Opioid stewardship training during the transition to residency to prepare medical students to recognize and treat opioid use disorder

Abstract

Background: With a drastic shortage of addiction medicine specialists—and an ever-growing number of patients with opioid use disorder (OUD)—there is a dire need for more clinicians to feel confident in prevention and management of OUD and obtain a DEA-X waiver to prescribe medications to treat OUD. Here we determine if it is feasible to certify 4th year medical students with DEA-X waiver training as a component of the PROUD (Prevent and Reduce Opioid Use Disorder) curriculum, and if PROUD enhanced preparedness for medical students to manage OUD as interns. Methods: We implemented a sequential mixed-methods IRB approved study to assess feasibility (completing all required components of DEA-X waiver training) and impact of PROUD (measured by knowledge growth, enhancement for residency, and utilization of training during internship). Students completed 11 hours of required OUD training. Quantitative data included pre-/post- knowledge and curriculum satisfaction assessments as well as long-term impact with follow up survey as interns. Qualitative data was collected by survey and semi-structured focus groups. Results: All 120 graduating medical students completed the required components of the curriculum. Knowledge improved on the Provider Clinical Support Services (12.9–17.3, p < 0.0001) and Brief Opioid Overdose Knowledge assessments (10.15–10.81, p < 0.0001). Course satisfaction was high: 90% recommended online modules; 85% recommended training overall. Six qualitative themes emerged: (1) curriculum content was practical, (2) online modules allowed flexibility, (3) in-person seminars ensured authenticity, (4) timing at the transition to residency was optimal, (5) curriculum enhanced awareness and confidence, and (6) training was applicable to future careers. At 3 months, 60% reported using their training during internship; 64% felt more prepared to treat OUD than peers. Conclusions: PROUD trained 4th year medical students in opioid stewardship. As interns, students felt ready to serve as change agents to prevent, diagnose, and treat OUD.

Keywords:

• DATA 2000 waiver
• opioid stewardship
• transition to residency
• medical education
• buprenorphine
• MOUD
• OUD

Acknowledgements

Research supported in part by the Qualitative and Patient-Reported Outcomes Developing Shared Resource of the Wake Forest Baptist Comprehensive Cancer Center’s NCI Cancer Center Support Grant P30CA012197.

Project and research supported by the Governor’s Institute in partnership with Providers Clinical Support System, the American Association of Addiction Psychiatry and SAMHSA.

Ethical approval

This study was reviewed and approved by the Institutional Review Board of Wake Forest School of Medicine (IRB00057215).

Disclosure statement

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

Author contributions

All authors participated in main conceptual ideas and design. PME, MLJ, RES were responsible for data collection and analysis. Details on contribution of qualitative data analysis is described in methods. All authors discussed interpretation of results and general themes of the qualitative data presented. PME and MLJ drafted the manuscript, and all authors provided significant edits and reviews.

Additional information

Funding

Support for this initiative was made possible from SAMHSA, in part, by grant nos. 1H79TI081656 and 1H79TI081968. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.