In the US, deaths from prescription opioids have quadrupled since 1999, prompting authorities to declare an "opioid abuse" crisis. Rising overdose deaths were attributed to trends in the overprescription of opioids, specifically the strength and duration of the initial prescription. We describe educational interventions designed to control healthcare professionals' (HCPs) opioid prescribing in the wake of this crisis. A review of relevant programs for practicing providers, medical residents, and medical students reveals a focus on educational interventions that we describe, borrowing from sociologist John McKinlay's metaphor for public health interventions, as "downstream." These downstream interventions concentrate on regulating and educating practicing HCPs rather than transforming the training environment for medical students and residents. We draw on theories of behavior change to call for the development of complementary "upstream" educational programs for future practitioners that focus on structural and psychosocial factors and may contribute to more sustainable behavior change outcomes.
An emphasis on competency-based curricula has led to the concept of Entrustable Professional Activities (EPAs), responsibilities that a trainee can perform with minimum to no supervision. Establishment of EPAs in medical education seeks to standardize clinical learning experiences and ensure that graduates can perform at the resident level. To date, no study has addressed the medical student perspective regarding EPA implementation. A pilot case-based survey examined student confidence of proposed EPAs. Clinical year students reported greater confidence (p < .01) for all EPAs, demonstrating progressive confidence during training. Casebased subjective assessment of EPAs could be used to evaluate curricula, identify the learning needs of students and target educational interventions.
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