Training Family Medicine Clerkship Students in Screening, Brief Intervention, and Referral to Treatment for Substance Use Disorders: A CERA Study

BACKGROUND AND OBJECTIVES: Federal agencies and professional societies have promoted adoption of screening, brief intervention, and referral to treatment (SBIRT) for substance use disorders in primary care. As it is unknown whether instruction in SBIRT occurs in medical schools, this study examines SBIRT training in family medicine clerkships of allopathic medical schools in the United States and Canada. METHODS: Questions assessing familiarity with SBIRT, inclusion of SBIRT in curricula, and teaching on substance use were included in the 2014 CERA Family Medicine Clerkship Director Survey. SBIRT was defined as "a public health approach to the delivery of early intervention and treatment services for people with substance use disorders and those at risk of developing substance use disorders." Responses were summarized with univariate and bivariate descriptive statistics. RESULTS: Surveys were completed by 124 of 137 (91% response rate) family medicine clerkship directors. Forty-six percent reported being familiar with SBIRT, and only 8% teach SBIRT to all their students. Approximately 44% of clerkship directors responded that only the psychiatry department covered the topic of substance use disorders, while 36% of directors indicated family medicine in combination with other departments covered such topics. Lack of curricular time was cited as the primary barrier to addressing substance use by 65% of the respondents, while 43% also cited lack of faculty expertise. CONCLUSIONS: The findings suggest that few family medicine clerkships are modeling or training medical students in the use of SBIRT in order to identify, reduce, and treat problematic use of alcohol and other substances.