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Fockele C, Lindgren E, Ferreira J, Salehipour D, Shandro J, Jauregui J. Community-engaged pedagogy in an emergency medicine clerkship: Teaching trauma-informed addiction care and harm reduction through a peer-assisted learning case. AEM EDUCATION AND TRAINING 2024; 8:e10989. [PMID: 38765708 PMCID: PMC11101990 DOI: 10.1002/aet2.10989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 05/22/2024]
Abstract
Background The impact of opioid use disorder (OUD) in the United States continues to rise, yet this topic has limited coverage in most medical school curricula. The study partnered with academic and community harm reductionists to design a peer-assisted learning case of opioid withdrawal to teach fourth-year medical students about trauma-informed OUD care and harm reduction services during their emergency medicine clerkship. Methods Academic and community harm reductionists iteratively codesigned this case in partnership with the research team. Community-engaged pedagogy informed this process to promote social action and power sharing through education. This case was integrated into the existing weekly peer-assisted learning curriculum (i.e., medical students teaching medical students through a structured case) for all fourth-year medical students during their required emergency medicine clinical rotation. Participants completed a postcase evaluation survey. Results Sixty-four medical students completed the survey between June and November 2022. A total of 98.5% of participants found the educational session quite or extremely relevant to their medical education, and 87.5% believed the case to be quite or extremely effective in achieving the learning objectives. A total of 45.3% initially felt quite or extremely competent in talking with patients about their drug use, whereas 53.2% felt quite or extremely more competent after participating in the case. Finally, 21.9% initially felt quite or extremely competent in proposing a treatment plan for a patient who uses drugs, whereas 62.5% felt quite or extremely more competent after participating in the case. Conclusions This study supports the feasibility and importance of incorporating the voices of people with lived and living experience into medical school curricular development. This peer-assisted learning case focused on the treatment of OUD in the emergency department was seamlessly integrated into the existing curriculum and well received by medical students. By engaging local experts, it could easily be adapted and expanded to other sites.
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Affiliation(s)
- Callan Fockele
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Elsa Lindgren
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jordan Ferreira
- University of Washington School of MedicineSeattleWashingtonUSA
| | - Dena Salehipour
- University of Washington School of Public HealthSeattleWashingtonUSA
| | - Jamie Shandro
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Joshua Jauregui
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
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Saberi SA, Moore S, Li S, Mather RV, Daniels MB, Shahani A, Barreveld A, Griswold T, McGuire P, Connery HS. Systemized approach to equipping medical students with naloxone: a student-driven initiative to combat the opioid crisis. BMC MEDICAL EDUCATION 2024; 24:241. [PMID: 38448949 PMCID: PMC10916177 DOI: 10.1186/s12909-024-05221-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Naloxone is an effective and safe opioid reversal medication now approved by the U.S. Food and Drug Administration (FDA) for use with or without a prescription. Despite this, naloxone dissemination lags at a time when U.S. opioid-related mortality expands. The authors proposed distributing naloxone to all U.S. medical students using established statewide standing prescription orders for naloxone, eliminating the financial burden of over-the-counter costs on students and streamlining workflow for the pharmacy. By focusing naloxone distribution on medical students, we are able to capitalize on a group that is already primed on healthcare intervention, while also working to combat stigma in the emerging physician workforce. METHODS Beginning August 2022, the authors established a partnership between Harvard Medical School (HMS) and the outpatient pharmacy at Brigham and Women's Hospital (BWH) to facilitate access to naloxone for HMS medical students. BWH developed a HIPAA-secure electronic form to collect individual prescription information. BWH pharmacists processed submissions daily, integrating the naloxone prescription requests into their workflow for in-person pick-up or mail-order delivery. The electronic form was disseminated to medical students through a required longitudinal addiction medicine curriculum, listserv messaging, and an extracurricular harm reduction workshop. RESULTS Over the 2022-2023 academic year, 63 medical students obtained naloxone kits (two doses per kit) through this collaboration. CONCLUSIONS We propose that medical schools advocate for a hospital pharmacy-initiated workflow focused on convenience and accessibility to expand naloxone access to medical students as a strategy to strengthen the U.S. emergency response and prevention efforts aimed at reducing opioid-related morbidity and mortality. Expansion of our program to BWH internal medicine residents increased our distribution to over 110 healthcare workers, and efforts to expand the program to other BWH training programs and clinical sites such as the emergency department and outpatient infectious disease clinics are underway. With more than 90,000 medical students in the U.S., we believe that widespread implementation of targeted naloxone training and distribution to this population is an accessible approach to combating the public health crisis of opioid-related overdoses.
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Affiliation(s)
| | | | - Sienna Li
- Harvard Medical School, Boston, MA, USA
| | - Rory Vu Mather
- Harvard Medical School, Boston, MA, USA.
- Harvard/MIT MD-PhD Program, Boston, MA, 02115, USA.
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Program in Health, Sciences, and Technology, Massachusetts Institute of Technology, Boston, MA, USA.
| | - Mary B Daniels
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Amrita Shahani
- Outpatient Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Antje Barreveld
- Department of Anesthesiology, Newton-Wellesley Hospital, Newton, MA, USA
| | - Todd Griswold
- Harvard Medical School, Boston, MA, USA
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Patrick McGuire
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Hilary S Connery
- Harvard Medical School, Boston, MA, USA
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA
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Smith KR, Shah NK, Adamczyk AL, Weinstein LC, Kelly EL. Harm reduction in undergraduate and graduate medical education: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:986. [PMID: 38129846 PMCID: PMC10734177 DOI: 10.1186/s12909-023-04931-9] [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: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients' ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.
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Affiliation(s)
- Kelsey R Smith
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA.
| | - Nina K Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, #100, Philadelphia, PA, 19107, USA
| | - Abby L Adamczyk
- Scott Memorial Library, Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA, 19107, USA
| | - Lara C Weinstein
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
- Center for Social Medicine and Humanities, University of California Los Angeles, B7-435, Semel Institute, Los Angeles, CA, 90095-1759, USA
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Shang M, Thiel B, Liebschutz JM, Kraemer KL, Freund A, Jawa R. Implementing harm reduction kits in an office-based addiction treatment program. Harm Reduct J 2023; 20:163. [PMID: 37919741 PMCID: PMC10621216 DOI: 10.1186/s12954-023-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The rising rates of drug use-related complications call for a paradigm shift in the care for people who use drugs. While addiction treatment and harm reduction have historically been siloed in the US, co-location of these services in office-based addiction treatment (OBAT) settings offers a more realistic and patient-centered approach. We describe a quality improvement program on integrating harm reduction kits into an urban OBAT clinic. METHODS After engaging appropriate stakeholders and delivering clinician and staff trainings on safer use best practices, we developed a clinical workflow for universal offering and distribution of pre-packaged kits coupled with patient-facing educational handouts. We assessed: (1) kit uptake with kit number and types distributed; and (2) implementation outcomes of feasibility, acceptability, appropriateness, and patient perceptions. RESULTS One-month post-implementation, 28% (40/141) of completed in-person visits had at least one kit request, and a total of 121 kits were distributed. Staff and clinicians found the program to be highly feasible, acceptable, and appropriate, and patient perceptions were positive. CONCLUSIONS Incorporating kits in OBAT settings is an important step toward increasing patient access and utilization of life-saving services. Our program uncovered a significant unmet need among our patients, suggesting that kit integration within addiction treatment can improve the standard of care for people who use drugs.
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Affiliation(s)
- Margaret Shang
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brent Thiel
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Research on Healthcare, University of Pittsburgh School of Medicine, 3609 Forbes Ave, Pittsburgh, PA, 15213, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Research on Healthcare, University of Pittsburgh School of Medicine, 3609 Forbes Ave, Pittsburgh, PA, 15213, USA
| | - Ariana Freund
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raagini Jawa
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Center for Research on Healthcare, University of Pittsburgh School of Medicine, 3609 Forbes Ave, Pittsburgh, PA, 15213, USA.
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Rife-Pennington T, Dinges E, Ho MQ. Implementing syringe services programs within the Veterans Health Administration: facility experiences and next steps. J Am Pharm Assoc (2003) 2023; 63:234-240. [PMID: 36470732 DOI: 10.1016/j.japh.2022.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/20/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
Abstract
Syringe services programs are community-based prevention programs that provide evidence-based, lifesaving services for people who use illicit drugs, including access to syringes, naloxone, fentanyl test strips, infection screening, and linkage to treatment. Historically, syringe services programs did not exist within the Veterans Health Administration owing to many factors, including lack of clarity regarding legality for federal agency-purchased syringes. Three champions at Veterans Affairs facilities in Danville, IL, Orlando, FL, and San Francisco, CA, worked to clarify legal considerations, address barriers, and implement syringe services programs that are integrated in the health care systems. Since 2017, these 3 programs have engaged approximately 400 Veterans and distributed nearly 10,000 syringes, 2500 fentanyl test strips, 50 wound care kits, and 45 safer sex kits. These programs, both led by and in collaboration with clinical pharmacist practitioners, paved the way for nationwide implementation within the Veterans Health Administration. This commentary describes successes, challenges, and proposed next steps to increase Veteran access to syringe services programs, written from the perspective of 3 facility-based champions.
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