Learning About and Destigmatizing Substance Use Disorders: a Video-Based Educational Module Using Simulated Patients

Substance Use Disorder Stigma and Professional Decision Making Among Pre-Professional Healthcare Trainees

Provider stigma toward people who have substance use disorders (SUDs) may be a barrier to effective treatment delivery. The purpose of this study was to measure provider stigma among healthcare professionals-in-training and determine whether stigma levels were associated with professional decision making. A sample of 240 participants were recruited from the following academic programs at a large university in the southeastern United States: Nursing, Social Work, Counseling, Marriage and Family Therapy, and Psychology. Through an online, anonymous survey, provider stigma and other constructs were measured. The participants were also asked to make two hypothetical professional decisions: one regarding their choice to provide treatment for an SUD patient and the other regarding their likelihood of attending a professional development event (i.e., conference session) on the topic of SUDs. Results showed that self-reported stigma toward patients with SUDs was associated with a reduced likelihood of choosing to provide treatment for a patient with SUD (compared to patients with other conditions) and a reduced likelihood of attending SUD training at an upcoming conference (compared to other conference topics). Results have potential implications for the development of training programs for pre-professional healthcare trainees.

Evaluation of Two Videos that Apply Evidence-Based Strategies to Increase Self-Efficacy and Reduce Opioid-Related Stigma Among Medical Students

OBJECTIVE

This study evaluated the video-based application of evidence-based stigma reduction strategies to increase medical students' screening-diagnostic self-efficacy for opioid use disorder (OUD) and reduce stigma toward opioid use.

METHODS

Formative qualitative research informed development of two videos for medical students. One uses an education strategy by including education regarding non-stigmatizing language use and OUD screening and diagnosis (Video A); the other uses an interpersonal contact strategy by presenting narratives regarding opioid use from three people who have a history of opioid use and three physicians (Video B). Both videos were administered to all respondents, with video order randomized. Effects on outcomes were evaluated using a pre-/post-test design with a 1-month follow-up. Participants also provided feedback on video content and design.

RESULTS

Medical students (N = 103) watched the videos and completed the pre-/post-test, with 99% (N = 102) completing follow-up 1 month after viewing both videos. Self-efficacy increased directly following viewing Video A, and this increase was sustained at 1-month follow-up. Stigma toward opioid use decreased directly following viewing Video B, and this decrease was sustained at 1-month follow-up for participants who watched Video B first. Statistically significant improvements were observed in most secondary outcomes (e.g., harm reduction acceptability) directly following watching each video and most were sustained at 1-month follow-up. Feedback about the videos suggested the delivery of evidence-based strategies in each video was appropriate.

CONCLUSIONS

Video-based applications of these evidence-based strategies were found acceptable by medical students and have potential to elicit sustained improvement in their screening-diagnostic self-efficacy and opioid-related stigma.

An Occupational Perspective on Psychedelic Therapy: A Scoping Review

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

Treating Children With Physical Disabilities: A Video-Based Educational Resource Using Simulated Participants

OBJECTIVES

Children with physical disabilities (CWPD) have historically experienced inadequate and insensitive care across medical settings. A lack of comfort and knowledge about CWPD is prevalent among healthcare provider trainees. We developed a new, readily distributable educational resource about CWPD for healthcare students and conducted a study to determine its efficacy in improving their attitudes toward CWPD.

METHODS

We collaborated with a working group of stakeholders in the disability community to develop an educational resource for healthcare students. We developed nine short video clips (with a cumulative duration of 27 min) of a primary care visit using simulated participants and embedded them into a 50-min workshop. We conducted a study of the workshop's utility for volunteer healthcare students using synchronous videoconferencing. Participating students completed assessments at baseline and after the workshop. Our primary outcome measure was a change in the Attitudes to Disabled Persons-Original (ATDP-O) scale.

RESULTS

Forty-nine healthcare students participated in the training session: 29 (59%) from medicine, and 21 (41%) from physician assistant or nursing programs. The materials were easy to deliver virtually. The workshop resulted in measurable change in attitudes regarding physical disabilities, with improvement in ATDP-O scores between baseline (M = 31.2, SD = 8.9) and endpoint (M = 34.8, SD = 10.1) scores (t ₍₄₉₎= 3.28, P = .002, Cohen's d = 0.38).

CONCLUSION

This video-based educational resource on CWPD is readily distributable and can be delivered virtually as a workshop. The video-enhanced workshop improved healthcare students' perceptions and attitudes toward CWPDs. All materials are available to view, download, or adapt by end-use instructors.

Collaborating with transgender youth to educate healthcare trainees and professionals: randomized controlled trial of a didactic enhanced by brief videos

BACKGROUND

In collaboration with members of the transgender and gender diverse (TGD) community, we created a didactic resource about the unique needs of TGD youth.

METHODS

We developed teaching materials enhanced by video clips of two TGD adolescents openly sharing aspects of their lived experience. We compared the video and no video conditions in a randomized controlled trial (RCT) in which participants were assigned to one of four parallel conditions: 1) a transgender [TgV] or 2) a cisgender [CgV] woman presenting with videos embedded into the presentation, 3) the same cisgender woman presenting without the videos [CgN], or 4) a no intervention control [NiC]. Our primary outcome was change in the total score of the Transgender Knowledge, Attitudes, and Beliefs Scale (T-KAB).

RESULTS

We recruited and proportionally randomized 467 individuals, 200 of whom completed ratings before and after the intervention: TgV (n = 46), CgV (N = 46), CgN (n = 44), and NiC (n = 64). Mean scores on all measures of TGD acceptance increased in the video group, compared to the no video group. Improvements persisted after 30 days (p < 0.01), except on perceptions about TGD family members. The three active intervention groups did not differ in efficacy.

CONCLUSIONS

These findings provide empirical evidence that a well-informed presenter, regardless of their gender, can achieve similar improvements in perceptions and knowledge about TGD youth when using a resource that can be disseminated free of cost.

Making It Real: From Telling to Showing, Sharing, and Doing in Psychiatric Education

OBJECTIVE

Innovations in contemporary medical education could inform remedies to address enduring challenges such as the marginalization and stigmatization of psychiatry, of mental illnesses, and of those affected by them.

METHODS

In blending the works of Bleakley, Bligh, and Brown (2011) and of Kumagai and Naidu (2015), we developed an overarching heuristic with practical relevance and concrete applications to psychiatric education.

RESULTS

We identify three areas to enhance psychiatric education embedded into this blended framework: 1) Showing, or the more accurate depiction or imaging of mental illnesses and of psychiatric practice, as exemplified by the incorporation into didactic content of asynchronous video-based clinical materials produced with specific educational objectives in mind; 2) Sharing, or addressing the image problem of mental illnesses, of those living with or affected by them, and of psychiatry as a profession, as exemplified by psychiatrists embracing their role as experts by professional and personal experience when sharing their own journeys with mental illness, treatment, and recovery; and 3) Doing, or reimagining reflective psychiatric practice, as exemplified by the novel methodology of co-constructive patient simulation (CCPS), through which learners can engage in reflective practice and supervision in a participatory and democratic setting that does not privilege participants' hierarchical standing.

CONCLUSION

The blended model and the sample applications we describe offer a range of teaching, learning, and professional development opportunities, should psychiatric educators choose to pursue them and reap their promise.