Addiction medicine in teaching - a situation report from Switzerland

Addiction medicine training is neglected in the study of human medicine. Within the framework of university teaching, coordinated cooperation between the various disciplines involved would be important. The universities of Great Britain are showing how this can be done.

Problematic and dependent substance use is common in our society: about one third of patients in a GP's practice are affected. However, compared with other chronic diseases, dependency diseases receive little attention. The consequence: Problematic consumption is often only noticed when the long-term consequences are already apparent.

It is therefore central that doctors are better trained in the subject of addiction and are more sensitive to it. The Federal Council's National Strategy on Addiction, for example, stipulates that "health professionals in primary health care are particularly important for the prevention, early detection and treatment of addicts and dependent persons. That is why it is necessary to include addiction aspects in training." (BAG 2015)

**Best practice example at universities in the UK.

In the UK, basic training in drug use and addictive behaviour was introduced at all medical schools in 2014. To this end, a consensus guideline was first developed that outlines how training can be integrated into the curriculum of the bachelor's programme. This was followed by an implementation guideline. The curriculum does justice to the interdisciplinary nature of the area by looking at the clinical, psychological and social implications of problem substance use and defining learning objectives in the areas of primary care, psychiatry and problem-oriented learning. One coordinator has been appointed per faculty, while the International Centre for Drug Policy at St George's University in London is responsible for national coordination.

Current situation in Switzerland

In Switzerland, on the other hand, the situation is still quite different, as shown by an inventory published in 2014 and commissioned by the FOPH:

• All Swiss medical faculties offer training in addiction medicine, but there are large differences in the extent of this training: depending on the faculty, the hours of instruction range between 14 and 52 hours during the 6-year basic training period.
• There were some coordination efforts, but they were neither systematic nor continuous.
• The training was generally based on teachers' own initiatives and interests, without any teaching concept or coordination.
• The courses were offered mainly by addiction doctors and partly by the Institutes for General Practitioner Medicine. This is contrary to the clinical reality in which most patients with problematic substance consumption are treated in primary care.
• The teaching was mostly substance-related, not as a cross-sectional concept integrated into daily medical practice (screening, evaluation, etc.).
• Most faculties proposed a form of evaluation of the material imparted ( multiple choice examination, clinical examination with standardised patients), but there was no clearly defined place for evaluation, not even in the state examination.

In order to reduce the existing treatment gaps for patients with problematic substance use, various measures are necessary:

• In addiction medicine, there is a need for well-coordinated cooperation between all disciplines involved in teaching in order to do justice to the interdisciplinary nature of the discipline. That is why it makes sense to appoint a coordinator at each medical faculty.
• It is also important to create a coordinating office which, similar to the universities in Great Britain, will also coordinate teaching activities at the various universities throughout the country. For this purpose, the affiliation to the National Society for Addiction Medicine (SSAM) is an appropriate option.
• The Society for Addiction Medicine should also develop the necessary learning objectives, monitor their achievement, provide the necessary documentation and train the teaching staff.

Source:
Bruggmann, P., Broers, B. (2019). "Addiction medicine in teaching - a situation report from Switzerland". Addiction medicine 21 (4), 272-276...