to the small available pool. Recommendations for improvement are suggested

Substance Misuse Education for Physicians: Why Older People are Important.

This perspective article focuses on the need for training and education for undergraduate medical students on substance-related disorders, and describes initiatives undertaken in the United Kingdom (UK), Netherlands, United States (US), and Norway to develop the skills, knowledge, and attitudes needed by future doctors to treat patients adequately. In addition, we stress that in postgraduate training, further steps should be taken to develop Addiction Medicine as a specialized and transverse medical domain. Alcohol use disorder is a growing public health problem in the geriatric population, and one that is likely to continue to increase as the baby boomer generation ages. Prescription drug misuse is a major concern, and nicotine misuse remains problematic in a substantial minority. Thus, Addiction Medicine training should address the problems for this specific population. In recent years, several countries have started an Addiction Medicine specialty. Although addiction psychiatry has been a subspecialty in the UK and US for more than 20 years, in most countries it has been a more recent development. Additional courses on addiction should be integrated into the curriculum at both undergraduate and postgraduate levels, as well as form part of the continuous training of other medical specialists. It is recommended that further research and mapping of what is currently taught in medical programs be undertaken, so as to enhance medical education in addiction and improve treatment services

Addiction-related genes in gambling disorders:new insights from parallel human and pre-clinical models

Neurobiological research supports the characterization of disordered gambling (DG) as a behavioral addiction. Recently, an animal model of gambling behavior was developed (rat gambling task, rGT), expanding the available tools to investigate DG neurobiology. We investigated whether rGT performance and associated risk gene expression in the rat's brain could provide cross-translational understanding of the neuromolecular mechanisms of addiction in DG. We genotyped tagSNPs (single-nucleotide polymorphisms) in 38 addiction-related genes in 400 DG and 345 non-DG subjects. Genes with P<0.1 in the human association analyses were selected to be investigated in the animal arm to determine whether their mRNA expression in rats was associated with the rat's performance on the rGT. In humans, DG was significantly associated with tagSNPs in DRD3 (rs167771) and CAMK2D (rs3815072). Our results suggest that age and gender might moderate the association between CAMK2D and DG. Moderation effects could not be investigated due to sample power. In the animal arm, only the association between rGT performance and Drd3 expression remained significant after Bonferroni correction for 59 brain regions. As male rats were used, gender effects could not be investigated. Our results corroborate previous findings reporting the involvement of DRD3 receptor in addictions. To our knowledge, the use of human genetics, pre-clinical models and gene expression as a cross-translation paradigm has not previously been attempted in the field of addictions. The cross-validation of human findings in animal models is crucial for improving the translation of basic research into clinical treatments, which could accelerate neurobiological and pharmacological investigations in addictions

Comorbid Depression Among Untreated Illicit Opiate Users : Results From a Multisite Canadian Study

This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression. Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression. Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05). Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population

Compulsive features in behavioural addictions: the case of pathological gambling

Aims To describe, in the context of DSM-V, how a focus on addiction and compulsion is emerging in the consideration of pathological gambling (PG). Methods A systematic literature review of evidence for the proposed re-classification of PG as an addiction. Results Findings include: (i) phenomenological models of addiction highlighting a motivational shift from impulsivity to compulsivity associated with a protracted withdrawal syndrome and blurring of the ego-syntonic/ego-dystonic dichotomy; (ii) common neurotransmitter (dopamine, serotonin) contributions to PG and substance use disorders (SUDs); (iii) neuroimaging support for shared neurocircuitries between behavioural and substance addictions and differences between obsessivecompulsive disorder (OCD), impulse control disorders (ICDs) and SUDs; (iv) genetic findings more closely related to endophenotypic constructs such as compulsivity and impulsivity than to psychiatric disorders; (v) psychological measures such as harm avoidance identifying a closer association between SUDs and PG than with OCD; (vi) community and pharmacotherapeutic trials data supporting a closer association between SUDs and PG than with OCD. Adapted behavioural therapies, such as exposure therapy, appear applicable to OCD, PG or SUDs, suggesting some commonalities across disorders. Conclusions PG shares more similarities with SUDs than with OCD. Similar to the investigation of impulsivity, studies of compulsivity hold promising insights concerning the course, differential diagnosis and treatment of PG, SUDs, and OCD.LundbeckLundbeckServierServierCristaliaCristaliaRocheRocheSandozSandozMohegan Sun CasinoMohegan Sun CasinoNational Center for Responsible GamingNational Center for Responsible GamingAlberta Gaming Research InstituteAlberta Gaming Research InstituteNIH [R01 DA019039, R01 DA020908, RL1 AA017539, RC1 DA028279, P20 DA027844]NI