Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey

Abstract

Summary: The United States opioid epidemic is among this century’s most profound threats to public health and demands that all physicians consider their role in reversing its trajectory. Previous literature demonstrated that plastic surgery trainees lack vital practices that promote opioid stewardship. However, it is not understood why this practice gap exists. This is a national survey-based study evaluating the availability and effectiveness of opioid education in US plastic surgery programs. A total of 91 residents completed the survey. Our study found that there is an unmet need for practical and comprehensive training regarding safe opioid prescribing among plastic surgery trainees. “Informal training,” defined as the “learn as you go” method, was found to be more common than formal training and considerably more valuable according to trainees. Trainees cited real-world applicability of informal training and that it comes from teachers whom they know and trust as valuable attributes of this type of education. Furthermore, the severity of the opioid epidemic has not translated into improved trainee education, as there was no significant difference in knowledge on safe opioid prescribing practices between junior and senior residents. To change the course of the epidemic, plastic surgery programs need to better train younger generations who believe they are critical stakeholders. This study lays the framework for the “formalization of informal training,” and the creation of practical and efficacious educational initiatives.

Variability in Opioid Prescribing Among Plastic Surgery Residents After Bilateral Breast Reduction

“…Importantly, few surgical residents are receiving opioid prescribing education despite evidence that opioid-related pain management curricula are effective. [46][47][48][49] Opioid-specific prescription training has been associated with lower opioid prescriptions among surgical trainees. However, in the absence of such training, it should be unsurprising that prescribing patterns of surgical trainees are variable and excessive.…”

“…Opioid prescribing variability and excessive prescriptions found among plastic surgery residents are reflective of poor communication with attending surgeons about opioid prescriptions, inadequate education, and little oversight. Importantly, few surgical residents are receiving opioid prescribing education despite evidence that opioid-related pain management curricula are effective 46–49 . Opioid-specific prescription training has been associated with lower opioid prescriptions among surgical trainees.…”

The I‐STOP Program and Narcotic Prescriptions Following Facial Reconstructive Plastic Surgeries

“…A study conducted on US plastic surgery residents showed that the majority of formal resident education related to opioids was with respect to reversal of opioid overdose. 17 Within this sample informal training for junior residents about opioid prescribing was most often conducted through a senior resident or attending, without explanation or discussion. 17 Thus, further efforts are needed to improve resident physician understanding of appropriate use of opioid medications for postoperative analgesia.…”

“…17 Within this sample informal training for junior residents about opioid prescribing was most often conducted through a senior resident or attending, without explanation or discussion. 17 Thus, further efforts are needed to improve resident physician understanding of appropriate use of opioid medications for postoperative analgesia. Less than 1 /3 patients undergoing plastic surgeries expect a prescription for opioids following their procedure.…”