Medical Education in Alcohol and Other Drugs: Curriculum Development for Primary Care.

Significant progress has been made during the past two decades in the development of curriculum materials for medical education in the field of alcohol and other drugs. The development of these materials has followed various trends in medical education, from slide-lecture-style didactic teaching(1) to competency-based instruction and learner-centered and problem-based learning.Over time, curricula in the alcohol and other drug abuse field have reflected a change in medical education, away from the biomedical model and toward the biopsychosocial model of care. This has been prompted by a host of factors, including the emergence of a primary care specialty, a movement toward the family practice model, a greater emphasis on holistic medicine, and a better understanding of the mind-body connection.This article reviews the evolution of alcohol and other drug abuse medical education during the last two decades and presents current and future trends in learning.CURRICULUM DEVELOPMENT DURING THE LAST Two DECADESPublished curricula in the substance abuse field date back to the career teacher project, which began in 1971 and continued through 1983. As an outgrowth of this program, Hostetler (1982) published a methodology guide for teaching about alcohol and other drug abuse (table 1). (Table 1 omitted) This guide identified and described many of the newer methodologies for medical education, including interactive discussion, role play, and patient management problems. It also provided curriculum objectives for teaching.Developing a Structured FormatIn 1984, the Commonwealth Harvard Alcohol Research and Teaching (CHART) program (Barnes et al. 1984) published an important curriculum that included detailed teaching outlines and an annotated bibliography. The teaching material was content oriented, used a seminar format, and provided some basic guidance on teaching clinical techniques and approaches. This new orientation toward clinical techniques and skills was significant because most teaching at that time focused only on content.Expanding the FocusIn 1987, the Society of Teachers of Family Medicine (STFM) published The Family Medicine Curriculum Guide to Substance Abuse (Liepman et al. 1987), which provided extensive reference and background information in a variety of areas, including pharmacology, pathophysiology, detoxification, prevention, and substance abuse in the family. Learning objectives were listed for each of 10 teaching sessions. Teaching “hints” also were provided, including references for support material and ideas about laboratory experiments, films, and case presentations.Biomedical-Based ModelsThese models focus on the physical and medical characteristics of a disorder.In 1981 and 1982, Project CORK (name for the developers), out of Dartmouth College, developed seven instructional units in a series called “The Biomedical Aspect of Alcohol Use.” The units contained more than 40 slides each, with accompanying text, and addressed topics such as pharmacology, alcohol and the liver, and alcohol an pregnancy. Three more units were published in 1989, featuring medical complications, abuse and dependence, and Native American use. A new unit, only on cocaine, is scheduled for release this year (VanWart personal communication, March 1994).Biopsychosocial-Based ModelsIn contrast to biomedical models of disease, biopsychosocial models take into consideration the psychological aspects a disorder as well as social settings, such as the patient’s family, living arrangements, and resources.Learner-Centered Models. In the early 1980’s, the Society of General Internal Medicine’ s task force on medical interviewing (now the American Academy on Physician and Patient) began offering an innovative faculty development course that used a learner-centered model. This model included role play, small group process, personal awareness, and application/feedback techniques.