Graduate Medical Education

ACGME Residency Curriculum: Longitudinal SBIRT & Behavioral Health

A three-year PGY-1 through PGY-3 family medicine and internal medicine training progression combining observed OSCE interviews, faculty precepting, and panel quality audits.

Training Blueprint

Residency programs embed SBIRT longitudinally rather than as a single intern lecture: PGY-1 builds universal screening and FLO interviewing, PGY-2 integrates billing codes and warm handoffs in continuity clinic, and PGY-3 leads pharmacotherapy initiation (naltrexone, buprenorphine) and panel quality-improvement audits aligned with ACGME milestones.

Evidence basis: Pringle et al., 2012 JGME National SBIRT Residency Training Project (PMC3312535).

Family medicine resident physicians and an integrated behavioral health educator discussing a clinical case in a teaching clinic hallway — Continuity clinic hallway precepting between family medicine residents and an integrated behavioral health specialist.

1. PGY-1 to PGY-3 Longitudinal Training Progression

PGY-1 · Orientation & Continuity Block

Universal Screening, Standard Drink Math & Ask-Tell-Ask

Complete 4 hours of interactive standardized-patient OSCE role-play covering AUDIT-C, DAST-10, and non-judgmental permission asking; achieve 100% accuracy in precepted clinic scoring.
PGY-2 · Continuity Clinic & Behavioral Rotation

Brief Negotiated Interviews, Warm Handoffs & CPT Coding

Shadow integrated behavioral health specialists for 20 warm handoffs, execute 10 video-recorded or faculty-observed FLO interviews, and document CPT 99408/G0396 time thresholds reliably.
PGY-3 · Senior Clinic Lead & QI Capstone

MOUD Prescribing, Naloxone Protocols & Panel QI Audit

Manage continuity patients on oral/IM naltrexone, acamprosate, or buprenorphine; run a quarterly EHR dashboard audit comparing clinic positive-screen rates against documented warm handoffs.

2. ACGME Competency Milestone Mapping Matrix

ACGME Domain	Milestone Anchor	Observable Resident Behavior	Precepting Verification Method
PC-3 Patient Care	Brief Intervention & MOUD	Delivers 5-15 min FLO interview and initiates naltrexone or buprenorphine safely	Direct observation + chart audit
MK-2 Medical Knowledge	Cutoffs & Withdrawal	Applies sex/age AUDIT-C cutoffs (>=3 F / >=4 M) and CIWA-Ar risk stratification	Didactic quiz + OSCE rubric
ICS-1 Communication	Motivational Interviewing	Uses Readiness Ruler scaling without lecturing or confrontational labels	Standardized patient checklist
SBP-2 Systems Practice	Warm Handoff & Coding	Coordinates same-day PCBH handoff and bills CPT 99408/G0396 with Modifier 25	Clinic billing audit
PBLI-1 Practice-Based	Panel Quality Audit	Measures clinic screening yield and closes racial/linguistic warm-handoff gaps	PGY-3 QI presentation

3. Resident OSCE Precepting Rubric Selector

PGY Entrustment & OSCE Debrief Target

ACGME PC-1 / ICS-1

Select Resident Training Year

PGY-1 Milestone Target

4. Residency Training Questions

How many residents were trained in the National SBIRT Residency Training Project?

As reported in the Journal of Graduate Medical Education (Pringle et al., 2012, PMC3312535), the national SAMHSA-funded residency initiative trained nearly 3,000 resident physicians across primary care, emergency medicine, and obstetrics-gynecology.

Which ACGME competencies map directly to outpatient SBIRT delivery?

SBIRT maps directly to Patient Care (PC-3 brief intervention and MOUD), Medical Knowledge (MK-2 screening cutoffs), Interpersonal and Communication Skills (ICS-1 motivational interviewing), Systems-Based Practice (SBP-2 warm handoffs and coding), and Practice-Based Learning (PBLI-1 clinic QI).