Curriculum

**The Behavioral Health Integrated SUD clinic: The fellow will work collaboratively with an interdisciplinary team (addiction nurse, pain pharmacist, psychologist, recovery coach) to provide addiction care to patients with SUDs referred by PCPs within the clinic. The fellow will supervise and teach residents while being overseen by an Attending.

##PASS (Pain & Addiction Consultation Service): The fellow will serve on a consultation service with a group of interdisciplinary providers, including addiction experts, psychiatrists, psychologists, pain pharmacists, palliative care, complex care manager, and other primary care physicians. The PASS team reviews complex patient cases around pain and addiction and makes recommendations to the referring PCP, taking a biopsychosocial approach to management. This is a great way to learn from others across disciplines!

^^Thursday didactic series (with Brown, BMC, MGH): Fellows will participate in weekly didactics virtually with other Addiction Medicine fellows and their faculty at Brown, MGH, and BMC. One week of the month is dedicated to case presentations when fellows and a supervising faculty member present and discuss a learning-rich case. The other three weeks of the month include faculty presentations around various addiction- related topics. This is a great way to share experiences and knowledge across health systems.

Inpatient Medicine (3 months)

There are 3 months of Inpatient Medicine time:

The Fellow will spend three one-month-long rotations providing addiction consultation to the three Inpatient Medical-Surgical teams, one Psychiatric team, and our Emergency Department providers at our community hospitals, supervised by an Addiction Psychiatrist Attending.

Fellows will take a proactive approach by:

1. Attending rounds with the medical-surgical teams, identifying patients with addiction care needs, and providing consultation to the teams (before an addiction consultation is placed)
2. Attending daily Multidisciplinary Rounds (MDR) that includes social workers, case management, physical therapists, nurses, and physicians to collaboratively assess and provide recommendations around patients on the service with addiction needs.

Fellows will take a reactive approach by:

• Responding to consultations placed by the Medical-Surgery teams, the Psychiatry teams, and the Emergency Department providers

In their consultation role, the Fellow will directly assess the patient, develop a plan/set of recommendations (based on discussion with the supervising Addiction Psychiatrist Attending), share this with the referring provider(s), and continue to follow the patient while he/she is in the hospital and offer daily support/recommendations/mentorship to the referring team as the patient’s care progresses.

The Fellow will continue to attend their ACAAM didactics and Thursday didactic sessions, and GBOT groups during their inpatient months.

Elective opportunities:

• Bridge Clinic- Fellows will see patients with OUD who are not on maintenance Buprenorphine but are transitioning to long-term treatment with OUD. Fellows will evaluate patients, prescribe short-courses of Buprenorphine, and coordinate next steps management (ie long-term Bup maintenance in one of our primary care centers or at Outpatient Addiction Services) or higher level of care needs.
• Chelsea Hub- Fellows will participate in discussions with an interdisciplinary care team of providers (including social workers, case managers, physicians with expertise in addiction, pain, and general medicine, recovery coaches, street navigators, and police officers) that identify “high risk” patients in our community (with multiple “at risk” social determinants of health) and develop a collaborative plan to help mitigate their risk and improve their health.
  More info here: https://chelseapolice.com/chelsea-hub/
• Center for Mindfulness and Compassion- Fellows will participate in group-based therapy that focuses on in-depth teaching around mindfulness among patients struggling with substance use disorders, mental health disorders, chronic pain, and/or desiring coping strategies for managing stress. Fellows will have the opportunity to observe, co-lead groups, and obtain additional training in mindfulness-based techniques, based on their interest levels.
  More info here: https://www.chacmc.org/
• Lynn Community Health Center Outpatient OB rotation- Fellows will have the opportunity to see patients for prenatal and postpartum care who are prescribed Buprenorphine for OUD before, during, and after pregnancy. Fellows will also participate chart review and interdisciplinary team discussions with physician, nurses, peer moms/recovery coaches, and behavioral health clinicians to collaboratively manage their care, especially as it relates to harm reduction, behavioral health supports, medicolegal aspects of care, and interfacing with the Department of Children and Families
• Masters in Medical Education work- Fellows will have the opportunity to participate in coursework and small group discussions with other fellows who are enrolled in a Masters in Medical Education fellowship at our Malden Family Medicine Center site. Course work content from the University of Dundee Masters in Medical Education Program and is facilitated by Dr. Allen Shaughnessy. Topics relate to Teaching and Learning, Curriculum Planning, Principles of Assessment, Education Management and Leadership, and Medical Education Research.
  More info here: https://www.challiance.org/academic/family-medicine-master-teacher-fellowship
• Drug Story Theater with Dr. Joe Shrand: Fellows will join Adolescent Substance Abuse groups that support adolescents struggling with various SUDs by empowering them to lead theatrical productions about drugs with high school and college students.
  More info here: https://www.drugstorytheater.org/
• Additional research work -Fellows with interest in research can receive mentorship from Dr. Schuman-Olivier, Director of Addictions Research at CHA and Director of CHA’s Center for Mindfulness and Compassion, who has particular expertise around young adults with substance use disorders, group-based treatment, and mindfulness. They can also receive mentorship with Dr. Wang, Chair and Chief of Psychiatry at Cambridge Health Alliance and Harvard Medical School to get involved in NIDA’s practice-based research network and an electronic patient registry (Psych PRO) named the Addiction Medicine Network (AMNet) to explore data sets that relate to SUD and treatment efficacy. They can also get involved with Dr. Sokol’s research work that relates to evaluating addiction medical education curriculum and studying the effectiveness of group-based opioid treatment. Dr. Sokol will work with the fellow to identify if they have research interests and, if so, partner the fellow with an appropriate mentor.