Proposed elective at medical school focuses on assessment and treatment of substance use disorder in pregnancy
Helping patients with substance use disorder requires treatment from a variety of angles, including psychiatry, medication assistance, and counseling, among other services. When patients are also pregnant, they need additional layers of support to help both the mother and baby on the way.
During her third year of medical school at the Virginia Tech Carilion School of Medicine (VTCSOM), Ayesha Kar learned more about this population during her required psychiatry rotations. Kar knew she wanted to pursue residency in obstetrics and gynecology, so she requested to work with Jen Wells, assistant professor at VTCSOM and a psychiatrist who specializes in working with pregnancy patients, including pregnant women with substance use disorders.
“While working with Dr. Wells, I got to see the Emerald Program first-hand,” Kar said. “The program helps pregnant women fighting addiction by giving them access not only to psychiatric care, but also their obstetric care, counseling, medication assistance, and more within the same clinical practice as Dr. Wells and Dr. Simcox work together in coordination with other medical providers.”
Another VTCSOM student, Meyha Swaroop, was also interested in obstetrics and gynecology residency. “While on my ob/gyn clinical rotation, I noticed a lot of pregnant patients with substance use disorder,” Swaroop said. “I was also researching some away rotations at other health systems and found one with a perinatal substance abuse elective and thought, why don’t we have one here?”
Kar and Swaroop shared their experiences with each other and thought additional clinical training in this area would be beneficial for their future careers as well as for future VTCSOM students. They presented their idea for a two-week elective focused on perinatal substance use disorders to Wells and another faculty member, Kimberly Simcox, who supported it.
“I’m proud that these young women saw an opportunity to add value to the medical school curriculum so that more future doctors can learn about this patient population,” said Simcox, assistant professor at VTCSOM and physician at Carilion Clinic who is trained in both obstetrics and gynecology and addiction medicine. “While complex, we have found that families are more apt to seek help for their addiction at this stage as they look to the future.”
Simcox and Wells established one of Virginia’s first office-based opioid treatment programs specifically for pregnant women at Carilion Clinic, allowing patients to come to one clinic and receive medication for addiction treatment, on-site behavioral health services, obstetric care, and care coordination.
“Patients with substance use disorder can face stigma or judgement, and that feeling is only heightened for pregnant patients,” Wells said. “We want future physicians to recognize this as a chronic disease and treat it just like any other chronic disease. The elective will help future physicians recognize these patients are worthy of help.”
Kar and Swaroop worked with Simcox and Wells to develop a two-week elective that aims to give VTCSOM students an in-depth experience at the clinic. Medical students will go on rounds with physicians like Simcox and Wells, but will also attend group counseling sessions with patients, shadow peer recovery specialists, and observe in the transitional nursery for babies born to patients with substance use disorder.
The proposed elective is being submitted to the Virginia Tech Graduate Curriculum Committee in the fall for approval. Kar and Swaroop did a test run of the elective as a special studies during their final year at VTCSOM, ahead of their graduation in May.
“I hope future students who are interested in a variety of specialities will still take this elective,” Swaroop said. “It merges a lot of disciplines together and is a great example of how clinicians need to work together to best serve patients.”
Kar echoed this sentiment. “This elective is incredibly interdisciplinary. It showcases the value of interprofessional teams with physicians from obstetrics and gynecology, psychiatry, emergency medicine, and pediatrics working on interdisciplinary teams with nurses, counselors, and care coordinators. I believe the elective exemplifies one of the pillars of the school curriculum, [health systems science and interprofessional practice], showcasing integrated care and teamwork.”
Now, Kar and Swaroop are headed onto their residency programs in obstetrics and gynecology. Kar will be at the University of Chicago and Swaroop at Wake Forest University. They are confident what they learned through the development of this proposed elective will impact their careers and help improve their care for patients.
“I hope to be an advocate for all patients, but especially this population, wherever I serve in the future,” Swaroop said. “This training will help me feel more empowered to speak up and help.”