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Borgemenke S, Durstock N, DeShetler L, Matus C, Beverly EA. Perception of opioids among medical students: unveiling the complexities and implications. J Osteopath Med 2024; 124:195-203. [PMID: 38294183 DOI: 10.1515/jom-2023-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024]
Abstract
CONTEXT From 2000 to 2019, drug overdoses, combined intentional and unintentional, were the number one cause of death for Americans under 50 years old,with the number of overdoses increasing every year. Between 2012 and 2018, approximately 85 % of all opioid users obtained their opioids through prescriptions from healthcare providers, predominantly physicians. Increased education about the severity of this issue may increase the likelihood of physicians integrating alternative forms of care such as cognitive behavioral approaches, nonopioid therapies, and nonpharmacologic therapies into treatment plans for chronic pain. OBJECTIVES This study investigates medical students' beliefs, experiences, and perceived impact of opioids at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) and University of Toledo College of Medicine and Life Sciences (UT). METHODS A total of 377 students from OU-HCOM (years 1-4, n=312) and UT (years 1-2, n=65) were surveyed on their beliefs, experiences, and perceived impact of opioids. Multiple t tests were conducted to compare the difference in perceived severity and stigma between participants who were impacted by the epidemic and those who were not. A Kendall rank test was performed to analyze the relationship between the county drug overdose rate and perceived severity for medical students. p <0.05 defined statistical significance for all statistical tests performed in this study. RESULTS In comparing medical students' personal experiences with the opioid crisis, it was found that many more participants had experiences with an affected classmate or patient (4.1; 95 % CI, 4.0-4.2), as opposed to direct experiences within their family or group of friends (1.9; 95 % CI, 1.8-2.0). However, this group of participants who directly experienced the opioid crisis were found to be more likely to view the crisis as more severe in Ohio's adult population than those without that direct experience (p=0.03, α=0.05). The difference in experience and severity outlook did not make one group of medical students more likely to hold a stigma toward those struggling with opioid addiction (p=0.3, α=0.05). The study did not find a significant relationship between the county drug overdose rate and the perceived severity among medical students (R=0.05, p=0.6, α=0.05). CONCLUSIONS This study gave an insight into the beliefs, experiences, and perceived impact of opioids within a group of 377 medical students. It was shown that differences in background can lead to differences in perception of the crisis. Knowing these differences can lead to beneficial changes in education and curriculum design in medical education.
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Affiliation(s)
- Samuel Borgemenke
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute, Athens, OH, USA
| | - Nicholas Durstock
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute, Athens, OH, USA
| | - Lori DeShetler
- Department of Medical Education, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Coral Matus
- Department of Family Medicine, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute, Athens, OH, USA
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Barnard M, Reid D, LaPorte K, Yang J, Johnson T. Pharmacy Student Education Related to Opioids: A Scoping Review of the Literature. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100688. [PMID: 38513804 DOI: 10.1016/j.ajpe.2024.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This scoping review explores and assesses the extent of the literature on the current state of opioid-related training and education of student pharmacists and identifies areas for further research to improve the preparedness of future pharmacists in managing care for patients using opioid medications. This review also examines and maps the literature as it relates to the 4 substance misuse educational content areas (legal/ethical issues; screening, treatment, and stigma; pharmacology and toxicology; and psychosocial aspects) recommended by the 2020 American Association of Colleges of Pharmacy Special Committee on Substance Use and Pharmacy Education. FINDINGS A systematic literature search was conducted to identify articles reporting opioid-related educational and training initiatives for student pharmacists in the United States through May 2023. A total of 52 articles were included in the review. Nearly 40% of the included studies reported content that addressed all 4 recommended content areas, with only 8 addressing only 1 or 2 content areas. The majority of studies included students in the third year of their pharmacy program, with many reporting interprofessional educational initiatives. Assessments of opioid-related knowledge and attitudes, satisfaction with the activity, and interprofessional attitudes and competencies were reported. SUMMARY Most of the reported activities addressed at least 3 of the recommended educational content areas. However, relatively few reported sufficient details to support the replication of the activities and there is a need to evaluate the effectiveness of these educational initiatives with more vigorous research methodology to determine their potential effectiveness.
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Affiliation(s)
- Marie Barnard
- School of Pharmacy, University of Mississippi, University, MS, USA.
| | - Dorothy Reid
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Kennedy LaPorte
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Jiaxin Yang
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Tess Johnson
- School of Pharmacy, University of Mississippi, University, MS, USA
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Cao L, Van Deusen J. 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. FRONTIERS IN PAIN RESEARCH 2023; 4:1257141. [PMID: 37965208 PMCID: PMC10641501 DOI: 10.3389/fpain.2023.1257141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
The opioid crisis in the US severely affected and continues to affect population's health. The opioid crisis was in part fueled by inadequate pain management, which is in part due to the inadequate education in both pain and opioid use disorder (OUD) for health care professionals. In 2021, the Coalition on Physician Education in Substance Use Disorders (COPE) organized a curricular competition soliciting US medical students-designed OUD-related curricula. Twelve winning curricula were identified. Here, we first conducted a topic review regarding current US medical school OUD curricula. Then we evaluated the COPE winning curricula and compared them to the curricula identified in the topic review. For the topic review, ten relevant databases were searched up to December 31, 2021 using a combination of pre-determined keywords. Total of 25 peer-reviewed articles were selected based on the pre-determined criteria, which included 5 articles describing opioid curricular development at the state level (AZ, CA, MA, PA, and RI), 17 research articles evaluating a curriculum developed in a single institution, 2 literature reviews, and 1 article detailing curricular development and validation processes in a single institution. Although vary in organizations and formats, state-level curricula were comprehensive and could be adopted by other states or institutions with necessary local issue-based modifications. Faculty development and critical resources were major challenges for curricular implementation. The 17 research articles exhibited good scientific quality (Medical Education Research Study Quality Instrument (MERSQI) score = 11.94 ± 2.33 (maximal score = 18)). All research articles reported to some extent, the success of respective curriculum, in improving students' knowledge in and/or attitude towards OUD, based on primarily pre- and post- comparisons. Compared to these published curricula, winning students-designed curricula had more specific focuses, diverse learning activities, and varieties in assessment methods. For all curricula, long-term evaluations were lacking. Except for the state level curricula, majority of the other curricula did not emphasize specifically on chronic pain education or the biopsychosocial approach. Interprofessional education approach was also lacking. Our topic review and curricular evaluation highlighted the needs for integrating OUD and chronic pain medical curricula, developing long-term assessment tools, and more OUD curriculum research overall.
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Affiliation(s)
- Ling Cao
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME, United States
| | - Jennifer Van Deusen
- The Coalition on Physician Education in Substance Use Disorders (COPE), Bath, ME, United States
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Liu E, Moumen M, Goforth J, Keating M, Hsu FC, Douglas H, Oliver J, Strowd RE. Characterizing the Impact of Clinical Exposure to Patients with Opioid Use Disorder on Medical Students' Perceptions of Stigma and Patient Care. TEACHING AND LEARNING IN MEDICINE 2023; 35:128-142. [PMID: 35249428 DOI: 10.1080/10401334.2022.2038175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
PHENOMENON Opioid use disorder (OUD) is a growing public health crisis. Many residents and physicians do not feel comfortable working with patients with OUD. Social stigma promotes negative attitudes toward these patients and is a roadblock to delivering equitable and effective care. This study sought to (1) characterize medical students' experiences with patients with OUD, (2) understand the features that make a patient encounter memorable, (3) explore factors that influence future practice, and (4) describe the influence on stigma toward patients with OUD. Approach: A study was conducted using qualitative descriptive theory and purposive sampling of fourth-year medical students (M4s) enrolled at Wake Forest School of Medicine (WFSOM). Data collection consisted of a free-text question as a part of a larger survey to M4s in the Class of 2019 and 2020, followed by semi-structured interviews. The goal of the survey was to gain a broad understanding of student encounters with patients with OUD. The goal of the interviews was to gain a deeper understanding of the impact of these encounters on future practice and stigma. Thematic analysis was used to analyze all data. Findings: One-hundred-seventy out of 237 students (RR = 71.7%) completed the free text question describing a memorable encounter with a patient with OUD. Twelve students then completed interviews. Patient encounters occurred in three primary settings: Emergency department, inpatient clerkship, or Intensive Outpatient Program (IOP) meetings during psychiatry clerkship. Clinical encounters were memorable when there was: (1) conflict with patients or teams, (2) complicated care, (3) inadequate care, and (4) relevance to the student's future career. Memorable encounters influenced future practice by changing students' approaches to: (1) future treatment, (2) future communication, or (3) allowing students to practice professionalism. Regarding opioid stigma, students reported that these encounters made them: (1) more aware of stereotypes in medicine, (2) stereotypes in their personal lives, and (3) generated actions that students want to take in the future. Insights: A single, influential clinical encounter has the potential to substantially influence medical students' approach to patients with OUD, including both clinical management and attitudes toward care. Affecting encounters increased knowledge of OUD and fostered empathy and perspective-taking. Not all encounters had a defining impact on students' stigma toward OUD. Medical schools need to create opportunities that will have lasting impact by encouraging students to fully engage with patients with OUD. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2022.2038175 .
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Affiliation(s)
- Ewen Liu
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mohammed Moumen
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jon Goforth
- Department of Academic Medical Education, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michelle Keating
- Department of Family Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Heather Douglas
- Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Oliver
- Department of Pain Management/Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Serota DP, Tookes HE, Tomita-Barber J, Bartholomew TS, Forrest DW, St. Onge J, Ford H, Taldone S. Integrating Persons With Lived Experience in Opioid Use Disorder Education: A Small Group Exercise and Patient Panel. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231180172. [PMID: 37342657 PMCID: PMC10278406 DOI: 10.1177/23821205231180172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/18/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES Based on increasing drug overdose deaths and a shortage of healthcare professionals trained in the management of opioid use disorder (OUD), it is imperative to improve health professional education in addiction medicine. This small group learning exercise and patient panel was designed to provide first year medical students with insights into the lives of people with OUD-through a lens of harm reduction-and to connect biomedical knowledge to the core values and professional themes of their doctoring courses. METHODS Facilitators were assigned to each small group of 8 students for the harm reduction-centered Long and Winding Road small group case exercise. This was followed by a patient panel of 2 to 3 persons with OUD. The small group was conducted with first-year medical students as a virtual training session due to the COVID-19 pandemic. Students completed pre- and post-session surveys about agreement with statements pertaining to the learning objectives. RESULTS The small group and patient panel were delivered over 8 sessions and attended by all first-year medical students (N = 201). Survey response rate was 67%. Post-session, there was significantly greater agreement with knowledge on all learning objectives compared to pre-session. Two relevant multiple-choice questions on the medical student final exam were answered correctly by 79% and 98% of students. CONCLUSION Centering on people with lived experience, we completed small groups and patient panels to introduce concepts of OUD and harm reduction to first year medical students. Pre- and post-session surveys showed short-term achievement of the learning objectives.
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Affiliation(s)
- David P Serota
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jasmine Tomita-Barber
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joan St. Onge
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Henri Ford
- Department of Surgery, University of Miami Miler School of Medicine, Miami, FL, USA
| | - Sabrina Taldone
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Interprofessional Naloxone Student Training to Manage Suspected Opioid Overdose. CLIN NURSE SPEC 2023; 37:26-35. [PMID: 36508232 DOI: 10.1097/nur.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The study purpose was to examine the effect of interprofessional naloxone training on students' knowledge, confidence, and interprofessional collaboration competency. The overarching goal was to decrease mortality related to opioid overdoses. DESIGN/METHODS A training session for interprofessional students consisted of a lecture presentation, demonstration, and hands-on practice regarding appropriate administration of naloxone for suspected opioid overdose. A questionnaire elicited baseline and change in knowledge, confidence, and interprofessional collaboration competency scores at pretraining and posttraining. In addition, changes in knowledge and confidence were also measured 3 weeks after the training. Thematic analysis explored training components that students perceived as valuable or needing improvement. RESULTS Participants (N = 100) were nursing (n = 33), physician assistant (n = 37), and pharmacy (n = 30) students. Pretraining and posttraining comparison demonstrated increased knowledge (P < .001), confidence (P < .001), and collaboration scores (P < .001). At 3 weeks, knowledge and confidence remained higher than pretraining (P < .001). Knowledge was trending downward compared with posttraining (P = .09). Thematic analysis identified 4 themes: (a) indications for administration of different naloxone types, (b) learning modalities, (c) knowledge application, and (d) improvements. CONCLUSIONS An interprofessional naloxone administration training resulted in increased knowledge, confidence, and interprofessional teamwork. Educators can adapt this training for a variety of future or current healthcare professionals to improve immediate intervention and outcomes in suspected opioid overdoses.
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Brown PCM, Button DA, Bethune D, Kelly E, Tierney HR, Nerurkar RM, Nicolaidis C, Harrison RA, Levander XA. Assessing Student Readiness to Work with People Who Use Drugs: Development of a Multi-disciplinary Addiction Educational Survey. J Gen Intern Med 2022; 37:3900-3906. [PMID: 35419741 PMCID: PMC9640533 DOI: 10.1007/s11606-022-07494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND As health profession schools implement addiction curricula, they need survey instruments to evaluate the impact of the educational interventions. However, existing measures do not use current non-stigmatizing language and fail to capture core concepts. OBJECTIVE To develop a brief measure of health profession student readiness to work with people who use drugs (PWUDs) and establish its content validity. METHODS We conducted a literature review of existing instruments and desired clinical competencies related to providing care to PWUD and used results and expert feedback to create and revise a pool of 72 items. We conducted cognitive interviews with ten pre-clinical health profession students from various US schools of nursing, pharmacy, and medicine to ensure the items were easy to understand. Finally, we used a modified Delphi process with twenty-four health professions educators and addiction experts (eight each from nursing, pharmacy, and medicine) to select items for inclusion in the final scale. We analyzed expert ratings of individual items and interdisciplinary agreement on ratings to decide how to prioritize items. We ultimately selected 12 attitudes and 12 confidence items to include in the REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM). Experts rated their overall assessment of the final scale. RESULTS Twenty-two of twenty-four experts agreed or strongly agreed that the attitudes scale measures student attitudes that impact readiness to work with PWUDs. Twenty-three of twenty-four experts agreed or strongly agreed that the confidence scale measures student self-efficacy in competencies that impact readiness to work with PWUDs. Seven of 72 initial items and none of the 24 selected items had statistically significant differences between disciplines. CONCLUSIONS The REDUCE-HARM instrument has strong content validity and may serve as a useful tool in evaluating addiction education. Additional research is needed to establish its reliability, construct validity, and responsiveness to change.
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Affiliation(s)
- Patrick C M Brown
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Dana A Button
- School of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Danika Bethune
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Emily Kelly
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Hannah R Tierney
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR, USA
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Rebecca A Harrison
- Division of Hospital Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ximena A Levander
- Division of General Internal Medicine & Geriatrics, Addiction Medicine Section, School of Medicine, Oregon Health & Science University, Portland, OR, USA
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Ginther J, Chipps E, Landers T, Sinnott L, Overcash J. The Complexity of Educating Acute Care Nurses on Opioid Use Disorder: A Quality Improvement Project. J Addict Nurs 2022; 33:299-308. [PMID: 37140417 DOI: 10.1097/jan.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) is a public health crisis, yet most acute care nurses are not educated to deliver evidence-based OUD care. Hospitalization provides a unique opportunity to initiate and coordinate OUD care in people presenting for other medical-surgical reasons. The aim of this quality improvement project was to determine the impact of an educational program on self-reported competencies of medical-surgical nurses caring for people with OUD at a large academic medical center in the Midwestern United States. METHOD Data were collected from two time points using a quality survey examining self-reported nurse competencies related to (a) assessment, (b) intervention, (c) treatment recommendation, (d) resource use, (e) beliefs, and (f) attitudes toward caring for people with OUD. RESULTS Nurses surveyed before education (T1G1, N = 123) and, after education, those who received the intervention (T2G2, N = 17) and those who did not (T2G3, N = 65) were included. Resource use subscores increased over time (T1G1: x = 3.83, T2G3: x = 4.07, p = .006). Results from the two measurement points found no difference in mean total scores (T1G1: x = 3.53, T2G3: x = 3.63, p = .09). Comparison of mean total scores of nurses who directly received the educational program with those who did not during the second time point showed no improvement (T2G2: x = 3.52, T2G3: x = 3.63, p = .30). CONCLUSIONS Education alone was insufficient in improving self-reported competencies of medical-surgical nurses caring for people with OUD. Findings can be used to inform efforts to increase nurse knowledge and understanding of OUD and to decrease negative attitudes, stigma, and discriminatory behaviors perpetuating care.
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Zhang J, Zhou F, Jiang J, Duan X, Yang X. Effective Teaching Behaviors of Clinical Nursing Teachers: A Qualitative Meta-Synthesis. Front Public Health 2022; 10:883204. [PMID: 35570969 PMCID: PMC9095952 DOI: 10.3389/fpubh.2022.883204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To identify, appraise, and synthesize the available evidence exploring the effective teaching behaviors of clinical nursing teachers. Design The Joanna Briggs Institute (JBI) guidelines were followed, and a meta-synthesis was conducted. Review Methods Following databases were searched for relevant qualitative studies published in English and reporting primary data analysis, including experiences and perceptions of nursing students: PubMed, EBSCOhost, OVID, etc. Qualitative Assessment and Review Instrument were used to pool the qualitative research findings. Through the repeated reading of the original literature, the similar findings were combined and sorted into new categories, and then summarized into different synthesized themes. Results A total of nine articles were included. The review process produced 29 subcategories that were aggregated into seven categories. The categories generated three synthesized findings: good teaching literacy, solid professional competence, and harmonious faculty-student relationship. Conclusions The effective teaching behaviors of clinical nursing teachers are the driving force for the progress and growth of nursing students. In order to improve the effectiveness of clinical nursing teaching, nursing teachers should be fully aware of effective teaching behaviors for nursing students to master nursing theories and skills.
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Affiliation(s)
- Jian Zhang
- Health School (Jinshan), Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Fenhua Zhou
- Health School (Jinshan), Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jinxia Jiang
- Emergency Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xia Duan
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Yang
- Department of Traditional Chinese Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Abstract
Medical educators' stressors continue to increase, and they increasingly find themselves removed from their learners. This distance is thought to contribute to the disenchantment many educators feel. The challenge for educators is to reengage with their learners and restore their satisfaction in teaching. Mindful teaching can help educators meet this challenge. Mindful teaching is not an instructional technique; rather, it is a way of being that the teacher embodies. Mindful teachers practice awareness, acceptance and curiosity. They recognize the needs of their learners, engaging with learners who are 'at the ready'; encouraging those who might not be engaged; and advocating for those who need support. These educators are less susceptible to burnout and help learners develop their own mindfulness. The Tips noted in this article can help educators make deeper connections with their learners, garner greater sense of personal accomplishment and become invigorated by their learners' achievements.
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Affiliation(s)
- Elisa Sottile
- University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
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11
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Compton P, Aronowitz SV, Klusaritz H, Anderson E. Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study. Harm Reduct J 2021; 18:131. [PMID: 34915913 PMCID: PMC8679978 DOI: 10.1186/s12954-021-00581-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients with substance use disorders are more likely than those without to have a self-directed hospital discharge, putting them at risk for poor health outcomes including progressing illness, readmissions, and death. Inadequate pain management has been identified as a potential motivator of self-directed discharge in this patient population. The objective of this study was to describe the association between acute pain and self-directed discharges among persons with opioid-related conditions; the presence of chronic pain in self-directed discharges was likewise considered. Methods We employed a large database of all hospitalizations at acute care hospitals during 2017 in the city of Philadelphia to identify adults with opioid-related conditions and compare the characteristics of admissions ending with routine discharge versus those ending in self-directed discharge. We examined all adult discharges with an ICD-10 diagnoses related to opioid use or poisoning and inspected the diagnostic data to systematically identify acute pain for the listed primary diagnosis and explore patterning in chronic pain diagnoses with respect to discharge outcomes. Results Sixteen percent of the 7972 admissions involving opioid-related conditions culminated in self-directed discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to complete a self-directed discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge. Conclusions These findings underscore the importance of pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00581-6.
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Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Claire Fagin Hall, Room 402, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Shoshana V Aronowitz
- School of Nursing, University of Pennsylvania, Claire Fagin Hall, Room 402, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Heather Klusaritz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Evan Anderson
- School of Nursing, University of Pennsylvania, Claire Fagin Hall, Room 402, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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12
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Moore PQ, Cheema N, Follman S, Celmins L, Scott G, Pho MT, Farnan J, Arora VM, Carter K. Medical Student Screening for Naloxone Eligibility in the Emergency Department: A Value-Added Role to Fight the Opioid Epidemic. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11196. [PMID: 34950768 PMCID: PMC8654700 DOI: 10.15766/mep_2374-8265.11196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Opioid overdose education and naloxone distribution (OEND) for use by laypersons are safe and effective at preventing deaths from opioid overdose, but emergency department (ED) implementation is challenging. Curricula addressing OEND could enable students to serve in value-added roles on the clinical team, overcome challenges of naloxone distribution, and improve patient care. METHODS We created a 1-hour didactic session on opioid use disorder and OEND for first-year medical students in the emergency medicine elective. During two clinical shifts, students used this knowledge to perform screenings to identify patients at high risk of overdose. If a patient screened positive, students performed patient education and then notified the physician, who ordered a naloxone kit. RESULTS Thirty students received the didactic and conducted screening shifts. Of 147 patients screened, 40% (n = 59) were positive for naloxone eligibility, 21% (n = 31) reported that someone close to them used opioids, 18% (n = 26) had witnessed an opioid overdose, 12% (n = 17) had previously overdosed themselves, and 12% (n = 18) previously knew what naloxone was. Fifty-nine naloxone kits were distributed over the 3-month pilot versus 13 naloxone prescriptions for patients discharged from the ED the prior year. DISCUSSION Through didactic training and structured patient engagement, medical students gained knowledge of and hands-on experience with addiction medicine, discussed sensitive topics with patients, and identified a high volume of patients eligible to receive naloxone. Medical student screening for OEND in ED patients is feasible and adds significant value to the clinical team.
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Affiliation(s)
- P. Quincy Moore
- Assistant Professor of Medicine, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine
| | - Navneet Cheema
- Assistant Professor of Medicine, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine
| | - Sarah Follman
- Resident Physician, Section of Emergency Medicine, University of Chicago Medicine
| | - Laura Celmins
- Clinical Pharmacist Specialist, Department of Pharmacy, University of Chicago Medicine
| | - Greg Scott
- Professor, Department of Sociology, DePaul University
| | - Mai T. Pho
- Associate Professor of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Pritzker School of Medicine
| | - Jeanne Farnan
- Professor of Medicine, Section of Hospital Medicine, University of Chicago Pritzker School of Medicine
| | - Vineet M. Arora
- Herbert T. Abelson Professor of Medicine, Section of Hospital Medicine, University of Chicago Pritzker School of Medicine
| | - Keme Carter
- Associate Professor of Medicine, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine
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13
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Fusco NM, Ohtake PJ. Confronting opioid use disorder through virtual interprofessional education. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas M. Fusco
- Department of Pharmacy Practice University at Buffalo School of Pharmacy and Pharmaceutical Sciences Buffalo New York USA
| | - Patricia J. Ohtake
- Office of the Vice President for Health Sciences University at Buffalo Buffalo New York USA
- Department of Rehabilitation Science University at Buffalo School of Public Health and Health Professions Buffalo New York USA
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Cernasev A, Frederick KD, Hall EA, Veve MP, Hohmeier KC. " Don't Label Them as Addicts!" Student Pharmacists' Views on the Stigma Associated with Opioid use Disorder. Innov Pharm 2021; 12. [PMID: 34345523 PMCID: PMC8326708 DOI: 10.24926/iip.v12i2.3388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Student pharmacists represent an important potential population for targeted educational interventions focused on skill and confidence development in order to improve interactions with opioid users and to decrease stigma. The objective of this study was to understand student pharmacists’ perceptions of opioid users. Methods: Focus groups were conducted with student pharmacists across Tennessee over two months in 2020. Concepts from the Transtheoretical Mode, Social Cognitive Theory, stigma, and results from a survey sent to student pharmacists were used to develop the open-ended questions. Thematic analysis was conducted to inductively identify main themes. The recruitment of student pharmacists continued until thematic saturation was obtained. Results: Three focus groups were conducted with a total of 16 student pharmacists in second, third, and fourth professional years. Thematic analysis revealed two themes: Don’t label them as addicts, Student Insight into OUD-Associated Stigma and five sub-themes: developing a judgment-free environment; unconscious bias; a possible connection between physical appearance and addiction; socio-cultural factors, addiction, and isolation; and motivators to decrease stigma. This study not only presents the pharmacy students experiences and their significance, but also reports their recommendations for addressing the stigma associated with OUD in the pharmacy curriculum. Conclusions: These findings highlight the need to normalize appropriate language when describing patients with OUD and avoid negative labels such as “addict.” The findings also indicate where the roots of stigma lie and provide some of the tools to fight stigma on different fronts. Future research should explore and address potential implicit biases throughout pharmacy curriculum.
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Affiliation(s)
- Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy
| | - Kelsey D Frederick
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy
| | - Elizabeth A Hall
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy
| | - Michael P Veve
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University
| | - Kenneth C Hohmeier
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy
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15
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Gummadi NH, D'Amico M, Chandra P, Krumholz JO, Mumber HE, Hoyo L, Miller M, Borba CP, Wachman EM. Impact of cuddler service-learning program in medical student education of opioid use disorder in pregnancy and neonatal opioid withdrawal syndrome. Subst Abus 2021; 42:951-956. [PMID: 33797332 DOI: 10.1080/08897077.2021.1900983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Given the increasing incidence of neonatal opioid withdrawal syndrome (NOWS), medical student training on substance use disorders (SUDs) and opioid use disorder (OUD) in pregnancy must be augmented. Through the Cuddling Assists in Lowering Maternal and Infant Stress (CALM) service-learning program, medical students attend SUD-related didactics and provide monthly cuddling services to infants with NOWS. Objective: This study examines the impact of CALM on medical students' attitudes toward individuals with SUDs and self-reported comfort with clinical skills related to caring for this population. Methods: Self-reported pre- and post-survey data was collected at the beginning and end of an academic year from the intervention group, CALM cuddlers, and the control group, non-cuddlers for 2 years. Mean total survey scores and individual survey questions using a 3-point Likert scale were compared before and after 1 year of participation for cuddlers and for non-cuddlers using paired t-tests and two sample t-tests. Results: The mean total score increased for cuddlers after participation in the intervention (MD 0.13, SD 0.26, p = 0.03). Mean scores for the comfort-related subset of questions also increased significantly for cuddlers after participation in the intervention (MD 0.22, SD 0.41, p = 0.01). Cuddlers felt more comfortable discussing substance use with appropriate language (72.0% vs 51.5%, p = 0.03), talking with patients about substance use (72.0% vs 36.0%, p = 0.01), and asking about substance use or recovery (80.0% vs 48.0%, p = 0.01). Conclusion: OUD- and NOWS-related service-learning positively impacts student attitudes and self-reported comfort with skills related to caring for individuals with SUDs, such as communicating about substance use.
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Affiliation(s)
| | - Maria D'Amico
- Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Leonie Hoyo
- Boston University School of Medicine, Boston, MA, USA
| | - Melissa Miller
- Boston University School of Public Health, Boston, MA, USA
| | - Christina P Borba
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
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Wilson M, Bray BS, Remsberg CM, Kobayashi R, Richardson B. Interprofessional education on opioid use and pain identifies team-based learning needs. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:429-437. [PMID: 33715807 DOI: 10.1016/j.cptl.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/14/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND An interprofessional education (IPE) activity was designed for health professional students in pharmacy, medicine, nursing, social work, and addiction studies. The goals were to practice team-based collaboration for patients who are prescribed opioids for chronic pain and to evaluate student responses to the activity. INTERPROFESSIONAL EDUCATION ACTIVITY Student teams were guided through an unfolding patient case that included evaluating the patient's history, screening tool results, morphine equivalent dose, prescription monitoring program report, and videos of a patient-provider interaction. The two-hour, in-person IPE activity culminated in creation of a patient-centered treatment plan. Surveys were administered to compare pre- and post-course opioid knowledge and post-course IPE attitudes among the healthcare professions. DISCUSSION Pharmacy students' baseline opioid knowledge scores were similar to nursing students, significantly lower than medical students, and significantly higher than social work students. Pharmacy students reported significantly higher gains in opioid knowledge than medical students. Nursing and social work students showed significantly higher levels of agreement that the course enhanced attitudes toward interprofessional collaboration compared to medicine and pharmacy students. Students most frequently noted working with other professions as the most valuable aspect of the IPE activity. IMPLICATIONS Training gaps can be met using novel IPE activities specific to chronic pain and opioid use. Depending on profession, students demonstrated varied baseline knowledge regarding opioid use for chronic pain. Comparing knowledge gains and attitudes on IPE collaboration among professions can detect areas for program refinement to address each professions' unique needs.
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Affiliation(s)
- Marian Wilson
- Associate Professor Nursing, Washington State University College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
| | - Brenda S Bray
- Clinical Professor Medicine, Washington State University Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
| | - Connie M Remsberg
- Clinical Assistant Professor Pharmaceutical Sciences, Washington State University College of Pharmacy and Pharmaceutical Sciences, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
| | - Rie Kobayashi
- Professor Social Work, Eastern Washington University School of Social Work, 102 Senior Hall, Cheney, WA 99004, United States.
| | - Barbara Richardson
- Interprofessional Education & Research, Medicine, Washington State University Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd., Spokane, WA 99202, United States.
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Mort SC, Díaz SR, Beverly EA. Using contact-based education to destigmatize opioid use disorder among medical students. TEACHING AND LEARNING IN MEDICINE 2021; 33:196-209. [PMID: 33196302 DOI: 10.1080/10401334.2020.1820869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, ηp2 = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.
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Affiliation(s)
- Sophia C Mort
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Graduate College, Translational Biomedical Sciences Program, Ohio University, Athens, Ohio, USA
| | - Sebastián R Díaz
- Dean's Office of Medical Education, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Diabetes Institute, Ohio University, Athens, Ohio, USA
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Schlaudecker J, Zamudio O, Goodnow K, Pallerla H, Regan S. Using Patient Voice to Personalize the Opioid Epidemic: An Evaluation of 2 Educational Interventions. J Patient Exp 2021; 7:964-968. [PMID: 33457529 PMCID: PMC7786768 DOI: 10.1177/2374373520948401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite rising opioid fatalities, attitudes remain indifferent toward those with opioid use disorder (OUD). Utilizing patient voice may be one way to move providers to action. We included persons with OUD in 2 educational sessions as an important tool of attitude change. Post-session surveys demonstrate increased compassion, deeper understanding of challenges, and positive change in attitude. Inclusion of patient voice was identified as the most useful feature of both educational sessions. Four themes emerged: value of patient voice; change in attitude; barriers to change; and enhanced provider role. Future educational sessions should include the voice of persons living with OUD.
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Affiliation(s)
- Jeffrey Schlaudecker
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA.,The Christ Hospital/University of Cincinnati Family Medicine Residency, Cincinnati, OH, USA
| | - Olivia Zamudio
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Keesha Goodnow
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Harini Pallerla
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Saundra Regan
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
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19
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James JR, Marolf M, Klein JW, Blalock KL, Merrill JO, Tsui JI. Staff Attitudes toward Buprenorphine before and after Implementation of an Office-Based Opioid Treatment Program in an Urban Teaching Clinic. Subst Use Misuse 2021; 56:1569-1575. [PMID: 34282999 DOI: 10.1080/10826084.2021.1928206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Improving access to buprenorphine treatment is necessary to address the national opioid use disorder (OUD) crisis. This study investigates attitudes about buprenorphine prescribing among staff at a primary care clinic and compares attitudes before and after implementation of an office-based opioid treatment (OBOT) program. METHODS Providers and staff in an academic primary care clinic were surveyed prior to and one year following implementation of an OBOT program. Descriptive statistics, Pearson's Chi-2 tests and logistic regression models were used to compare staff and provider attitudes about use of buprenorphine for OUD and to compare attitudes before and after OBOT implementation. RESULTS At baseline, 20% of staff indicated strong belief that buprenorphine is an effective treatment for OUD and 16% indicated strong belief that primary care providers should prescribe it. Staff appeared less likely than providers to believe strongly that buprenorphine is effective (OR 0.24, 95% CI= 0.08-.78, p = 0.02; aOR 0.28, 95% CI=.08-1.0, p = 0.05 adjusted for age, race and gender). Following implementation of an OBOT program, the percentage of staff who believed strongly in the effectiveness of buprenorphine for OUD increased from 20% to 40% (p = 0.31), and the percentage who believed that primary care providers (PCPs) should prescribe it increased from 16% to 30% (p = 0.52). CONCLUSIONS Staff in a primary care clinic were less likely than providers to believe in the effectiveness of buprenorphine treatment or that PCPs should prescribe it for OUD. That their beliefs substantially changed after implementation of an OBOT program suggests that direct experience impacts attitudes.
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Affiliation(s)
- Jocelyn R James
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Marissa Marolf
- Department of Medicine, University of Washington Internal Medicine Residency Program, Seattle, Washington, USA
| | - Jared W Klein
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Kendra L Blalock
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Joseph O Merrill
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
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20
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Pavuluri H, Poupore N, Schmidt WM, Boniface SG, Jindal M, Demosthenes L. Substance Use Disorder: A Model for Integration in Undergraduate Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:23821205211025859. [PMID: 34189271 PMCID: PMC8212362 DOI: 10.1177/23821205211025859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
Substance Use Disorder (SUD) is a debilitating chronic illness with significant morbidity and mortality across the United States. The AAMC and LCME have supported the efforts for more effective medical education of SUD to address the existing stigma, knowledge, and treatment gaps. The Coronavirus 2019 (COVID-19) pandemic and associated social, economic, and behavioral impacts have added to this urgency. The University of South Carolina School of Medicine Greenville (USCSOMG), in collaboration with community organizations, has successfully implemented an integrated SUD education curriculum for medical students. Students learn about SUD in basic sciences, receive case-based education during clinical exercises, and are provided the opportunity to become a recovery coach and participate in the patient and family recovery meetings through this curriculum during preclinical years. During the clinical years, SUD education is enhanced with exposure to Medication for Addition Treatment (MAT). Students also partake in the care coordination of patients with SUD between the hospital and community recovery organizations. All students receive MAT waiver training in their final year and are prepared to prescribe treatment for SUD upon graduation. The experiences in this integrated curriculum integration can perhaps assist other organizations to implement similar components and empower the next generation of physicians to be competent and effective in treating patients with SUD.
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Affiliation(s)
- Haritha Pavuluri
- University of South Carolina School of
Medicine Greenville, Greenville, SC, USA
| | - Nicolas Poupore
- University of South Carolina School of
Medicine Greenville, Greenville, SC, USA
| | | | | | - Meenu Jindal
- Department of Medicine, Prisma Health
Greenville, University of South Carolina School of Medicine Greenville, Greenville, SC,
USA
| | - Lauren Demosthenes
- Department of Obstetrics and Gynecology,
University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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21
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Balayssac D, Pereira B, Cuq P, Douris J, Ferrari L, Boutet-Robinet E, Lechevrel M, Demeilliers C, Rat P, Coudoré F, Verron E, Lacarelle B, Guitton J, Courtois A, Allorge D, Pain S, Guerbet M, Collin A, Vennat B, Brousse G, Authier N, Laporte C. Perception of pharmacy students toward opioid-related disorders and roles of community pharmacists: A French nationwide cross-sectional study. Subst Abus 2020; 42:706-715. [PMID: 33320801 DOI: 10.1080/08897077.2020.1850607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Community pharmacists are among the frontline health professionals who manage patients with an opioid-related disorder (ORD). Pharmacists frequently have a negative attitude toward these patients, which could have a negative impact on their management. However, education on ORD may improve the attitude of future healthcare professionals. This cross-sectional study aimed to assess French pharmacy students' perceptions of ORD. Methods: This online survey was performed by emails sent to French pharmacy schools (between January 14, 2019 and May 31, 2019). The primary outcome was the perception (visual analogic scale) of ORD as a disease, the roles of community pharmacies (delivery of opioid agonist therapy-OAT and harm reduction kits), and the efficacy of OAT. The secondary outcomes assessed professional experience, university experience of and education on ORD, and the individual characteristics of students. Results: Among the 1,994 students included, 76.3% perceived ORD as a disease and felt that it was normal for pharmacists to deliver OAT (78.9%) and harm reduction kits (74.6%). However, only 46.9% perceived OAT as being effective. Multivariable analyses showed that females had a more positive perception in recognizing ORD as a disease. The progression through university years increased the positive perception of ORD as a disease and the delivery of OAT and harm reduction kits by pharmacists. Education on substance-related disorders had no impact on any scores. Students who had already delivered OAT had a negative perception of their efficacy. The students who had already performed pharmacy jobs or traineeships had a negative perception of harm reduction kit delivery. Conclusion: Education on substance-related disorders had no impact on students' perceptions. It seemed that the maturity acquired through university years had a stronger impact on the students' perceptions of ORD. Efforts must be made to improve our teaching methods and reinforce the confidence of students in the roles of community pharmacists.
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Affiliation(s)
- David Balayssac
- Inserm U1107, NEURO-DOL, Université Clermont Auvergne, CHU Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à la recherche clinique et à l'innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Cuq
- Faculté de Pharmacie, Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, ENSCM, Université de Montpellier, Montpellier, France
| | - Juliette Douris
- UFR de Pharmacie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Luc Ferrari
- Institut Jean Lamour, UMR 7198 CNRS, Université de Lorraine, Nancy, France
| | - Elisa Boutet-Robinet
- Toxalim (Research Centre in Food Toxicology), INRAE, ENVT, INP-Purpan, UPS, Université de Toulouse, Toulouse, France
| | | | - Christine Demeilliers
- Environnement et Prédiction de la Santé des Populations, Laboratoire TIMC-IMAG (UMR-CNRS 5525), Université Grenoble-Alpes, La Tronche, France
| | - Patrice Rat
- Faculté de Pharmacie de Paris, CNRS UMR-8038 CiTCoM, Université de Paris, Paris, France
| | - François Coudoré
- Lab neuropharmacologie, CESP UMR-S1178, Université Paris-Saclay, Chatenay Malabry, Laboratoire de Microbiologie Clinique et Plateforme de dosage des anti-infectieux, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elise Verron
- UFR pharmacie, département E2M, CNRS 6230, Université de Nantes, Nantes, France
| | - Bruno Lacarelle
- SMARTc Unit, Centre de Recherche en Cancérologie de Marseille, Inserm U1068, Assistance Publique des Hôpitaux de Marseille, Laboratoire de Pharmacocinétique et Toxicologie, Université Aix Marseille, Marseille, France
| | - Jérôme Guitton
- Laboratoire de Toxicologie, ISPBL, Faculté de Pharmacie de Lyon, Université Lyon 1, Lyon, France
| | - Arnaud Courtois
- CHU de Bordeaux, Centre Antipoison et de Toxicovigilance de Nouvelle Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Delphine Allorge
- CHU Lille, Institut Pasteur de Lille, ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, Université de Lille, Lille, France
| | - Stéphanie Pain
- Laboratoire de Neurosciences Expérimentales et Cliniques - LNEC, INSERM U-1084, CHU Poitiers, Centre d'Addictovigilance, Pharmacologie clinique et vigilances, Université de Poitiers, Poitiers, France
| | - Michel Guerbet
- UNIROUEN, UNICAEN, ABTE, Normandie University, Rouen, France
| | - Aurore Collin
- Inserm U1107, NEURO-DOL, Université Clermont Auvergne, CHU Clermont-Ferrand, France
| | - Brigitte Vennat
- ACCePPT, UFR de Pharmacie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Georges Brousse
- EA7280, UFR de Médicine, CHU Clermont-Ferrand Service de Psychiatrie B et d'addictologie, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Inserm U1107, NEURO-DOL, Université Clermont Auvergne, CHU Clermont-Ferrand, France
| | - Catherine Laporte
- Département de Médecine Générale, EA7280, UFR de Médicine, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Pharmacy Students' Perceptions and Stigma Surrounding Naloxone Use in Patients with Opioid Use Disorder: A Mixed Methods Evaluation. PHARMACY 2020; 8:pharmacy8040205. [PMID: 33153144 PMCID: PMC7712231 DOI: 10.3390/pharmacy8040205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022] Open
Abstract
Pharmacists represent a key group of healthcare professionals that can increase awareness and destigmatize naloxone use. The objective of this study was to investigate pharmacy student perceptions of the use, dispensing, and stigma surrounding naloxone. An electronic survey was administered to pharmacy students that included questions about demographics, work history, naloxone use, and naloxone stigma. Separate qualitative interviews were performed to identify themes surrounding naloxone use. Two-hundred sixty-two participants completed the survey. The majority of participants were “highly willing” (74%) to fill a naloxone prescription for a patient and “somewhat comfortable” (38%) in counseling on naloxone; most were “somewhat comfortable” (38%) administering naloxone. Naloxone is “very rarely” (87%) recommended in community workplace settings, and the majority (64%) reported that patients never request information about naloxone availability. Seventy-six percent of respondents reported that naloxone-associated interactions have an influence on the way they communicate with patients in community pharmacy settings. Thematic analyses found that pharmacy students identify the importance of naloxone as a life-saving medication and the need for naloxone training, but patient-perceived stigma and limited access to naloxone remain prevalent. Pharmacy students are generally well-versed and inclined toward distributing, counseling on, and administering naloxone. Naloxone is rarely dispensed and patient conversations involving naloxone are infrequent in community settings. Future efforts focused on approaches toward difficult patient conversations and normalization of naloxone are needed to destigmatize and facilitate use.
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Tran T, Ball J, Bratberg JP, DeSimone EM, Franko TS, Hill LG, Sharp CPKK, Palombi L, Ventricelli D, Farrell D, Gandhi N, Moore T. Report of the 2020 Special Committee on Substance Use and Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:8421. [PMID: 34283760 PMCID: PMC7712728 DOI: 10.5688/ajpe8421] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.
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Affiliation(s)
- Tran Tran
- Midwestern University Chicago, College of Pharmacy, Downers Grove, Illinois
| | - Jennifer Ball
- South Dakota State University, College of Pharmacy and Allied Health Professions, Brookings, South Dakota
| | | | - Edward M DeSimone
- Creighton University, School of Pharmacy and Health Professions, Omaha, Nebraska
| | | | - Lucas G Hill
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | | | - Laura Palombi
- University of Minnesota, College of Pharmacy, Duluth, Minnesota
| | | | - Dorothy Farrell
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Terri Moore
- American Association of Colleges of Pharmacy, Arlington, Virginia
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Abstract
BACKGROUND Substance use disorder (SUD) is on the rise globally, and nurses are not prepared to care for this population. PURPOSE The purpose was to determine if a 4-hour antistigma intervention improved prelicensure student nurse attitudes and perceived stigma toward people with SUD. METHODS This was a nonrandomized quasi-experimental survey study. Participants completed the 20-item Drug and Drug Problems Perception Questionnaire (DDPPQ), the 8-item Perceived Stigma of Substance Abuse Scale (PSAS), and the 13-item Marlowe-Crowne Social Desirability Scale at baseline and repeated the DDPPQ and PSAS postintervention. Paired t tests were used to determine the mean differences in the total DDPPQ and total PSAS scores. RESULTS After the antistigma intervention, there was a significant improvement in overall therapeutic attitudes (t = 8.4, df = 108, P < .001) and perceived stigma (t = -2.5, df = 108, P = .01) in undergraduate nursing students (n = 126). CONCLUSIONS Incorporating antistigma educational approaches may lead to more involvement and compassionate care for people with SUD.
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Thomas J, Slat S, Woods G, Cross K, Macleod C, Lagisetty P. Assessing Medical Student Interest in Training About Medications for Opioid Use Disorder: A Pilot Intervention. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520923994. [PMID: 32537516 PMCID: PMC7268112 DOI: 10.1177/2382120520923994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Educating medical students about buprenorphine may lessen barriers to providing treatment for opioid use disorder (OUD) by addressing stigma, removing the need to complete training while practicing, and normalizing it as a pharmacological option. We conducted a needs assessment to measure student interest in buprenorphine waiver training and pilot tested an online course with an in-person discussion for feasibility and acceptability. METHODS All 2019 graduating students were surveyed to assess interest in completing buprenorphine waiver training and understand in which format they preferred to receive the training. Interested students received information about a free online buprenorphine waiver course and an optional in-person case discussion with a faculty member. Baseline and follow-up surveys were used to assess the intervention. RESULTS Out of 228 students contacted, 173 (75.9%) responded to at least 1 survey. Of the 228, 62 (27.2%) responded to the initial survey asking students about receiving buprenorphine waiver training. The 166 non-responding students were sent a second survey, and 111 (66.9%) students responded. Of those 111, 29 (26.1%) indicated they forgot to respond to the first survey, and 24 (21.6%) did not see the survey. Of the 62 interested students, 41 students (66.1%) wanted a combination of online and in-person training. Of the 62, 30 (48.4%) interested students completed the online course and 10 (16.1%) attended the case discussion. While not significantly different, a higher proportion of students (88.9%) indicated being likely to prescribe buprenorphine after attending the case discussion than after completing the online course only (69.2%). CONCLUSIONS This assessment suggested that most of the medical students are willing to complete a buprenorphine waiver course. Feedback indicated an in-person component could increase future prescribing more than an online-only curriculum, and additional advertising could result in higher participation.
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Affiliation(s)
- Jennifer Thomas
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie Slat
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gregory Woods
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristen Cross
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Colin Macleod
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Abstract
Across all care environments, pharmacists play an essential role in the care of people who use and misuse psychoactive substances, including those diagnosed with substance use disorders. To optimize, sustain, and expand these independent and collaborative roles, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has developed core competencies for pharmacists to address substance use in the 21st century. Key concepts, skills, and attitudes are outlined, with links to entrustable professional activities to assist with integration into a variety of ideally interdisciplinary curricular activities.
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Affiliation(s)
- Jeffrey Bratberg
- Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
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Langford DJ, Gordon DB, Loeseer JD, Tauben DJ, Doorenbos AZ. Evaluation of an interprofessional active learning session on acute pain and opioid use disorder using the interprofessional collaborative competency attainment scale. J Interprof Care 2019; 34:193-201. [DOI: 10.1080/13561820.2019.1629398] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Dale J Langford
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Debra B Gordon
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - John D Loeseer
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - David J Tauben
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Ardith Z Doorenbos
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, USA
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