Advertisement

Teaching Safe Opioid Prescribing During the Opioid Epidemic: Results of the 2018 Clerkship Directors in Internal Medicine Survey

  • Mim AriEmail author
  • Michael Kisielewski
  • Nora Y. Osman
  • Karen Szauter
  • Clifford D. Packer
  • Amber T. Pincavage
Original Research

Abstract

Background

Educating medical trainees across the continuum is essential to a multifaceted strategy for addressing the opioid epidemic.

Objective

To assess the current state of internal medicine clerkship content on safe opioid prescribing and opioid use disorder, and barriers to curriculum implementation.

Design

National Annual (2018) Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey.

Participants

One hundred thirty-four clerkship directors at all Liaison Committee of Medical Education accredited US medical schools with CDIM membership as of October 1, 2018.

Main Measures

The survey section on safe opioid prescribing and opioid use disorder education in the internal medicine clerkship addressed assessment of current curricula, perceived importance of curricula, barriers to implementation, and plans to start or expand curricula. Descriptive statistics were used to summarize responses, and Pearson’s chi-square and Fisher’s exact tests for statistical comparisons.

Key Results

The survey response rate was 82% (110/134). Overall 54.1% of responding institutions reported covering one or more topics related to safe opioid prescribing or opioid use disorder in the internal medicine clerkship. A preponderance of clerkship directors (range 51–86%) reported that various opioid-related topics were important to cover in the internal medicine clerkship. Safe opioid prescribing topics were covered more frequently than topics related specifically to opioid use disorder. The main barriers identified included time (80.9%) and lack of faculty expertise (65.5%).

Conclusions

Clerkship directors agreed that incorporating safe opioid prescribing and opioid use disorder topics in the internal medicine clerkship is important, despite wide variation in current curricula. Addressing curricular time constraints and lack of faculty expertise in internal medicine clerkships will be key to successfully integrating content to address the opioid epidemic.

KEY WORDS

undergraduate medical education internal medicine clerkship opioid chronic pain 

Notes

Contributors

The authors wish to thank the Alliance for Academic Internal Medicine (AAIM) and the Clerkship Directors in Internal Medicine (CDIM).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5203_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 33 kb)

References

  1. 1.
    Volkow N. Statement on federal efforts to combat the opioid crisis: a status update on CARA and other initiatives before the House Committee on Energy and Commerce. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2017/federal-efforts-to-combat-opioid-crisis-status-update-cara-other-initiatives. Accessed May 21, 2019.
  2. 2.
    Centers for Disease Control and Prevention. Opioid overdose: understanding the epidemic. https://www.cdc.gov/drugoverdose/epidemic/. Revised December 18, 2018. Accessed May 21, 2019.
  3. 3.
    Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf. Published September 2016. Accessed May 21, 2019.
  4. 4.
    Educating future physicians of substance abuse and pain management [news release]. Washington, DC: Association of American Medical Colleges; January, 2016. https://www.aamc.org/download/453538/data/20160129_educatingfuturephysiciansonsubstanceabuseandpainmanage.pdf. Accessed May 21, 2019.
  5. 5.
    Howley L, Whelan A, Rasouli T. Addressing the opioid epidemic: U.S. medical school curricular approaches. AAMC Analysis in Brief. 2018;18(1):1–3. https://www.aamc.org/download/485934/data/january2018addressingtheopioidepidemicu.s.medicalschoolcurricul.pdf. Accessed May 21, 2019.
  6. 6.
    Ram A, Chisolm MS. The Time is Now: Improving Substance Abuse Training in Medical Schools. Acad Psychiatry. 2016;40(3):454–460.CrossRefGoogle Scholar
  7. 7.
    Ratycz MC, Papadimos TJ, Vanderbilt AA. Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula. Med Educ Online. 2018;23(1):1466574.CrossRefGoogle Scholar
  8. 8.
    Antman KH, Berman HA, Flotte TR, Flier J, Dimitri DM, Bharel M. Developing Core Competencies for the Prevention and Management of Prescription Drug Misuse: A Medical Education Collaboration in Massachusetts. Acad Med. 2016;91(10):1348–1351.CrossRefGoogle Scholar
  9. 9.
    Responding to the opioid epidemic through education, patient care and research [news release]. Washington, DC: Association of American Medical Colleges; May 14, 2019. https://news.aamc.org/for-the-media/article/medical-schools-address-opioid-epidemic/. Accessed May 21, 2019.
  10. 10.
    Wakeman SE, Baggett MV, Pham-Kanter G, Campbell EG. Internal medicine residents’ training in substance use disorders: a survey of the quality of instruction and residents’ self-perceived preparedness to diagnose and treat addiction. Subst Abus. 2013;34(4):363–370.CrossRefGoogle Scholar
  11. 11.
    Saitz R, Daaleman TP. Now is the Time to Address Substance Use Disorders in Primary Care. Ann Fam Med. 2017;15(4):306–308.CrossRefGoogle Scholar
  12. 12.
    Liasion Committee on Medical Education (LCME). Medical School Directory. http://lcme.org/directory. Accessed September 1, 2017.
  13. 13.
    US Census Bureau. Census Regions and Divisions of the United States. www.census.gov/geo/www/us_regdiv.pdf. Accessed December 1, 2017.
  14. 14.
    Rice K, Ryu JE, Whitehead C, Katz J, Webster F. Medical Trainees’ Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education. Acad Med. 2018;93(5):775–780.CrossRefGoogle Scholar
  15. 15.
    Meltzer EC, Suppes A, Burns S, et al. Stigmatization of substance use disorders among internal medicine residents. Subst Abus. 2013;34(4):356–362.CrossRefGoogle Scholar
  16. 16.
    Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000;61(6):912–915.CrossRefGoogle Scholar
  17. 17.
    Tesema L, Marshall J, Hathaway R, et al. Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors. Subst Abus. 2018:1–7.Google Scholar
  18. 18.
    Tong S, Sabo R, Aycock R, et al. Assessment of Addiction Medicine Training in Family Medicine Residency Programs: A CERA Study. Fam Med. 2017;49(7):537–543.Google Scholar
  19. 19.
    Schwartz AC, Frank A, Welsh JW, Blankenship K, DeJong SM. Addictions Training in General Psychiatry Training Programs: Current Gaps and Barriers. Acad Psychiatry. 2018;42(5):642–647.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Department of Medicine University of Chicago Pritzker School of MedicineChicagoUSA
  2. 2.Alliance for Academic Internal MedicineAlexandriaUSA
  3. 3.Department of MedicineBrigham & Women’s Hospital and Harvard Medical SchoolBostonUSA
  4. 4.Department of MedicineUniversity of Texas Medical BranchGalvestonUSA
  5. 5.Department of MedicineCase Western Reserve University School of MedicineClevelandUSA
  6. 6.Department of MedicineLouis Stokes Cleveland VA Medical CenterClevelandUSA

Personalised recommendations