Developing Medical Cannabis Competencies: A Consensus Statement

The use of medical cannabis continues to expand rapidly across the US, yet most health care practitioners and trainees report feeling unprepared to counsel patients or integrate cannabis into care. Despite its clinical relevance, standardized education on medical cannabis remains absent from most medical school curricula.

To develop a consensus-based set of core competencies for educating medical students about medical cannabis, including its clinical utility, risks, legal landscape, and evidence base.

Between February and October 2023, a modified Delphi process was conducted with 23 experts representing a broad range of clinical and academic expertise. Through 2 rounds of anonymous, web-based surveys, panelists provided quantitative ratings and qualitative feedback on draft competencies. Competencies and subcompetencies were iteratively revised by the research team and re-evaluated by the panel. Final inclusion of competencies required a mean score of 4 or higher (on a 1 to 5 scale) on both importance and wording appropriateness. Subcompetencies were reviewed for comprehensiveness and educational value.

The expert panel included 14 physicians across multiple specialties, along with nurses, a pharmacist, and individuals with leadership roles in academic medicine. An initial list of 9 competencies was refined and consolidated into 6 core competencies: (1) understand the basics of the endocannabinoid system; (2) describe the main components of the cannabis plant and their biological effects; (3) review the legal and regulatory landscape of cannabis in the US; (4) describe the evidence base for health conditions that are commonly managed with cannabis; (5) understand the potential risks of medical cannabis use; and (6) understand basic clinical management with medical cannabis. Each competency is supported by 2 to 7 subcompetencies, resulting in 26 subcompetencies reflecting granular topics, such as patient safety, vulnerable populations, structural inequities, and interdisciplinary care.

These consensus-derived competencies provide a structured, evidence-informed foundation to guide the integration of medical cannabis into undergraduate medical education. Aligned with competency-based education principles, the implementation of the proposed framework can help ensure that future clinicians are equipped to provide informed, evidence-based, and patient-centered guidance on medical cannabis use.