“It’s that longitudinal relationship that pays off”: A qualitative study of internal medicine residents’ perspectives on learning to prescribe buprenorphine

Abstract

Background: The opioid use disorder (OUD) epidemic is a national public health crisis. Access to effective treatment with buprenorphine is limited, in part because few physicians are trained to prescribe it. Little is known about how post-graduate trainees learn to prescribe buprenorphine or how to optimally train them to prescribe. We therefore aimed to explore the experiences and attitudes of residents learning to prescribe buprenorphine within two primary care-based opioid treatment models. Methods: We performed semi-structured interviews with second- and third-year internal medicine residents at an urban academic residency program. Participating residents practiced in clinics providing buprenorphine care using either a nurse care manager model or a provider-centric model. Subjects were sampled purposively to ensure that a diversity of perspectives were included. Interviews were conducted until theoretical saturation was reached and were analyzed using principles of thematic analysis. The research team developed a consensus code list. Each transcript was then independently coded by two researchers. The team then summarized each code and generated a set of themes that captured the main ideas emerging from the data. Results: We completed 14 interviews. Participants reported learning to prescribe buprenorphine through didactics, longitudinal outpatient prescribing, mentorship, and inpatient experiences. We characterized their attitudes toward patients with OUD, medication treatment of OUD, their own role in buprenorphine care, and future prescribing. Participants practicing in both clinical models viewed learning to prescribe buprenorphine as a normal part of their training and demonstrated positive attitudes toward buprenorphine prescribing. Conclusions: Longitudinal outpatient experiences with buprenorphine prescribing can prepare residents to prescribe buprenorphine and stimulate interest in prescribing after residency. Both nurse care manager and provider-centric clinical models can provide meaningful experiences for medical residents. Educators should attend to the volume of patients and inductions managed by each trainee, patient-provider continuity, and supporting trainees in the clinical encounter.

Keywords:

• Buprenorphine
• graduate medical education
• opioid use disorder
• office-based opioid treatment

Acknowledgements

The authors wish to acknowledge Jesse Moritz, B.A. for coordinating and performing the interviews upon which this study is based, as well as her assistance in revising the interview guide.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors, AL, HJ, JD, and JK together designed this study, formulated a consensus code list, coded transcripts, and analyzed the data to generate themes. AL led the writing of this manuscript. HJ, JD, and JK provided critical feedback and contributed to the writing of the manuscript. All authors had the opportunity to review the final manuscript prior to submission.

Additional information

Funding

The University of Washington Division of General Internal Medicine provided funds for transcription costs and analytic software. This research did not receive any other specific grant from funding agencies in the public, commercial, or not-for-profit sectors.