Teaching Safe Opioid Prescribing During the Opioid Epidemic: Results of the 2018 Clerkship Directors in Internal Medicine Survey
Educating medical trainees across the continuum is essential to a multifaceted strategy for addressing the opioid epidemic.
To assess the current state of internal medicine clerkship content on safe opioid prescribing and opioid use disorder, and barriers to curriculum implementation.
National Annual (2018) Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey.
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.
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.
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%).
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 WORDSundergraduate medical education internal medicine clerkship opioid chronic pain
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.
- 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.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.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.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.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.
- 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.
- 12.Liasion Committee on Medical Education (LCME). Medical School Directory. http://lcme.org/directory. Accessed September 1, 2017.
- 13.US Census Bureau. Census Regions and Divisions of the United States. www.census.gov/geo/www/us_regdiv.pdf. Accessed December 1, 2017.
- 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.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