An agenda for action Mary Jane Ashley, MD, FRCPC; Joan M. Brewster, PhD; Yuen-Ching Chow, MLS; James G. Rankin, MB, FRCPC; Eric Single, PhD; Harvey A. Skinner, PhD
for each school were collected in preparation for the national conference they may need to be augmented by surveys of students, interns, residents and faculty members and of individual curriculum elements and training programs. Such surveys may serve not only to collect information but also to alert respondents to existing deficiencies and to motivate and garner support for change. * If the review indicates inadequacies in professional education in this area it is essential to obtain the commitment of key faculty members for change. Reports documenting specific deficiencies within each school's medical education programs and highlighting the issues and findings discussed at the conference should be made to appropriate personnel, such as the dean, associate deans and department chairpersons, as well as to appropriate committees, such as the undergraduate curriculum committee and postgraduate training committees. * Recognizing that commitment to change must be accompanied by both leadership and coordination of the effort to change, the participants stressed the need for each medical school to ensure these key components. In some schools leadership and coordination responsibilities for undergraduate and postgraduate training might be assigned to faculty members, whereas in others committees or faculty-wide task forces might be established. Whatever structure is chosen it should be formally recognized within the medical school and have sufficient status to both address impediments and implement change. * Faculty development and the building of a multidisciplinary network of people with interest and skills in the alcohol field should be undertaken systematically. This may necessitate appointments of new faculty with specific responsibilities in this area. Special funding, perhaps under Canada's National Drug Strategy, may be necessary. As well, crossCanadian medical schools appointments from community agencies of people 0 Each Canadian medical school should exam- with knowledge and skills in this field may add an ine the current situation regarding professional edu- important dimension to training experiences. * Specific educational objectives for undercation on alcohol problems. Although baseline data
P articipants at the October 1989 national conference "Preventing Alcohol Problems: the Challenge for Medical Education" reached a consensus on several key issues, providing the basis for an ambitious agenda for action. First, there was consensus that the current educational experiences of medical students and residents relating to alcohol problems are inadequate. Canadian medical schools need to examine these deficiencies and find ways to correct them. Second, there was general agreement on the range of material that should be taught; it was recognized that considerable knowledge exists upon which the curriculum can be based. Third, it was clear that appropriate teaching vehicles of several kinds are already in place, although modifications or additions may be required. Fourth, it was agreed that agencies outside the medical school, such as provincial alcohol and other drug agencies and the major national certifying and accrediting bodies, have both significant and specific roles to play in ensuring the adequacy and appropriateness of professional education in this area. The 2-day meeting also produced agreement that the major challenge now facing medical schools and medical educators is "How do we do it?" A number of impediments were identified. There remain confusion concerning concepts and competing views on how best to teach concepts and ensure skills development. Concerns were expressed about how to overcome resistance to change and how to increase interest in teaching about alcohol problems and motivate both faculty members and schools to institute curriculum initiatives. The lack of curriculum time and other resources is another major obstacle. The conference participants tackled these issues in workshops and identified a number of steps.
From the departments of Preventive Medicine and Biostatistics, and Behavioural Science, Division of Community Health, Faculty of Medicine, University of Toronto and the Addiction Research Foundation of Ontario, Toronto
Correspondence to: Dr. Mary Jane Ashley, Chairperson, Department of Preventive Medicine and Biostatistics, McMurrich Building, University of Toronto, Toronto, Ont. MSS IA8 This report has not been peer reviewed.
CAN MED ASSOC J 1990; 143 (10)
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graduate and postgraduate training should be developed, recognizing that postgraduate training should build upon a good undergraduate foundation. Objectives for continuing education and the maintenance of competence also need to be developed in collaboration with major professional organizations. Medical school and continuing education programs should be consistent and well coordinated. * Basic science and community health elements in the undergraduate curriculum may require strengthening. In addition, there is a clear need at both the undergraduate and postgraduate levels of training for a wide range of clinical experiences that are directly relevant to the assessment, prevention and treatment of alcohol-related problems. It may be necessary to establish a multidisciplinary "division of substance abuse" to lead in the development and coordination of appropriate clinical experiences. These experiences should involve community agencies as well as hospitals. It would be appropriate to work with provincial alcohol and drug agencies in developing the range of clinical experiences available to undergraduates, interns and residents. * Each Canadian medical school should establish policies on alcohol use at school functions and by staff and students that are consistent with lowrisk alcohol consumption. In addition, each school should have facilities for preventing, assessing and treating alcohol-related problems among its students and faculty members.
The national level * The Association of Canadian Medical Colleges should organize a half-day symposium to highlight issues on physician education related to prevention, detection and treatment of alcohol problems. * The Medical Council of Canada should establish competency standards outlining the knowledge and skills needed by general physicians to deal with the prevention, detection and treatment of alcoholrelated problems. Questions covering these areas should be included in its examinations. * The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada should determine for each area of specialty and subspecialty training what knowledge and skills in the alcohol field might reasonably be considered basic requirements for certification. They should require all residency training programs to include appropriate components on alcohol problems and require that examinations and competency maintenance programs include testing of knowledge and skills appropriate to the specialties or subspecialties.
1098
CAN M ED ASSOC J 1990; 143 (10)
* The Canadian Medical Society on Alcohol and Other Drugs should establish committees on undergraduate, postgraduate and continuing education. Among other things, the committees should prepare generic training and competency objectives and, in conjunction with appropriate professional organizations, special educational materials that could be used by all training programs. For example, a primer on prevention, detection and treatment of alcohol problems might be developed for undergraduate students, perhaps in connection with one or more of the provincial alcohol and other drug agencies or Canada's National Drug Strategy. In addition, materials specific to the educational needs of all specialties, from family medicine to anesthesia, should be developed in collaboration with the College of Family Physicians of Canada and the various specialty societies. * Funding assistance should be sought under Canada's National Drug Strategy for a second survey of Canadian medical schools and another national conference to assess progress in professional education in this field. Assistance to medical schools and organizations involved in faculty development and in the preparation of specific materials and other teaching and continuing education aids is also needed. As well, assistance in the development of ongoing mechanisms for faculty support and for the sharing of resources and materials and the exchange of experiences among Canadian medical schools should be sought. Clearly, this agenda for action, if implemented, could go a long way in rectifying current deficiencies in medical education in the alcohol field in Canada. Indeed, several medical schools have already begun to address relevant issues. At the University of Toronto, for example, both expanded and new curriculum elements for undergraduates were introduced in September 1990. Specifically, the required second-year seminar course was expanded from 12 to 17 hours, and each student will be required to complete two case study reports before the end of year 3. The case studies may require field work and research by the student, including analysis of the epidemiologic, family, socioeconomic, preventive, clinical and biologic issues related to the cases. Finally, steps are being taken to integrate, by next year, teaching on alcohol and other drug-related problems into existing courses, such as nutrition, clinical neuroscience and pharmacology. One recommended step has been accomplished with the publication of this supplement, making the proceedings of the first national conference on medical education in the alcohol field available to participants and many others.m
for each school were collected in preparation for the national conference they may need to be augmented by surveys of students, interns, residents and faculty members and of individual curriculum elements and training programs. Such surveys may serve not only to collect information but also to alert respondents to existing deficiencies and to motivate and garner support for change. * If the review indicates inadequacies in professional education in this area it is essential to obtain the commitment of key faculty members for change. Reports documenting specific deficiencies within each school's medical education programs and highlighting the issues and findings discussed at the conference should be made to appropriate personnel, such as the dean, associate deans and department chairpersons, as well as to appropriate committees, such as the undergraduate curriculum committee and postgraduate training committees. * Recognizing that commitment to change must be accompanied by both leadership and coordination of the effort to change, the participants stressed the need for each medical school to ensure these key components. In some schools leadership and coordination responsibilities for undergraduate and postgraduate training might be assigned to faculty members, whereas in others committees or faculty-wide task forces might be established. Whatever structure is chosen it should be formally recognized within the medical school and have sufficient status to both address impediments and implement change. * Faculty development and the building of a multidisciplinary network of people with interest and skills in the alcohol field should be undertaken systematically. This may necessitate appointments of new faculty with specific responsibilities in this area. Special funding, perhaps under Canada's National Drug Strategy, may be necessary. As well, crossCanadian medical schools appointments from community agencies of people 0 Each Canadian medical school should exam- with knowledge and skills in this field may add an ine the current situation regarding professional edu- important dimension to training experiences. * Specific educational objectives for undercation on alcohol problems. Although baseline data
P articipants at the October 1989 national conference "Preventing Alcohol Problems: the Challenge for Medical Education" reached a consensus on several key issues, providing the basis for an ambitious agenda for action. First, there was consensus that the current educational experiences of medical students and residents relating to alcohol problems are inadequate. Canadian medical schools need to examine these deficiencies and find ways to correct them. Second, there was general agreement on the range of material that should be taught; it was recognized that considerable knowledge exists upon which the curriculum can be based. Third, it was clear that appropriate teaching vehicles of several kinds are already in place, although modifications or additions may be required. Fourth, it was agreed that agencies outside the medical school, such as provincial alcohol and other drug agencies and the major national certifying and accrediting bodies, have both significant and specific roles to play in ensuring the adequacy and appropriateness of professional education in this area. The 2-day meeting also produced agreement that the major challenge now facing medical schools and medical educators is "How do we do it?" A number of impediments were identified. There remain confusion concerning concepts and competing views on how best to teach concepts and ensure skills development. Concerns were expressed about how to overcome resistance to change and how to increase interest in teaching about alcohol problems and motivate both faculty members and schools to institute curriculum initiatives. The lack of curriculum time and other resources is another major obstacle. The conference participants tackled these issues in workshops and identified a number of steps.
From the departments of Preventive Medicine and Biostatistics, and Behavioural Science, Division of Community Health, Faculty of Medicine, University of Toronto and the Addiction Research Foundation of Ontario, Toronto
Correspondence to: Dr. Mary Jane Ashley, Chairperson, Department of Preventive Medicine and Biostatistics, McMurrich Building, University of Toronto, Toronto, Ont. MSS IA8 This report has not been peer reviewed.
CAN MED ASSOC J 1990; 143 (10)
1097
graduate and postgraduate training should be developed, recognizing that postgraduate training should build upon a good undergraduate foundation. Objectives for continuing education and the maintenance of competence also need to be developed in collaboration with major professional organizations. Medical school and continuing education programs should be consistent and well coordinated. * Basic science and community health elements in the undergraduate curriculum may require strengthening. In addition, there is a clear need at both the undergraduate and postgraduate levels of training for a wide range of clinical experiences that are directly relevant to the assessment, prevention and treatment of alcohol-related problems. It may be necessary to establish a multidisciplinary "division of substance abuse" to lead in the development and coordination of appropriate clinical experiences. These experiences should involve community agencies as well as hospitals. It would be appropriate to work with provincial alcohol and drug agencies in developing the range of clinical experiences available to undergraduates, interns and residents. * Each Canadian medical school should establish policies on alcohol use at school functions and by staff and students that are consistent with lowrisk alcohol consumption. In addition, each school should have facilities for preventing, assessing and treating alcohol-related problems among its students and faculty members.
The national level * The Association of Canadian Medical Colleges should organize a half-day symposium to highlight issues on physician education related to prevention, detection and treatment of alcohol problems. * The Medical Council of Canada should establish competency standards outlining the knowledge and skills needed by general physicians to deal with the prevention, detection and treatment of alcoholrelated problems. Questions covering these areas should be included in its examinations. * The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada should determine for each area of specialty and subspecialty training what knowledge and skills in the alcohol field might reasonably be considered basic requirements for certification. They should require all residency training programs to include appropriate components on alcohol problems and require that examinations and competency maintenance programs include testing of knowledge and skills appropriate to the specialties or subspecialties.
1098
CAN M ED ASSOC J 1990; 143 (10)
* The Canadian Medical Society on Alcohol and Other Drugs should establish committees on undergraduate, postgraduate and continuing education. Among other things, the committees should prepare generic training and competency objectives and, in conjunction with appropriate professional organizations, special educational materials that could be used by all training programs. For example, a primer on prevention, detection and treatment of alcohol problems might be developed for undergraduate students, perhaps in connection with one or more of the provincial alcohol and other drug agencies or Canada's National Drug Strategy. In addition, materials specific to the educational needs of all specialties, from family medicine to anesthesia, should be developed in collaboration with the College of Family Physicians of Canada and the various specialty societies. * Funding assistance should be sought under Canada's National Drug Strategy for a second survey of Canadian medical schools and another national conference to assess progress in professional education in this field. Assistance to medical schools and organizations involved in faculty development and in the preparation of specific materials and other teaching and continuing education aids is also needed. As well, assistance in the development of ongoing mechanisms for faculty support and for the sharing of resources and materials and the exchange of experiences among Canadian medical schools should be sought. Clearly, this agenda for action, if implemented, could go a long way in rectifying current deficiencies in medical education in the alcohol field in Canada. Indeed, several medical schools have already begun to address relevant issues. At the University of Toronto, for example, both expanded and new curriculum elements for undergraduates were introduced in September 1990. Specifically, the required second-year seminar course was expanded from 12 to 17 hours, and each student will be required to complete two case study reports before the end of year 3. The case studies may require field work and research by the student, including analysis of the epidemiologic, family, socioeconomic, preventive, clinical and biologic issues related to the cases. Finally, steps are being taken to integrate, by next year, teaching on alcohol and other drug-related problems into existing courses, such as nutrition, clinical neuroscience and pharmacology. One recommended step has been accomplished with the publication of this supplement, making the proceedings of the first national conference on medical education in the alcohol field available to participants and many others.m
