Welcome to Alaska Addiction Medicine Fellowship

Curriculum

Alaska Addiction Medicine Fellows will have unique opportunities to gain skills in the practice of addiction medicine. They will gain expertise in the prevention, diagnosis, and treatment of substance use disorders and be able to address common medical and psychiatric comorbidities found frequently in individuals who use substances.

As part of the training year, fellows will spend three months working on an inpatient addiction medicine consult service, three months working in a variety of outpatient settings, and three months divided throughout the year in a continuity clinic. Fellows will also have the unique opportunity of working in rural Alaska and are required to spend at least two weeks collaborating and working with a rural community. Importantly, fellows will have ample time to pursue areas of personal interest, including in leadership, administration, quality improvement and rural/underserved medicine.

Boot Camp

The introductory boot camp will take place during the first two weeks of fellowship. It will include an orientation and introduction to Alaska (including restaurant and hiking recommendations!) along with foundational training in addiction medicine, harm reduction, and the management of psychiatric and medical comorbidities in individuals with substance use disorders. During boot camp, we will review the rich cultural milieu of Alaska, and fellows will be given a foundation for ongoing consideration of the unique healthcare delivery challenges and opportunities in their communities.

Boot Camp

The introductory boot camp will take place during the first two weeks of fellowship. It will include an orientation and introduction to Alaska (including restaurant and hiking recommendations!) along with foundational training in addiction medicine, harm reduction, and the management of psychiatric and medical comorbidities in individuals with substance use disorders. During boot camp, we will review the rich cultural milieu of Alaska, and fellows will be given a foundation for ongoing consideration of the unique healthcare delivery challenges and opportunities in their communities.

Inpatient
  • Providence Alaska Medical Center

This rotation is a robust clinical experience set at the Providence Alaska Medicine Center. Fellows lead an interdisciplinary consult team and provide addiction treatment with recommendations for management to inpatient and emergency department providers at PAMC. Fellows will manage acute intoxication, make recommendations to manage behavioral disturbances associated with intoxication or withdrawal, conduct comprehensive assessments, initiate MAT, and make dispositional recommendations.

As part of this rotation, fellows will collaborate with colleagues on the perinatal floor at PAMC. There, fellows will have opportunities to work with new mothers and their babies participating in the Eat, Sleep, Console Program.

  • Southcentral foundation

SCF is an Alaska Native-owned, nonprofit health care organization. They co-manage the Alaska Native Medical Center. Southcentral Foundation employs the innovative NUKA model of care, a relationship-based, customer-owner-centric approach to healthcare delivery. Care is delivered in interdisciplinary teams. One such team, the BURT team, provides care throughout the Alaska Native Medical Center (a secondary and tertiary care referral hospital for the Alaska Region of the Indian Health Service.) Here fellows will be working closely with behavioral health and internal medicine colleagues in supporting patients with substance use disorders. The team will provide telephonic and telemedical consults to rural and critical access hospital providers.

 

 

Outpatient Experiences
  • Breakthrough Clinic

Breakthrough is a substance use treatment clinic at Providence Alaska Medical Center. Breakthrough offers intensive outpatient (IOP), partial hospital program (PHP), and outpatient (OP) services to patients with substance use disorder. Patients of the PHP and IOP clinic are more likely to have insurance than not, come from diverse socioeconomic backgrounds, and have adequate resources (employment, transportation, and social supports.) to attend multiple meetings per week. The Bridge Clinic, part of Breakthrough, is a low-barrier clinic meant to connect individuals to treatment and emphasizes a harm reduction approach. Patients in this clinic tend to have less access to resources, including treatment resources. Many are unstably housed and are treated at a local homeless shelter.

The Bridge Clinic allows for walk-in capacity for better patient access. Fellows will conduct comprehensive evaluations (evaluating SUD and medical and psychiatric comorbidities) for patients enrolled in the PHP, IOP, and OP programs. They will also assist in intakes at the Bridge Clinic. Fellows will have experiences with patient engagement, buprenorphine inductions, harm reduction services, and ambulatory detox. Throughout this experience, fellows will be collaborating with a multi-disciplinary care team, including LCSW, addiction medicine, addiction psychiatry, and APRNs.

  • The Wellness Clinic at PFMC

Providence Family Medicine Center is a patient-centered medical home and the primary site for the Alaska Family Medicine Residency. It is one of the few safety clinics for the Anchorage area and serves a diverse and generally underserved population. The Wellness Clinic within PFMC serves as a continuity experience for the addiction medicine fellows. Fellows will work ½ day each week alongside an interdisciplinary care team in providing trauma-informed care and comprehensive treatment to individuals throughout the lifespan with substance use disorders, including peripartum treatment to women. Fellows will manage a panel of continuity patients at Providence Family Medicine Center throughout their training year. They will spend ½ day per week in this clinic and work collaboratively with LCSW, Behavioral Health, and the CMA staff.

Fellows build their continuity panel and be responsible for diagnosing and treating substance use disorders and screening for co-occurring psychiatric and medical diagnoses. Fellows will serve primary care providers and patient advocates to a subset of their patients when appropriate. Supervision is provided by their colleagues in The Wellness Clinic, including psychiatry, addiction psychiatry, addiction medicine, and family practice doctors.

 

Rural Practice

All fellows will complete the Rural Practice Experience (two weeks minimum) at the beginning of their fellowship year. They will rotate at one among several rural sites that have or are developing MAT services. The Rural Practice Experience will introduce the unique challenges and opportunities of rural addiction treatment.

It will also provide a valuable relationship between the rural community and the fellow. Fellows will maintain contact with the site as a consultant and are encouraged to utilize elective time to spend more time in the community and work on community-based work.

Additional Required Rotations
  • Chronic pain clinic

All fellows will hold a panel of patients at PFMC who have comorbid diagnoses of chronic pain and substance use disorders. As interdisciplinary treatment is the best-known intervention for chronic pain, this rotation aims to work alongside patients towards achieving improved functionality and quality of life.

Fellows will work with an interdisciplinary care team to work towards opioid tapers when appropriate, optimizing pharmacological pain management, and utilizing a wide range of non-pharmacological interventions, including virtual reality and biofeedback. Fellows will also have an opportunity to evaluate patients with chronic pain for comorbid substance use and psychiatric disorders and will have experiences transitioning patients from full-agonists to partial agonists, as appropriate.

  • Trans-Cultural Medicine Rotation

The trans-Cultural Medicine/Community Medicine (TCM) curriculum is a long-revered rotation that was developed by the Department of Behavioral Health and community medicine faculty at AKFMR to connect, align, and understand the community needs of Anchorage and across the state.

TCM includes an introduction to integrative models of care and healing, nutrition, herbal medicine, motivational interviewing techniques, health promotion, disease prevention, and an introduction to Alaska and Alaskan healthcare delivery systems. Educators include community leaders, public health leaders, and colleagues from a variety of specialties in medicine.

Elective Rotations
  • Arctic Recovery Program

Arctic Recovery is an intensive, holistic treatment inpatient program dedicated to individuals 18 and older who need detoxification and rehabilitation for substance use. Fellows will assist with medically supervised detoxes, conduct initial assessments for individuals being admitted to the unit (including screening for comorbid medical and psychiatric pathology), and work with psychology staff to co-lead recovery groups.

  • Rainforest Recovery

Rainforest Recovery Center (RRC), located in Juneau, Alaska, is an inpatient treatment program serving residents from across the state since 1980. It’s a 16-bed, co-ed, free-standing facility utilizing a Dialectical Behavior Therapy informed approach, an evidence-based treatment for substance use and most co-occurring mental health disorders. Staff includes master’s and bachelor’s level counselors, behavior health associates, case managers, activity therapists, nurses, and psychiatrists. Fellows will be

  • The Summit

The Summit provides residential psychiatric treatment for preteen and teen boys aged 11-18 years old. Located outside of Palmer, AK (population 7,000), The Summit is an outdoor behavioral healthcare facility. Addiction medicine fellows will have an opportunity to work with adolescents one-on-one, as part of therapeutic groups, in wilderness settings. They will have opportunities to learn about psychiatric and substance use issues in this population. The Summit utilizes MAT for residents when appropriate.

Scholarly Project

Fellows who are interested in research and quality metrics will be paired with a faculty mentor. Fellows will have protected time for this project throughout the year. Questions for inquiry must be relevant to the addictions field and the population served by PFMC. This project’s desired outcome is a poster presentation at a national addiction conference or acceptance for publication in a peer-reviewed journal and presenting findings to the Alaska Family Medicine Residency.

Teaching Opportunities
  • Participate in addiction-related didactics for medical students and AKFMR residents
  • Provide Screening, Brief Intervention, and Referral to Treatment (SBIRT) training to primary care providers throughout the state.
  • Statewide buprenorphine training
  • Participate in local harm reduction efforts