Curriculum

Skills set 1

  • Upon completion of the four-week orientation phase for addiction medicine fellows, the fellow should be able to:
  •  Engage a new patient in a professional dialogue about health, chemical dependency and record any interaction into the electronic medical record
  •  Demonstrate a working knowledge of the underlying neurobiology of addiction
  •  Demonstrate a working knowledge of appropriate detoxification strategies
  •  Demonstrate a working knowledge of common psychiatric comorbid conditions
  •  Demonstrate a working knowledge of appropriate pharmacologic agents employed in the treatment of common comorbid psychiatric conditions
  •  Describe the roles of Marworth clinicians to which the fellow is assigned
  •  Set goals for the addiction medicine fellowship with a plan written with the resident fellows’ advisor about skill development
  •  Appreciate the physical, medical, mental, spiritual needs of the hospitalized chemical dependency patient
  •  Identify agencies/referrals/follow-up resources important in the maintenance of continuity of care for the patient
  •  Demonstrate clinical confidence in general medicine with time management strategies
  •  Demonstrate a proficiency in professional communication with peers and allied healthcare professionals
  •  Develop a working knowledge of 12-step self-help programs

Skills set 2
The fellow will be expected to develop an in depth understanding of addictive disease including in depth pathophysiologic concepts of chemical dependency. The fellow will be expected to understand and explain the various toxidromes for various substances, as well as detox regimens and detox dilemmas for common, as well as uncommon drugs of abuse. The fellow will be expected to gain an insight in understanding the various psychological and psychiatric manifestations of chemical dependency and the behaviors fostered by chemical dependency. The fellow will be expected to demonstrate a mastery of the DSM IV nosology regarding chemical abuse and chemical dependency diagnostic criteria.

Skills set 3 - therapy
The fellow will be taught the basics of individual and group therapy and will be expected to gradually assimilate the skills set possessed by the Marworth counseling staff/therapists. The fellow will receive individual and group therapy techniques through seminars and tutorials, as well as individual mentoring. The fellow will be expected to understand practical 12-step dynamics and learn the relevant history and theory of various 12-step self-help movements appropriate to psychiatric and addictive disease. The fellow will be expected to attend Wednesday morning seminars, specifically addressing 12-step theory and practice.

Skills set 4 - opioid agonist therapy
The fellow will be expected to develop a working knowledge of the rationale behind opioid agonist therapy and the various opioid agonists approved for treatment of opioid dependence. The fellow will be expected to apply knowledge related to the indications and contraindications for such therapy. The fellow will be expected to understand various metabolic pathways of opioid agonist agents and also the various drugs, chemicals, food stuffs etc. that either hasten or retard the metabolism of drugs used for opioid agonist therapy. The fellow will develop an understanding of how to select appropriate patients for opioid agonist therapy, as well as retention strategies to keep the patient engaged in opioid agonist therapy.

Skills set 5 - process addictions
The fellow will be expected to demonstrate a working knowledge of various process addictions such as pathological gambling, sexual addiction, compulsive overeating, anorexia, bulimia, and compulsive spending. The fellow will observe and eventually participate in patient therapy sessions at Marworth for these process addictions.

Skills set 6 - outpatient
The fellow will be expected to develop a working knowledge of the modalities employed in the outpatient treatment of chemically dependent individuals, in the interest of continuity of care and developing recognition and skills appropriate to the establishment and maintenance of ongoing care and continuity of such care. The fellow will follow patients longitudinally to see progress over time.

Skills set 7 - psychiatry
The fellow will have a psychiatric rotation at the Geisinger campus in Danville. During this phase of training the fellows activities will be overseen by Steven Paolucci, MD, of the psychiatry department at Geisinger. Specifically, the fellow will be asked to learn about the history, diagnosis, treatment, prevalence, and nosology of the following:

Mood disorder                  Sexual and gender identity disorder           
Personality disorder         Dissociative disorder
Anxiety disorder               Somatoform disorder
Adjustment disorder         Psychotic disorder
Sleep disorder                  Factitious disorder

In addition, the fellow will be expected to develop a practical working knowledge of the DSM IV multiaxial classification employed in the field of psychiatry/chemical dependency.

Skills set 8 - special populations
The fellow will be given a broad exposure to chemical dependency in special populations. The fellow will be expected to develop skills appropriate to deal with populations such as uniformed services (fire/police etc.); healthcare populations (physicians, dentists, optometrists, nurses, pharmacists etc.); and attorneys. Each of these subpopulations of chemically dependent individuals have somewhat unique concerns specific to their profession, which have to be addressed during treatment.

In addition, highly accountable individuals may be subject to additional oversight by employers/licensing authorities/advocacy groups. Given that Marworth treats individuals from a variety of ethnic, racial, and religious backgrounds, the fellow will be expected to understand the special needs of these various subpopulations in chemical dependency treatment. The special needs of female patients with chemical dependency, including unique barriers posed by family responsibilities and social norms, will be addressed.

Skills set 9 - medical/legal issues
The fellow will be taught and expected to assimilate skills necessary in the writing of forensically valid reports for licensure bodies/courts etc. The fellow will be taught the complex interplay that exists between chemical dependency treatment and the criminal justice system/various licensing authorities/industry etc. The fellow will be expected to assimilate knowledge in toxicology and forensic toxicology in particular.

The fellow will learn basics, as well as more obscure aspects of drug and alcohol testing by various modalities. The fellow will be expected to learn the strengths and weaknesses of these various testing modalities. The fellow will be expected to learn the underlying basic scientific principles employed in toxicologic analyses. The fellow will be taught ways of developing accurate evaluations of chemically dependent individuals intending to enter or reenter highly accountable professions. The fellow will be expected to develop a working knowledge of the nuances involving applicable administrative law statutes, civil statutes and criminal statutes.

The fellow will be expected to develop a working knowledge of the activities of professional licensing bodies and health regulatory authorities. The fellow additionally will develop an understanding for the prognosticators for relapse into drug and alcohol usage. The fellow will be expected to learn the ASAM placement criteria for the various levels of chemical dependency treatment.

Skills set 10 - administrative medicine

The fellow will be gradually introduced to the various administrative functions appropriate to a physician. Specific areas will involve exposure to quality insurance activities, critical incident analysis, health insurance and reimbursement concerns, and malpractice issues. The fellow will be expected to gradually assimilate a variety of leadership skills such that he or she will be able to function at a high level administratively in his or her future career.

Skills set 11 - research
The fellow will be expected to be able to develop, with help and consultation of the Marworth/Geisinger faculty, a research project during the fellowship year. It is expected that this research project would produce an article appropriate for submission to a journal for consideration of publication or conference poster session etc.