Embracing Social Media in Academic Medicine

[The first in a three-part series exploring the use of social media by medical professionals seeking greater academic impact.]

By Kristina Dzara, Ph.D., M.M.Sc.
July 12, 2017

The choice to engage with—or even embrace—social media is yours. Those who don’t may find that in the near future that it will be a challenge to share information, grow professional networks, and stay on top of relevant literature.

Sample Altmetrics Score Depiction
Sample Altmetrics score

Academic medicine is harnessing the power of social media for networking, professional development, education, and dissemination of information.1 An ever-growing cadre of individuals and organizations in healthcare have Twitter, Facebook, and Instagram accounts, e-newsletters, podcasts and blogs.1-3 In fact, Twitter is the social media of choice for academic medicine.3,4 Although there is debate about professionalism and social media—as well as a concern that we spend too much time using social media without concrete evidence of educational and academic worth—social media has a strong foothold in our community of practice.3,5-7

The journal article remains the gold standard for dissemination of scholarly work. Yet, the publication process continues to be disrupted by new models of publication—prime examples are open access e-journals such as MedEdPortal and MedEdWorld. These advances are symbiotic with social media, especially Twitter. A number of journals have started including author Twitter handles in their publications and encourage tweets about new articles. Several offer a link providing free access to a limited number of readers, to be used for social media dissemination.

Blogs are multipurpose and can allow for the rapid spread of information.2 Blogs are colloquially written, and authors can write without the time and resources required to construct a full-length research article. Blogging can also help authors explore areas of early professional interest to increase familiarity with the topic. Certainly, the content and quality of blogs vary, but studies are being conducted to offer objective, scientific evidence of quality.8 Moreover, some journals, such as Health Affairs and the British Medical Journal, have blogs and encourage participation.

Although traditional journal-based citation metrics such as the impact factor and h-index  remain the standard, researchers are embracing new alternative metrics including usage (views, downloads, clicks), mentions (blog, media coverage), citations (Scopus, Web of Science, Pubmed), and number of tweets and Facebook likes for their own articles to supplement journal impact factors.4,9,10 These and other alternatives, such as the Altmetric Attention Score, are becoming more commonly used in academic medicine.4,9,10 Altmetrics are social-media based, have both a numeric score and a visual depiction of reach, and can objectively measure the impact of articles, webinars, educational videos, and blogs in real time.4,9,10 Although there is some concern that Altmetric scores can be gamed or manipulated, overall they can be utilized as an additional measure which can be triangulated with traditional metrics to gain a more comprehensive portrait of impact.4,5,9,10

The choice to engage with—or even embrace—social media is yours. Those who don’t may find that in the near future that it will be a challenge to share information, grow professional networks, and stay on top of relevant literature. We know that our millennial learners and colleagues have embraced social media, and that the technology which allows us to engage worldwide is expanding by the day. If information truly is power, social media offers us more than we could have ever previously imagined.


Already using Twitter? Be sure to follow HMS Global Academy @AcademyHMS.


Kristina Dzara_100x125

Kristina Dzara, Ph.D., M.M.Sc. (@KristinaDzara) is a medical educator and researcher with 5+ years of experience in academic medicine. A recent graduate of the Harvard Medical School Master’s in Medical Education program and a Harvard Macy scholar, Kristina’s areas of professional interest include evaluation and assessment, faculty development, and social media in medical education.

References:

  1. Chisolm MS. Social Media in Medicine: The Volume that Twitter Built. Int Rev Psychiatry. 2015; 27(2):83-84.
  2. Khadpe J, Joshi N. How to Utilize Blogs for Residency Education. Journal of Graduate Medical Education. 2016; 8(4):605-606.
  3. Gallo T. Twitter is Trending in Academic Medicine. 2017. https://goo.gl/grJz1w.
  4. Chisholm MS. Altmetrics for Medical Educators. Acad Psychiatry. 2016.
  5. Wise J. Promoting Research on Social Media Has Little Impact. BMJ. 2014; 349:g7016.
  6. Choo EK, Ranney ML, Chan TM, et al. Twitter as a Tool for Communication and Knowledge Exchange in Academic Medicine: A Guide for Skeptics and Novices. Med Teach. 2015; 37(5):411-416.
  7. Kesselheim JC, Batra M, Belmonte F, Boland KA, McGregor RS. New Professionalism Challenge in Medical Training: An Exploration of Social Networking. J Grad Med Educ. 2014; 6(1):100-105.
  8. Chan T, Trueger NS, Roland D, Thoma B. Evidence-based Medicine in the Era of Social Media: Scholarly Engagement Through Participation and Online Interaction. Cjem. 2017:1-6.
  9. Handel MJ. Article-level Metrics-It’s Not Just About Citations. J Exp Biol. 2014; 217(Pt 24):4271-4272.
  10. Cress PE. Using Altmetrics and Social Media to Supplement Impact Factor: Maximizing Your Article’s Academic and Societal Impact. Aesthet Surg J. 2014; 34(7):1123-1126.

 

Supervised Injection Sites: A Boston Doctor Speaks Out

(photo: Massachusetts General Hospital, Boston. Ma.)

June 29, 2017

Dr. Sarah Wakeman speaks about the process that informed her opinion on supervised injection facilities:

Opening supervised injection sites to address the opioid crisis in America is a controversial subject. Dr. Sarah Wakeman, the medical director of Massachusetts General Hospital’s Substance Use Disorder Initiative and Addiction Consult Team, has something to say about it.

As a staunch supporter of evidence-based treatment for patients with substance use disorders, you may hear her expert opinion by clicking on the brief video below…

Do you have an opinion to share as well, or questions for Dr. Wakeman? Use the comment section to start a conversation about supervised injection sites.

Read more posts by Dr. Sarah Wakeman:

Waiting for Addiction Treatment: A Deadly Proposition
Summary: Dr. Wakeman discusses the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.


Harvard Medical School is offering free online accredited CE/CME courses in identifying and treating opioid use disorder for physicians, physician assistants, nurse practitioners, nurses, and social workers. Each course contains additional resources to assist health care providers in treating patients with opioid use disorder. Select a course below to learn more and enroll:

Understanding Addiction

Identification, Counseling, and Treatment of OUD

Collaborative Care Approaches for Management of OUD


Dr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School and course director for Understanding Addiction. Twitter

(photo credit:https://commons.wikimedia.org/wiki/File:MassGeneralHospital.jpg)

Effective Clinical Teaching on Rounds: Microskills Worth Practicing

By Martina M. McGrath, MD
May 24, 2017

On-the-job clinical teaching of students and physicians in training is a central aspect of medical education. For trainees, skilled teachers can become mentors and role models; often inspiring them choose a particular specialty and also having a formative influence on their clinical practice. For the teacher, it can be one of the most rewarding and enjoyable aspects of their practice. However, due to the frenetic nature of the clinical work environment with many competing demands, clinical teaching is frequently rushed, disjointed, and interrupted. Most of us would like to be better teachers, but how do we best make use of our limited time to impart some clinical pearls and support our trainees in their professional development?

Using a structured approach to teaching during a clinical encounter can maximize the learning opportunity without placing excessive burden on busy clinical teachers. Many approaches have been proposed but one of the more appealing ones, due to its simplicity, is The One minute preceptor: Microskills model of clinical teaching as proposed by Neher.1 This model distills a large body of learning theory into a manageable, five-step approach to a clinical teaching encounter:

Step 1: Get a commitment:  “What do you think is going on?”
Encouraging the trainee to commit to a diagnosis/plan of evaluation helps them to synthesize their thoughts and focus on the question at hand. Committing also helps them recognize their own learning needs, which encourages self-directed learning.

Step 2: Probe for supporting evidence: “Why do you think that?”
At this point, the temptation on the part of the teacher is to simply provide the correct answer or begin an explanation. However, encouraging active participation by the trainee will give them a much better learning experience. The aim is to encourage the trainee to reflect and work through the problem. This will in turn allow the teacher to provide more directed instruction related to the trainee’s level of knowledge and expertise.

Step 3: Teach general rules
Teaching is frequently more transferable and applicable when provided as general rules.1 An approach such as ‘when this happens, do this…’ can be very helpful. Having encouraged the trainee to work though the problem will allow the teacher to appropriately target this information to the trainee’s level.

Step 4: Reinforce what was done correctly
Feedback, which is specific to the task at hand and delivered in a timely manner, is an important way to reinforce learning. As many trainees are still developing their professional identities, reinforcing positive professional attributes also encourages their personal development.

Step 5: Correct Mistakes
Many teachers struggle to give negative feedback. Encouraging the trainee to reflect on his or her own performance is a nonconfrontational way to open the discussion of any errors that were made. Similarly, criticism should be of the approach rather than the individual (‘this aspect of the case could have been better dealt with by xx…’ as opposed to ‘you handled this case badly’).

Informal, opportunistic teaching is a central component of medical education. Applying an outline structure can improve the efficiency and effectiveness of a given teaching opportunity. By encouraging a discussion rather than a lecture, this type of approach can give educational benefit, and more enjoyment, for both the learner and the instructor.

References:

  1. Neher, et al. A Five-step “Microskills” Model of Clinical Teaching. Journal of the American Board of Family Practice. 5:419-424, 1992.

Developing Essential Skills in Clinical Research

This 1.25 credit CME course is designed for medical doctors who desire to pursue a career in clinical research in the US. The course will help you develop knowledge on key elements required to be an effective clinical investigator, understand what it takes to become a clinician-investigator, understand the importance of mentorship in your career trajectory, and develop specific skills in writing proposals, crafting scientific papers, and making effective presentations. Click on the title link to learn more.


Headshot of Dr. McGrathDr. Martina McGrath is an Instructor in Medicine at Harvard Medical School, and a member of the Renal Division, Department of Medicine, at Brigham and Women’s Hospital, both in Boston. Dr. McGrath is the Medical Editor for the Trends in Medicine blog.

Waiting for Addiction Treatment: A Deadly Proposition

By Sarah E. Wakeman, MD, FASAM
May 3, 2017

In a 2016 research letter to the New England Journal of Medicine, Dr. Sigmon and colleagues describe the results of a randomized pilot study of interim buprenorphine dosing for individuals with opioid use disorder.1 Interim buprenorphine dosing means offering medication alone to people on a waiting list to get into a buprenorphine treatment program, which generally involves medication plus counseling. This study randomized patients to either staying on the waiting list or getting just the buprenorphine administered at home by an automated and locked pill dispenser. The results were compelling. All of the participants who remained on the waiting list continued to use illicit opioids. In contrast, the majority of those treated with buprenorphine stopped using opioids completely, with abstinence rates of 88%, 84%, and 68% at 4, 8, and 12 weeks (P<0.001 for all comparisons).

Given the requirement to offer counseling with buprenorphine treatment and the emphasis placed on psychosocial interventions in the treatment of addiction, these results may seem surprising. It is important to highlight that Sigmon’s findings build on a robust base of evidence which calls into question counseling requirements. It turns out that effective counseling for people getting buprenorphine doesn't have to come from a therapist; another trial found that medication management visits with the prescribing physician providing counseling in the office were as effective as additional psychosocial interventions.2 Previous research has also shown that interim methadone treatment significantly reduces drug use and improves clinical outcomes.3 In fact, no rigorous study has ever been able to show that the addition of psychosocial services to opioid agonist therapy alone improves outcomes in the treatment of opioid use disorder.4,5 So why then do we continue to limit access to these lifesaving medication treatments? In a thought-provoking piece about the history of addiction treatment in the US, Dr. Walter Ling, a renowned physician-scientist, reflects on our approach to limiting access to methadone and buprenorphine.6

From the very beginning our policy has been: Addicts are sick, they need help; but they also sin and must suffer a little. So we built treatment programs and put up barriers making it difficult for patients to get into treatment. The justification was to prove their motivation... We as a society basically … think addicts should just get off drugs and by strenuously hauling up on their own bootstraps and should stay off no matter what. Policymakers and some clinicians continue to promote detoxification as treatment,even though detoxification does nothing to help people stay off drugs.

If today is like any other day in the US, 144 people will die in the next 24 hours from a lethal overdose including 91 from an opioid overdose.7 The World Health Organization estimates that treatment with methadone or buprenorphine reduces an individual’s risk of overdose death by nearly 90%.8 And yet, less than half of the 2.2 million Americans with opioid use disorder are receiving treatment, with waiting lists for medications for addiction treatment the norm rather than the exception. In Vermont alone there are 500 people on a waiting list to access buprenorphine.9 Waiting lists are not merely an inconvenience, they are quite literally deadly. A study of people on a waiting list for methadone treatment found the risk of death to be ten-fold higher than in those on the medication.10 A recent news article made personal the devastating impact waiting lists can have by sharing the story of Taylor Wilson, a young woman who waited 41 days to get buprenorphine treatment and died from an overdose hours before the clinic called to finally offer her an appointment.

[Are Supervised Injection Facilities an Answer to Saving Lives in the Opioid Epidemic?]

Voltaire’s famous quote, “Don’t let perfect be the enemy of the good,” is frequently referenced in medicine as a reminder to not let lofty ambitions prevent important progress and innovation. Yes, opioid addiction is a complex disease ideally treated with comprehensive care. Yet the evidence is clear that medications alone can be highly effective. Deaths due to opioid use and addiction now kill more Americans than car accidents or firearms. Why limit access to these medications which can substantially reduce opioid use and overdose death? As Ling describes, stigma and belief have historically influenced treatment models for addiction to a far greater degree than science. In the midst of an epidemic we can no longer afford this unscientific approach. We have the tools to end the crisis, so the question now becomes whether we have the will.


Opioid Use Disorder Education Program

Learn more about the latest medical and psychosocial treatment options, best practices, and legal guidelines for identifying and treating OUD in a free online program produced by Harvard Medical School.

The Opioid Use Disorder Education Program (OUDEP) is comprised of three CE/CME courses produced by Harvard Medical School with scientific contributions from The National Institute on Drug Abuse (NIDA). These courses are intended for nurses, nurse practitioners, physician assistants, physicians, and other health care providers collaborating to treat patients with substance use disorders.


References:

1. Sigmon SC, Ochalek TA, Meyer AC et al. Interim Buprenorphine vs. Waiting List for Opioid Dependence. N Engl J Med. 2016 Dec 22;375(25):2504-2505.

2. Fiellin DA, Barry DT, Sullivan LE, et al. A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med. 2013 Jan;126(1):74.e11-7.

3. Schwartz RP, Kelly SM, O’Grady KE, Gandhi D, Jaffe JH. Randomized trial of standard methadone treatment compared to initiating methadone without counseling: 12-month findings. Addiction. 2012 May;107(5):943-52.

4. Schwartz RP. When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids: A Comment on Dugosh et al. J Addict Med. 2016 Jul-Aug;10(4):283-5

5.  Ling W, Hillhouse M, Ang A, Jenkins J, Fahey J. Comparison of behavioral treatment conditions in buprenorphine maintenance. Addiction. 2013 Oct;108(10):1788-98.

6. Ling, W. A Perspective on Opioid Pharmacotherapy: Where We Are and How We Got Here. J Neuroimmune Pharmacol (2016) 11:394–400

7. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452.

8. United Nations Office on Drugs and Crime/World Health organization (UNODC/WHO). Opioid Overdose: preventing and reducing opioid overdose mortality. 2013. Retrieved from https://www.unodc.org/docs/treatment/overdose.pdf Accessed on April 13, 2017.

9. http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/02/11/waiting-lists-grow-for-medicine-to-fight-opioid-addiction

10. Peles ESchreiber SAdelson M. Opiate-dependent patients on a waiting list for methadone maintenance treatment are at high risk for mortality until treatment entry. J Addict Med. 2013 May-Jun;7(3):177-82.

Sarah Wakeman_100x150Dr. Sarah Wakeman is medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital (MGH), co-chair of the Mass General Opioid Task Force, and clinical lead for the Partners Healthcare Substance Use Disorder Initiative. Dr. Wakeman is also an assistant professor in medicine at Harvard Medical School. Twitter

Kissing Bugs and Heart Disease: Identifying Chagas’ Patients

By Ajay K. Singh, MBBS, FRCP, MBA
April 18, 2017

In managing patients with heart disease, most of us do not think about the possibility of Chagas’ disease (CD). CD is estimated to affect 5 million people worldwide and according to CDC seroprevalence estimates, affects about 300,000 people. CD accounts for nearly five times as many disability-adjusted life years lost as malaria. CD is estimated to cause approximately 7000 deaths annually.

A recent study by Sheba and colleagues of a convenience cohort of 4,755 Latin American-born residents of Los Angeles County reports that 1.24% tested positive for CD.

Bern and colleagues provide a comprehensive review of CD.  The disease was discovered in 1909 and is named after the Brazilian physician Carlos Chagas; Chagas’ is also known as American trypanosomiasis.

The protozoan parasite Trypanosoma cruzi (T. cruzi) is the cause of CD. It is thought that immigrants from Latin American countries acquire the trypanosomal infection from transmission by insect vectors (carried in the gastrointestinal tract of triatomine bugs) found in impoverished rural areas of Latin America. Triatomine bugs are also known as “kissing bugs”  because they bite while a person is asleep around the thin skin of the face around the eyes and mouth. T. cruzi transmission occurs when infected bug feces contaminate the bite site or intact mucous membranes, but it can also be transmitted through transfusion, via a transplanted organ, and congenitally.

CD has both an acute and chronic phase of disease. The acute phase is either asymptomatic, or associated with fever in a subset of patients with a chagoma. These chagomas contain the parasite and present with swelling and inflammation at the site of inoculation. Acute CD can rarely also present with more severe myocardial and central nervous manifestations.

[Review HMS lectures on Current Trends in Cardiology.]

The chronic phase manifests either with cardiac or digestive disease. Cardiac CD is a cardiomyopathy characterized by a chronic inflammatory process involving all chambers, conduction system damage, and a progressive dilated cardiomyopathy with congestive heart failure. Patients may also present with thromboembolism due to thrombus formation in the dilated left ventricle or aneurysm. Gastrointestinal CD disease is less common than cardiac CD and geographically distinct (mostly detected in Argentina, Bolivia, Chile, Paraguay, Southern Peru, Uruguay, and parts of Brazil rather than northern Latin America, Central America, or Mexico) and usually affects the esophagus and/or colon, resulting from damage to intramural neurons.

So what are the implications from the Sheba study? Sheba and colleagues make several recommendations. First, the prevalence of CD in the US has been underestimated and more awareness is necessary. Indeed, the US Center of Disease Control (CDC) considers CD, along with as cysticercosis, toxocariasis, toxoplasmosis and trichomoniasis, as a neglected parasitic infection.  Second, earlier diagnosis and treatment of CD might significantly impact the morbidity and mortality of the disease. And, third screening strategies should be considered for individuals at high risk: Latin American immigrants from endemic areas would be at the top of the list for screening. Indeed, screening tests are available for CD. Besides these, while CD is more common among immigrants, it has been detected in native-born Americans underscoring the importance of considering CD in the differential diagnosis of a cardiomyopathy.

Ajay Singh, MBBS, FRCPDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

Understanding Regret Leads to Clinical Empathy

By Ajay K. Singh, MBBS, FRCP, MBA
April 4, 2017

“There is a tide in the affairs of men
Which taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries”
William Shakespeare: Julius Caesar, Act 4 Scene 3

This idea of opportunity versus regret from Shakespeare was recently addressed by Anjana Ahuja a science writer for the Financial Times as she discusses the conflicting emotions generated around Brexit: opportunity in the minds of some and regret among others.

Ahuja writes: “Regret is a powerful emotion, and a universal one. Who among us has not felt a pang, even a churn in the stomach… that, in retrospect, was the wrong one?” Continue reading “Understanding Regret Leads to Clinical Empathy”

Are Supervised Injection Facilities an Answer to Saving Lives in the Opioid Epidemic?

By Ajay K. Singh, MBBS, FRCP, MBA
March 28, 2017

I would recommend a perspective article by Sarah Wakeman in the New England Journal of Medicine as a “must read” for health care professionals wondering what still remains to be done in the dealing with the opioid epidemic. However, Dr. Wakeman’s view is not necessarily widely shared and might explain why the supervised injection facility (or site) idea hasn’t been widely adopted in the US.

In her article, Wakeman talks poignantly about the value of supervised injection facilities in saving lives. Says Wakeman,

“The cruel reality of opioid addiction is that any episode of use can be immediately fatal. Even when recovery is the goal, the path to it is circuitous, and most people with addiction have recurrences along the way. The odds of dying before arriving at the goal are tragically high.”

She continues, “But we do not have to accept this reality as the only option. Supervised injection facilities have been proven to save lives, improve health, increase neighborhood safety, reduce cost, and ultimately increase engagement in treatment. These facilities are monitored spaces, staffed by medical professionals, where people who use drugs can do so safely. Insite, a supervised injection facility in Vancouver, has seen thousands of overdoses since opening its doors but not a single death, thanks to the nurses and naloxone on site.”

Wakeman points out that several countries like Canada, Australia, the Netherlands, and Switzerland have supervised injection facilities. Their experience, and published research findings, provide support for the lifesaving benefit of these facilities.

Still, the obvious question is what are we missing here? Why doesn’t the US have even one facility? (Disclosure: Seattle and King County are planning facilities, but there are none in the US at the present time).

One reason, perhaps, is that even though the Surgeon General’s report and the publicity around it, made the case for addiction not being a “moral failing,” the view prevails. These supervised injection facilities might be viewed as “enabling” injections of opioids.

Some policy makers have expressed consternation about needle exchanges. Others have argued that allowing supervised injection of opioids goes against federal law.

In an article in the National Post, a leading Toronto Newspaper, columnist Jeremy Devine pushes back referencing, “an uncomfortable belief underlying the harm-reduction philosophy — the view that some addicts are without hope of ever leading a full, productive life free of drug use.”

Devine continues:

“It may be true that, for some, the best we can do is safe, controlled sedation. But the medical community and society should not be so quick to condemn many others to the compromised mental prison that is the life of the addict.”

Devine concludes: “Harm-reduction researchers have conveniently neglected to investigate any potentially negative findings of their policies. Their studies focus exclusively on the obvious benefits such as decreased overdose deaths, cost savings, and so-called ‘treatment retention.’ That addicts will remain “in treatment” longer when freely administered their drug of choice is not surprising, but that this is in their best interests is highly questionable.”

In California, where the state legislature is considering allowing supervised injection sites, the California Police Chief’s Association has been resistant. Quoting an article on the KPCC website , they argue that it would “put California law enforcement in the inappropriate position of enforcing a state law at odds with federal law.” On the other hand, Californian lawmakers have pushed for decriminalizing this issue and treating addiction as a medical or social issue.

Some have made the point that supervised injection sites only address a part of the problem. For example, fentanyl is frequently ingested as a pill, and other drugs are smoked or inhaled.

The health legislation proposed by President Trump, if passed, could also have a devastating effect on the idea of supervised injection sites because Medicaid funding from states that accepted expanded Medicaid funding as a part of the Affordable Care Act (“Obamacare”) is slated for major cuts, and this will affect opioid-related care.

Perhaps Sarah Wakeman’s perspective article doesn’t resonate widely at this point, but it should, because she does have a point: “If the current epidemic can teach us anything, it’s that drug use is soaring unassisted. The time has come to think instead about how we can enable people to stay alive.”


The Opioid Use Disorder Education Program

Are you prepared to treat patients with opioid use disorder? Learn more about the latest medical and psychosocial treatment options, best practices, and legal guidelines in a free online program produced by Harvard Medical School.

The Opioid Use Disorder Education Program (OUDEP) is now available from HMS Global Academy. Comprised of 3 free online CE/CME courses produced by Harvard Medical School, these courses were developed with scientific contributions from The National Institute on Drug Abuse (NIDA) and are intended for nurses, nurse practitioners, physician assistants, physicians, and other health care providers collaborating to treat patients with substance use disorders.


Ajay Singh, MBBS, FRCPDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.