Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes.

BACKGROUND AND OBJECTIVES: Strong evidence supports efficacy of medications for opioid use disorder (MOUD), but stringent prescribing policies impair access. Many physicians report discomfort prescribing MOUD due to inadequate knowledge. Most medical students believe MOUD training should occur during undergraduate medical education (UME). As legislation surrounding buprenorphine prescribing shifts, it is timely to consider how best to incorporate MOUD training into UME. METHODS: At the start of 3rd year, all students (n = 290) received a survey regarding experiences working with people with OUDs, and beliefs and knowledge regarding harm reduction and treatment. During orientation, students completed an 8-h online MOUD training. Afterwards, students completed another survey, including questions about training perceptions. RESULTS: One-third of students (32.8%) completed MOUD training and both surveys. Before training, 60.0% had not heard of the waiver, but 82.1% endorsed interest in prescribing buprenorphine. Despite mixed feelings about training content and delivery, 79.1% believed future classes should receive it. Most thought it should be integrated longitudinally throughout the curriculum rather than as separate online training. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Medical students want more MOUD education throughout their training; however, the 8-h online training may be less-than-optimal. As this training is no longer required to prescribe buprenorphine, there is an opportunity to modify the content presented. There is an urgent need for physicians with the knowledge and willingness to treat patients with OUD. Introducing integrated training about MOUD should help future physicians feel confident in their knowledge to treat patients and comfortable applying for the waiver.

Developing and validating an opioid overdose prevention and response curriculum for undergraduate medical education.

Introduction: As rates of overdose and substance use disorders (SUDs) increase, medical schools are starting to incorporate more content on SUDs and harm reduction in undergraduate medical education (UME). Initial data suggest these additions may improve medical student knowledge and attitudes toward patients with SUDs; however, there is no standard curriculum. Methods: This project uses a six-step approach to UME curricular development to identify needs and goals regarding SUDs and opioid overdose at a large single-campus medical school in the United States. We first developed and delivered a pilot curriculum to a small group of medical students. Pilot results and a larger survey led to implementing a one-hour Opioid Overdose Prevention and Response (OOPR) Training for first-year students. Effects of training were tracked using baseline and post-training surveys examining knowledge and attitudes toward opioid overdose and patients with SUDs. Results: Needs assessment indicated desire and need for training. The pilot study (N = 66) resulted in significantly improved knowledge regarding opioid overdose; 100% of students enjoyed training and believed others should receive it. The larger replication study surveyed all incoming students (N = 266) to gauge initial knowledge and experiences with these topics. Results prompted enhancement of the OOPR Training curriculum, which was delivered to half of the first-year class. Post-training survey results replicated the pilot study findings. The majority (95.2%) of students enjoyed training and 98.4% believed all students should receive it. Conclusion: Delivering a thorough curriculum on SUDs and harm reduction in UME is critical. Although many schools are implementing training, there is no standard curriculum. We outline a low-resource training intervention for OOPR. Our findings identified key features to include in these UME curricula. This approach provides a replicable template for schools seeking to develop brief educational interventions and identify essential content for curricula in SUDs and harm reduction.

Incoming medical students' knowledge of and attitudes toward people with substance use disorders: Implications for curricular training.

Background: Medical students may be in an ideal position to identify patients with substance use disorders (SUDs) and provide them with information about harm reduction and treatment options. Specific education regarding opioid use disorder (OUD) and naloxone during undergraduate medical training may help students identify these patients and decrease their own negative attitudes toward patients with OUD. To plan for curriculum development, this study aimed to understand baseline knowledge and attitudes among students entering medical school. Methods: During orientation, all first-year medical students (Class of 2023) were asked to complete a survey that explored their previous experiences in healthcare and with SUDs as well as their attitudes toward opioid overdose and patients with SUDs. We administered the Opioid Overdose Knowledge Scale (OOKS), Opioid Overdose Attitudes Scale (OOAS), Medical Conditions Regard Scale (MCRS), and Naloxone Related Risk Compensation Beliefs (NaRRC-B). Results: 266 students (89.6% of the class) completed the survey. Generally, these students were relatively proficient in opioid overdose knowledge, but did not feel they were competent enough to respond to an overdose. Attitudes toward patients with SUDs were mixed. Approximately half of the students thought naloxone distribution should be unrestricted, but many were uncertain whether naloxone receipt would deter individuals from seeking treatment or increase opioid use. Students' previous experiences in healthcare (e.g., employment) results in significantly different knowledge and attitudes toward opioid overdose response. Conclusions: These incoming medical students have greater healthcare experience and level of opioid overdose knowledge than the general population, but still harbor significant misinformation and stigma toward patients with SUDs. These findings provide a foundation upon which to tailor didactic efforts, starting early in medical school, so that graduating physicians can be adequately prepared for clinical care.

When Bad Things Happen: Training Medical Students to Anticipate the Aftermath of Medical Errors.

OBJECTIVE: Medical errors affect trainees. Existing curricula emphasize tenets of patient safety but rarely address the impact of medical errors on health care providers, particularly at the undergraduate level. The authors developed an interactive session exploring the professional and personal effects of medical errors for 300 second-year medical students. METHODS: The session utilized case-based learning, small group discussion, and video vignettes. Physicians in multiple specialties were interviewed, sharing narrative accounts of their experience with medical errors and adverse events. Discussions were facilitated by local physicians, who delivered content and shared personal anecdotes. Surveys using a 5-point Likert scale were conducted before and after the session. RESULTS: Pre- and post-test surveys resulted in 91 responses in 2016 and 174 in 2017. In 2016, results showed significant change in student responses by 0.34 units (SD 0.35 units; p < 0.001). Two survey items addressing student awareness and three items addressing confidence were significant. The domains assessing students' attitudes and knowledge regarding medical errors were not significant. In 2017, the overall mean change was 0.33 with a lower standard error, 0.03 (p < 0.001), showing significance in both years the session was delivered. CONCLUSION: A 1-h, small-group session increased medical students' understanding of the impact of medical errors and adverse events on providers and the supportive resources available. Recruitment of local faculty to facilitate discussions and share personal anecdotes enhanced the success of the session.

Building a strong foundation from the ground up: the impact of a medical student substance use disorder organization on curriculum and community.

Due to the increasing rates of substance use disorders (SUDs), accidental overdoses, and associated high mortality rates, there is an urgent need for well-trained physicians who can grasp these complex issues and help struggling patients. Preparing these physicians occurs through targeted education and clinical exposure in conjunction with medical school curricula in the field of addiction medicine. Medical students can often feel overwhelmed by the medical school curriculum and changes to the curriculum take time, money, and administrative commitment to ratify. Implementing a student organization dedicated to SUD education can be a solution to provide clinical exposure, education and student autonomy in their medical school experience. At Wayne State University School of Medicine, Detroit vs. Addiction (DvA) is a student-run organization that is filling the gap in SUD education for medical students whilst providing assistance to the community. DvA not only extends clinical education for physicians in training, but it also provides the medical school with an opportunity to allow students to create a blueprint for education initiatives that can be incorporated as a mainstay in the school's technical trainings. Herein, we describe the evolution of this organization and its activities.

Long-term effects of opioid overdose prevention and response training on medical student knowledge and attitudes toward opioid overdose: A pilot study.

BACKGROUND: Medical settings provide ideal opportunities to identify patients with substance use disorders and provide harm reduction and treatment resources. Medical students often volunteer in the community and can spend substantial time with patients, serving as touchpoints. Accordingly, medical schools have begun training in harm reduction. Initial studies show such training acutely improves knowledge, but sustained effects remain unclear. This pilot study explored longer-term impacts of Opioid Overdose Prevention and Response Training (OOPRT) on medical student knowledge about opioids, overdose, and naloxone. METHODS: Students completed a survey about knowledge of opioid use disorder, overdoses, and attitudes towards patients. This included Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales. A subset of students was invited to attend OOPRT and complete a post-training survey. All who completed the baseline survey were invited to complete a 6-month follow-up. We analyzed long-term training effects on OOKS and OOAS scores. RESULTS: 89 students completed baseline and 6-month follow-up surveys; of these, 22 received training. OOPRT yielded significant improvements in knowledge of signs of opioid overdose (F(2,38) = 18.04, P < .001), actions to take during overdose (F(2,38) = 8.32, P = .001), and naloxone use (F(2,38) = 35.46, P < .001), along with attitudes regarding overdose competencies (F(2,38) = 99.40, P < .001) and concerns (F(2,38) = 8.86, P < .001). When comparing over time, students who attended OOPRT retained significantly higher competency scores than those who did not attend F(1,87) = 40.82, P < .001). No other significant differences were observed. CONCLUSIONS: This study demonstrates immediate efficacy of OOPRT in improving opioid overdose knowledge and attitudes and sustained changes at 6 months, compared to standard undergraduate medical curricula alone. Future research with larger sample sizes is underway to validate these preliminary findings and examine the difference in attitudes and knowledge retention over time. Given that students report interest in receiving OOPRT and consider it worthwhile, systematic study is warranted.

Training medical students in opioid overdose prevention and response: Comparison of In-Person versus online formats.

Medical education has increasingly shifted towards replacing large lectures with a combination of online and smaller in-person group sessions. This study compares the efficacy of a virtual Opioid Overdose Prevention and Response Training (OOPRT) for first-year medical students with an identical in-person training. During their first unit of medical school, students in the class of 2023 (cohort 1) received OOPRT in-person and students in the class of 2024 (cohort 2) received training via Zoom. Aside from the delivery format, trainings were identical. Both cohorts completed identical surveys at medical school entry and post-training to evaluate knowledge and experiences using the Opioid Overdose Knowledge Scale, Opioid Overdose Attitudes Scale, Medical Conditions Regard Scale, and Naloxone Related Risk Compensation Beliefs. Of 430 students, 84.2% (362: 124 in cohort 1; 238 in cohort 2) completed baseline and post-training surveys. Students reported significantly improved opioid overdose knowledge and attitudes in all 4 knowledge and 3 attitudes subscales after training. Only one outcome differed by training type: knowledge of opioid overdose signs. Cohorts did not differ in opinions of training; 97.2% enjoyed it and 99.4% believed future classes should receive it. Medical students' attitudes and knowledge significantly improved after OOPRT; only one of 13 outcomes showed a cohort difference. There were no differences in enjoyment, indicating that switching to virtual learning does not undermine the learning experience. Further studies are needed to confirm that these results can be extended to other medical school topics where small group interactive discussion is preferred.

Eight-hour medication-assisted treatment waiver training for opioid use disorder: integration into medical school curriculum.

Background: The opioid epidemic is a growing problem in the USA. Use of medication-assisted treatment (MAT) has been effective in treating patients with opioid use disorders (OUD) and maintaining sobriety; however, there is a significant shortage of physicians formally trained in MAT. Objective: Wayne State University School of Medicine integrated the 8-hour MAT waiver training into its Internal Medicine clerkship curriculum. The objectives of integrating this into the curriculum were to (1) introduce opioid use education during students' Internal Medicine clerkship and (2) assess whether the curriculum prepares students to feel more comfortable evaluating and treating patients with OUD. Design: MAT training specifically for medical students was provided free online by the Providers Clinical Support System (PCSS). All students on the Internal Medicine clerkship were required to complete the training. A 7-question pre-survey and post-survey assessed students' comfort in evaluating and treating OUD. Significant changes were assessed with a paired McNemar Bowker Test. Results: Medical students (n = 141) completed the pre-survey and post-survey. After the MAT training, students' perspective of their clinical knowledge about OUD, familiarity with MAT, and likelihood to utilize MAT for their patients significantly differed, with increased proportions of medical students in agreement across 6 of 7 pre-post survey items (p <.0001). Conclusions: Online MAT waiver training is a low-cost (free) way to introduce MAT education into the undergraduate clinical curriculum. Upon completing of the training, medical students self-reported improvements in their knowledge and attitudes about OUD and the different treatment options. Our hope is that MAT waiver training will allow for graduation of medical students who are ready to care for patients with OUD during residency and as practitioners upon completion of their residency.

Sexual health education: a psychiatric resident's perspective.

OBJECTIVE: This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements. METHODS: An anonymous, web-based survey was sent to residents in one general psychiatry program (N=33). The response rate was 69.7%. RESULTS: Residents reported inadequate experience in multiple areas of sexual health. In every topic surveyed, 61.5% or more of the early residency group and 20% or more of the late residency group reported "none" or "too little" to both clinical and didactic experiences. Approximately one-half of residents responded that more time should be spent on every topic surveyed. The teaching modalities of didactics and outpatient clinical work were thought to provide the greatest educational benefit. CONCLUSION: Psychiatric residents value education regarding sexual health and would like more opportunities to learn about this topic.

Instagram as a Window to Societal Perspective on Mental Health, Gender, and Race: Observational Pilot Study.

BACKGROUND: Gender and race are known to impact attitudes toward mental health topics and help-seeking behavior. Men and minorities are more likely to cite stigma as a reason for not seeking help for mental health concerns, which is of particular relevance given the high rate of suicide in men and challenges of historic proportion currently facing minority communities. Instagram provides a platform to discuss mental health, though a lack of male and minority representation may further alienate these populations. OBJECTIVE: We aimed to investigate whether men and nonwhite individuals are underrepresented in Instagram photos tagged with #mentalhealth (compared to photos tagged with #health) to better understand how gender and race-based representations are manifested on this popular social media platform and discuss the implications. METHODS: Three investigators of different genders and racial backgrounds met on nine different days via teleconference to analyze a total of 215 publicly available Instagram photos tagged with #mentalhealth and 215 with #health. These photos were generated using Instagram's search function, and search results were sorted by most recently published at the time of data collection. For each photo, the three investigators recorded their observations about the gender (male versus female) and race (white versus nonwhite versus racially unclassifiable) of subjects featured in the photo, which they did not discuss with other investigators. Chi-squared analysis was performed on each investigator's data set to compare the frequency of male versus female and white versus nonwhite subjects identified in each hashtag category. Kappa interrater agreement was calculated for each investigator pair, category (gender or race), and hashtag. RESULTS: All three investigators observed significantly more female as compared to male subjects in photos tagged with #mentalhealth (X2=14.4, P<.001 for all investigators) while observing no significant difference between numbers of male and female subjects in photos tagged with #health (X2=1.533, P=.22; X2=1.241, P=.27; X2=0.096, P=.76). All three investigators identified significantly more white than nonwhite subjects in photos tagged with both #health and #mentalhealth (X2 values range from 11.912 to 98.927, P<.001 for all). Kappa interrater agreement revealed almost perfect agreement for gender (kappa=0.908-0.992) with the agreement for race ranging from 0.614 to 0.822, depending on hashtag and rater pair. CONCLUSIONS: Women are featured more frequently than men in Instagram photos tagged with #mentalhealth. The topic of #health, meanwhile, is not gendered this way. Low visibility of mental health among men may both represent and exacerbate existing stigma and barriers to care. White subjects are featured significantly more frequently than nonwhite subjects in photos tagged with both #mentalhealth and #health. Directed interventions using the Instagram platform may be indicated to increase the visibility of underrepresented groups and break the cycle of stigma.