Opioid Stewardship Training during the Transition to Residency to Prepare Medical Students to Recognize and Treat Opioid use Disorder

Abstract

Background: With a drastic shortage of addiction medicine specialists-and an ever-growing number of patients with opioid use disorder (OUD)-there is a dire need for more clinicians to feel confident in prevention and management of OUD and obtain a DEA-X waiver to prescribe medications to treat OUD. Here we determine if it is feasible to certify 4th year medical students with DEA-X waiver training as a component of the PROUD (Prevent and Reduce Opioid Use Disorder) curriculum, and if PROUD enhanced preparedness for medical students to manage OUD as interns. Methods: We implemented a sequential mixed-methods IRB approved study to assess feasibility (completing all required components of DEA-X waiver training) and impact of PROUD (measured by knowledge growth, enhancement for residency, and utilization of training during internship). Students completed 11 hours of required OUD training. Quantitative data included pre-/postknowledge and curriculum satisfaction assessments as well as long-term impact with follow up survey as interns. Qualitative data was collected by survey and semi-structured focus groups. Results: All 120 graduating medical students completed the required components of the curriculum. Knowledge improved on the Provider Clinical Support Services (12.9-17.3, p < 0.0001) and Brief Opioid Overdose Knowledge assessments (10.15-10.81, p < 0.0001). Course satisfaction was high: 90% recommended online modules; 85% recommended training overall. Six qualitative themes emerged: (1) curriculum content was practical, (2) online modules allowed flexibility, (3) in-person seminars ensured authenticity, (4) timing at the transition to residency was optimal, (5) curriculum enhanced awareness and confidence, and ( 6) training was applicable to future careers. At 3 months, 60% reported using their training during internship; 64% felt more prepared to treat OUD than peers. Conclusions: PROUD trained 4th year medical students in opioid stewardship. As interns, students felt ready to serve as change agents to prevent, diagnose, and treat OUD.

US medical school curriculum on opioid use disorder—a topic review of current curricular research and evaluation of winning student-designed opioid curricula for the 2021 Coalition on Physician Education in Substance Use Disorders curricular competition

“…Many also included additional items related to OUD, such as opioid epidemic, racial/ethnicity and disparity in opioid epidemic, social stigma towards OUD, social barriers in treatment of patients with pain and/or OUD, and relevant law and regulations. Four programs used Drug Addiction Treatment Act of 2000 (DATA 2000) waiver trainings developed either by professional organizations or in-house ( 29 – 32 ). However, despite the recognition of the contribution from comorbid psychiatric disorders and relevant social factors, none of these articles mentioned specifically the use of biopsychosocial approaches in their curricula.…”

“…However, despite the recognition of the contribution from comorbid psychiatric disorders and relevant social factors, none of these articles mentioned specifically the use of biopsychosocial approaches in their curricula. Further, only 3 out of the 17 studied curricula mentioned pain in their major topic areas and the pain topic had a limited focus on managing pain in patient with OUD ( 29 , 30 , 33 ). In addition, a small number of programs focused on students' clinical skills, such as team-based practice, motivational interview and application of SBIRT (Screening, Brief Intervention, and Referral to Treatment), patient screening and education ( 34 – 36 ).…”

Preparing fourth year medical students to care for patients with opioid use disorder: how this training affects their intention to seek addiction care opportunities during residency

“… 26 , 27 Dedicated curricular time for opioid stewardship and buprenorphine waiver training during this transition has been shown to improve knowledge and is associated with high satisfaction among students. 23 Other studies have shown that brief sessions can lead to improved learning and learner satisfaction in medical training. 28 , 29 Our research similarly suggests that the Transition to Residency course may be an opportune setting for a brief, high-yield training covering many of the same topics but requiring less curricular time than formal X-waiver training, depending on the needs of the specific program.…”

“…They saw knowledge gains, high course satisfaction, and that students reported timing of the course was optimal. 23 In their study, they included pre- and post- knowledge asessments and a survey 3 months into intern year; in the future our group hopes to implement these methods.…”

Evaluation and guide for embedding opioid use disorder education in health professions’ curricula

“…For example, Zerbo and colleagues implemented a DATA waiver training with 4th year medical students with results showing 6-months post training statistically significant increases from their pre-tests in both knowledge and confidence with MOUD treatment, and an increase from baseline in reported likelihood to prescribe buprenorphine for OUD treatment [ 14 ]. Another program implementing the DATA waiver training with 4th year students showed similar increases in knowledge and feeling more prepared to treat patients with OUD using buprenorphine from pre to posttest [ 15 ]. Initiatives implementing the DATA wavier training with 3rd year medical students curricula shows similar positive results.…”