Commentary Article: Transforming an Educational Ecosystem for Substance use Disorders: A Multi-Modal Model for Continuous Curricular Improvement and Institutional Change

Health professions curricula are created to prepare learners to effectively address health issues affecting individ uals and their communities. Ideally, curricula emphasize the predominant biopsychosocial influences impacting the health of diverse populations. However, despite decades of investment and advances in educational research and design, we have failed to create a health professional workforce capable of equitably meeting the health care needs of the public. Particular communities, geographic regions, and patients with stigmatized diagnoses continue to be underserved, and the potential contributions of multidisciplinary health professionals and advanced practice providers continue to be unrealized within a predominantly physician-centric health care model. Genuine educational transformation requires multidimensional, iterative strategies used to meaningfully evolve traditional classroom curricula, break from the implicit and "hidden" curricula, and enrich the educational ecosystem in which all operate. This manuscript elaborates the construct and process of "educational ecosystem transformation" as a tool for the evolution of the educational ecosystem and its situated curriculum that will eventually drive the enrichment of the healthcare workforce. Drawing from traditional models of curriculum development, recent work on transforming the hidden curriculum, the clinical learning environment, and change management strategies, this new approach uses a health equity and structural competence lens to interrogate and deconstruct a learning system in order to identify opportunities to change, strengthen, and deepen a learner's experience around a specific topic. This process requires an in-depth, multidimensional assessment followed by the identification of key change targets and a stepwise, iterative plan for improvement and transformation. The topic area of substance use disorders (SUD) is used to illustrate how this complex process might be employed to improve the quality of care, realize and amplify the contributions of the entire healthcare team, stimulate interest in addiction medicine as a career, and reduce the stigma and disparities patients with SUDs often experience.