Background: The opioid epidemic remains a critical public health challenge. In 2022, more than 82,000 opioid-related overdose deaths occurred in the U.S., largely driven by fentanyl (CDC, 2024). Although medications for opioid use disorder (MOUD) are effective and evidence-based, only 21.5% of people with opioid use disorder (OUD) receive them (Dowell et al., 2024). A major factor is the limited number of clinicians trained to deliver addiction care.Advanced practice providers (APPs), including nurse practitioners (NPs) and physician associates (PAs), are well positioned to help close this gap. Hospital Medicine Advanced Practice Fellows (APFs) are nationally certified APPs who complete an optional additional year of inpatient training. However, most APFs lack formal addiction medicine education, leading to variability in preparedness, attitudes, and practice. Embedding OUD-focused training within the APF curriculum offers a scalable and innovative way to improve care and expand the addiction medicine workforce.In 2022, our team implemented a three-hour, lecture-based substance use curriculum for APFs. It is well known in medical education, didactics alone do not meaningfully shift clinical practice. Callister et al. (2024) found similar results among internal medicine residents at our institution, with markedly greater preparedness among trainees with clinical OUD exposure. To address these gaps, we redesigned the curriculum into an experiential rotation embedded within an inpatient Addiction Medicine consult service.
Purpose: This initiative aims to enhance APFs’ competence and confidence in diagnosing and managing OUD by integrating hands-on, patient-centered addiction medicine training with targeted didactic instruction. We are actively evaluating the rotation’s impact on preparedness, prescribing patterns, and implementation of harm-reduction strategies.
Description: The intervention combines focused didactic teaching with clinical immersion. APFs rotate on an inpatient addiction consult service supervised by addiction trained clinicians. Core topics include addiction neurobiology, MOUD prescribing, harm reduction, and stigma reduction. This dual approach—experiential learning supported by foundational knowledge—prepares APFs with practical skills and normalizes OUD treatment within inpatient medicine. Evaluation follows the Kirkpatrick Model by assessing learner reaction, changes in knowledge and confidence, and early practice changes through retrospective pre-post surveys and qualitative interviews.
Conclusions: Preliminary findings show strong feasibility and high learner acceptability. APFs reported significant gains in confidence with substance use history-taking and motivational interviewing. Many described the rotation as transformative, noting that observing nonjudgmental, patient-centered communication reshaped previously moralized views of substance use. Learners valued the experience and often recommended extending it to two weeks. Challenges included variable consult volume and coordinating multiple learners, but the model remains scalable and adaptable.This experiential curriculum offers a replicable framework for developing an APP workforce skilled in addiction medicine, with the potential to expand access to life-saving OUD treatment across a variety of treatment settings.