Creating Change Agents: An Interdisciplinary Substance Abuse Education
Marianne T. Marcus, EdD, University of Texas Health Science Center at Houston and Richard L. Brown, MD, University of Wisconsin-Madison.
Purpose: The purpose of the Project MAINSTREAM fellowship was to develop a model for interdisciplinary health professional faculty teams to work together to bring about sustainable substance abuse curricular enhancements in their respective disciplines. This study describes the extent to which the fellows achieved this educational objective. Methods: Fellows were required to apply in teams of three faculty members, each representative of a different health discipline. Fellowship teams received training at intensive two-day meetings, the three-day annual AMERSA National Conferences, and at regional meetings. Training included substance abuse knowledge and skills and aspects of pedagogy such as teaching strategies and evaluation. A mentor with substance abuse expertise was assigned to each team. Other resources included a comprehensive syllabus and $2000 to support project work. The main vehicle for curricular change was a required collaborative education project to develop trainees' core competencies in substance abuse prevention services. Data on curriculum change were collected as part of a 27 page confidential written evaluation survey. An additional telephone survey was administered when all of the fellows had completed their programs. Results: Thirty-nine faculty members from 20 institutions completed the two-year, part-time fellowship program. Fellows used a variety of approaches to implement 123 curricula. Lecture and discussion were the most common strategies used and screening techniques the most common content delivered. A total of 66,995 hours of substance use content was delivered by the 39 fellows. Each trainee received an average of 6.58 hours that would not have occurred without this project. Ninety percent of these training hours were designed as part of required courses in their institutions, increasing the likelihood that the content will be sustained in the future. Implications for Policy or Practice: Project MAINSTREAM was designed to promote substance abuse delivery in generalist health care settings, a major deficit in our current system. An important emphasis of this multi-faceted project was to assure that future health professionals are equipped with the evidenced-based competencies necessary to deliver these services. To achieve this goal it was necessary to create change agents among current faculty, individuals who would become champions for sustained curriculum revision. Initial reports of numbers of course offerings and trainees reached provide evidence of the impact of the project. If future studies support the durability of the changes achieved, Project MAINSTREAM could be considered an important model for overcoming other deficits in health care services that require enhanced education to create core competencies. New public health problems such as bioterrorism and emerging epidemics could be addressed in a similar manner, train faculty to revise the curriculum to include the critical competencies thus assuring a well-prepared workforce.