Use of Immersive Learning and Simulation Techniques to Teach and Research Opioid Prescribing Practices

Simulation-Based Education in Acute and Chronic Pain Training

PURPOSE OF REVIEW

The use of simulation-based education (SBE) in medical training has expanded greatly and has grown to include high fidelity and task simulation along with hybrid models using patient actors to enhance education and training of critical events as well as technical skills.

RECENT FINDINGS

In the field of anesthesiology, SBE has been particularly useful for crisis resource management and rare critical scenarios and new research into the use of SBE using task simulation for procedural skill development has been done highlighting the benefits to subspecialty procedural training. Medical simulation has become a common practice in medical training and research. SBE has demonstrated positive outcomes in improving technical skills, knowledge, comfort, and clinical performance. The widespread implementation of SBE in regional anesthesia and chronic pain training varies, with cost and availability being factors. Nonetheless, SBE has shown great potential in enhancing education and preparing physicians in subspecialties of anesthesia.

Time on shift in the emergency department and decision to prescribe opioids to patients without chronic opioid use

Objective To study the effect of time on shift on the opioid prescribing practices of emergency physicians among patients without chronic opioid use.Methods We analyzed pain-related visits for five painful conditions from 2010 to 2017 at a single academic hospital in Boston. Visits were categorized according to national guidelines as conditions for which opioids are “sometimes indicated” (fracture and renal colic) or “usually not indicated” (headache, low back pain, and fibromyalgia). Using conditional logistic regression with fixed effects for clinicians, we estimated the probability of opioid prescribing for pain-related visits as a function of shift hour at discharge, time of day, and patient-level confounders (age, sex, and pain score).Results Among 16,115 visits for which opioids were sometimes indicated, opioid prescribing increased over the course of a shift (28% in the first hour compared with 40% in the last hour; adjusted odds ratio, 1.06; 95% confidence interval, 1.02–1.10; adjusted P-trend <0.01). However, among visits for which opioids are usually not indicated, relative to the first hour, opioid prescriptions progressively fell (40% in the first hour compared with 23% in the last hour; adjusted odds ratio, 0.93; 95% confidence interval, 0.91–0.96; adjusted P-trend <0.01).Conclusion As shift hour progressed, emergency physicians became more likely to prescribe opioids for conditions that are sometimes indicated, and less likely to prescribe opioids for nonindicated conditions. Our study suggests that clinical decision making in the emergency department can be substantially influenced by external factors such as clinician shift hour.

e-Learning in regional anesthesia

PURPOSE OF REVIEW

To explore the role and impact of e-learning technologies on regional anesthesia.

RECENT FINDINGS

21st century technologies, such as 'smart' medical appliances, personal computers, sophisticated apps, the ubiquitous Internet, and online 'e-learning' curricula, are having a powerful impact on anesthesia training: when we learn, what we learn, and how we learn. But is 'new' necessarily 'better'? The answer will result from the application of developments in IT technology through the current vision of architects of future anesthesia training programs. This narrative review aims to summarize the recent developments in anesthesia e-learning, and to forecast trends using regional anesthesia as an example.

SUMMARY

The review offers some recommendations to ensure that the blessings promised to human learning by this 'Brave New Cyberworld' do not become its nemesis.

Introducing Simulation-Based Learning for Trainees in Chronic Pain Medicine: Needs Assessment and Suggestions for Training Scenarios

INTRODUCTION

Managing patients with chronic pain can be complex and requires specialized clinical knowledge and advanced communication skills. Simulation-based learning has been shown to improve learning outcomes for complex competencies and could be a valuable resource for trainees in chronic pain medicine.

METHODS

We assessed the need for a simulation-based course for trainees in chronic pain medicine at McMaster University in Canada. The needs assessment consisted of three steps: (1) literature review to identify preexisting needs assessments, (2) targeted interviews with six healthcare professionals in chronic pain management, and (3) an analysis of 366 routinely collected patient experience surveys.

RESULTS

The systematic review identified a small body of related literature and no previous needs assessment. We identified the following key competencies and skills that trainees in pain medicine need to develop: (1) communicating with distressed patients using skills such as de-escalation, active listening, and motivational interviewing, (2) managing patients in difficult emotional situations such as poorly controlled pain or showing signs of opioid misuse, and (3) recognizing and managing mental health issues related to chronic pain using appropriate instruments.

DISCUSSION

Suggestions for scenarios included the following: (1) consulting a patient with poor pain control and running out of treatment options, (2) managing a patient with suspected inappropriate opioid use, and (3) diagnosing depression in a patient suffering from chronic pain and developing an appropriate treatment plan.

CONCLUSION

We propose the development of suggested scenarios into simulation-based courses, and test and refine them together with trainees and experts in pain medicine.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01335-6.

An Objective Structured Clinical Examination Case for Opioid Management: Standardized Patient Ratings of Communication Skills as a Predictor of Systems-Based Practice Scores

The Wayne State University Office of Graduate Medical Education (WSUGME) uses an objective structured clinical examination (OSCE) to assess its programs' contribution to enhancing residents' communication skills. In response to revisions in Michigan's opioid-prescribing mandates in 2017, WSUGME developed a pain management case in collaboration with faculty and the Wayne State University School of Medicine to educate residents about these mandates while gauging their skills in Systems-Based Practice (SBP), an Accreditation Council for Graduate Medical Education Core Competency. This study examined whether resident OSCE performance predicted year-end milestones scores in SBP1 (coordinates patient care within various health care delivery settings), SBP2 (works in interdisciplinary teams to enhance patient safety and improve patient care quality), and SBP3 (practices and advocates for cost-effective, responsible care). Participants included two cohorts of first- (PRG-1) and second-year (PRG-2) residents in 6 programs: one cohort from academic year 2018-2019 (n=33), the other from 2019-2020 (n=37). Before the OSCE, WSUGME emailed residents the new state prescription requirements. During the simulated encounter, standardized patients rated residents on a validated communication instrument, and WSUGME conducted a linear regression of patient ratings on resident SBP milestone scores. The ratings of communication skills of PRG-1 residents did not predict any of the year-end SBP milestones. However, ratings of communication skills of PRG-2 residents predicted SBP1 and SBP2, though not SBP3, milestones. The OSCE opioid case proved to be a valid measure of PRG-2 residents' competence gained across the first year but was less meaningful when applied to PRG-1 residents.