"From All Walks of Life": Attending an Alcoholics Anonymous Meeting to Reduce Addiction Stigma Among Medical Students

Effects of Stigmatizing Language on Trainees' Clinical Decision-Making in Substance Use Disorders: A Randomized Controlled Trial

OBJECTIVES

Substance use disorder (SUD) continues to be one of the most stigmatized and under-treated conditions in the United States. Stigmatizing language used by healthcare workers can transmit bias to others within healthcare, including medical trainees. This study investigates how stigmatizing language and undergraduate medical education (UME) curricula may influence trainees' clinical decision-making for patients with SUD.

METHODS

Medical students from three Chicago-area medical schools were randomized to review either a stigmatizing or neutral version of a clinical scenario describing a patient experiencing opioid withdrawal. Participants (a) selected treatment plans for the fictional patient using two multiple-choice questions, (b) completed the Medical Condition Regard Scale (MCRS) to assess their attitudes, and (c) reported prior SUD experiences, both curricular and personal. Statistical analyses explored whether treatment decisions were influenced by attitudes, addiction medicine curricula, and exposure to the stigmatizing vignette.

RESULTS

Among the 366 medical students who completed this study, exposure to stigmatizing language (n = 191) led to clinical decision-making that would be less effective in treating opioid withdrawal for the fictional patient (p = 0.027; η2 = 0.013). Exposure to more SUD education during UME was correlated with more effective clinical decision-making for opioid withdrawal (β = 0.181; R2 = 0.033; p < 0.001) but was not correlated with attitudes toward patients with SUD (p = 0.231).

CONCLUSIONS

Stigmatizing language influences clinical decision-making when treating patients with SUD. Improving SUD education within UME may be an effective strategy for mitigating this effect within medical trainees.

Substance Use Disorder Stigma and Professional Decision Making Among Pre-Professional Healthcare Trainees

Provider stigma toward people who have substance use disorders (SUDs) may be a barrier to effective treatment delivery. The purpose of this study was to measure provider stigma among healthcare professionals-in-training and determine whether stigma levels were associated with professional decision making. A sample of 240 participants were recruited from the following academic programs at a large university in the southeastern United States: Nursing, Social Work, Counseling, Marriage and Family Therapy, and Psychology. Through an online, anonymous survey, provider stigma and other constructs were measured. The participants were also asked to make two hypothetical professional decisions: one regarding their choice to provide treatment for an SUD patient and the other regarding their likelihood of attending a professional development event (i.e., conference session) on the topic of SUDs. Results showed that self-reported stigma toward patients with SUDs was associated with a reduced likelihood of choosing to provide treatment for a patient with SUD (compared to patients with other conditions) and a reduced likelihood of attending SUD training at an upcoming conference (compared to other conference topics). Results have potential implications for the development of training programs for pre-professional healthcare trainees.

Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study

BACKGROUND

Stigma surrounding substance use disorder (SUD) is highly prevalent in health care. Negative attitudes toward patients with SUD have been shown to negatively impact patient care. Addressing SUD stigma in medical students is a promising approach, however, few curricula include experiential learning on addiction psychiatry clinical services. We describe a medical student rotation on an addiction psychiatry clinical service and examine its effect on attitudes toward patients with SUD.

METHODS

Medical students were integrated onto an addiction psychiatry consultation-liaison service serving medically/surgically hospitalized patients with co-occurring SUD and other psychiatric disorders. Students learned and practiced in-person assessment of patients and received instruction on basic principles of psychiatry and evaluation and management of SUD. A targeted anti-stigma curriculum was included. Attitudes toward patients with SUD were measured with the Medical Condition Regard Scale (MCRS) before and after the experience. Each item of the MCRS and an overall composite attitude score were analyzed.

RESULTS

Of the 36 students on the clinical rotation, 33 completed the survey. Attitudes showed widespread improvement toward patients with SUD. Mann-Whitney U tests showed significant improvement in most items of the MCRS. Further analysis of composite scores showed an improvement in overall attitudes toward patients with SUD.

CONCLUSIONS

Inclusion of medical students on an addiction psychiatry consult service as part of the core psychiatry clerkship may hold promise for helping improve student attitudes and decrease stigma toward patients with SUD. Controlled study is needed to compare other clinical experiences and determine specific causative effects.

How does problem-solving pedagogy affect creativity? A meta-analysis of empirical studies

The purpose of this study was to investigate the effects of problem-solving pedagogy on individual students' creativity in different teaching contexts and conditions, and to examine the role of moderating variables that may affect the overall effect size. The study screened 19 relevant studies from the Web of Science for inclusion in the meta-analysis, and extracted 77 effect sizes from these studies that could be used in the meta-analysis. The study first explored the relationship between problem-solving pedagogy and the development of learner creativity, and further analysis focused on moderating variables to investigate the effects of instructional method, grouping method, grade level, problem-solving scaffolding, source of problems, the application of thinking tools, and the application of technology. The results showed that problem-solving pedagogy enhances students' creativity, while at the same time, among the sources of problems, student-discovered problems are most conducive to creativity stimulation, while teacher-determined problems and problems that lead to student discovery are less effective in terms of promoting creativity. Among the grouping methods, heterogeneous grouping can better utilize the creativity cultivation effect of the problem-solving pedagogy than random grouping and homogeneous grouping. Among the different levels of grades, learners in elementary school are better able to gain creativity under the influence of problem-solving pedagogy than learners in middle school, high school, college, and those in on-the-job learning. However, this study did not reveal any significant benefits for creativity enhancement under the four conditions of instructional method, problem-solving scaffolding, thinking tools-assisted, or technology. The results of this study clarify the importance of problem-solving pedagogy for creativity development, and also reveal the actual effects of the various ways of applying problem-solving pedagogy on creativity development as well as the problems that exist, which provides inspiration for how to better utilize problem-solving pedagogy in the future.

Rewriting the Hidden Curriculum via Addiction Consult Services: Meeting Patients Where They Are At

Addiction Consult Services (ACS) deliver evidence-based care for patients with substance use disorder (SUD) during the course of general hospital admissions. Stigma toward patients with SUD is a known phenomenon and is part of the "hidden curriculum" that permeates medical training and healthcare settings. ACS have the potential to rewrite the hidden curriculum around SUD and to teach medical students and other trainees how to compassionately care for this patient population. Here, the authors explore the role of stigma within the hidden curriculum of medical training and outline how ACS can successfully contribute to combatting this stigma. The authors highlight two institutions' approaches to educational initiatives that incorporate health professional trainees into ACS. The authors end by providing a vision of how expansion of ACS can promote interdisciplinary learning for healthcare providers amidst the changing landscape of SUD treatment in the USA.

Transformative Learning and Critical Consciousness: A Model for Preclerkship Medical School Substance Use Disorder Education

OBJECTIVE

Preparing medical students to provide compassionate person-centered care for people with substance use disorders (SUD) requires a re-envisioning of preclerkship SUD education to allow for discussions on stigma, social determinants of health, systemic racism, and healthcare inequities. The authors created a curricular thread that fosters the development of preclerkship medical students' critical consciousness through discussion, personal reflection, and inclusion of lived experiences.

METHODS

The authors used transformative learning theories to design and implement this thread in the 2021-2022 academic year in the Duke University School of Medicine preclerkship curriculum. Content included lectures, person-centered workshops, case-based learning, motivational interviewing of a standardized patient, and an opioid overdose simulation. Community advocates and people with SUD and an interdisciplinary faculty were involved in the thread design and delivery and modeled their lived experiences. Students wrote a 500-word critical reflection essay that examined their personal beliefs in the context of providing care for people with SUD.

RESULTS

One hundred and twenty-two students submitted essays and 30 (25%) essays were randomly selected for a qualitative analysis. Seven major themes emerged: race/racism, systemic barriers, bias and stigma, personal growth/transformation, language or word usage, future plans for advocacy, and existing poor outcomes. Students were able to link material with prior knowledge and experiences, and their attitudes towards advocacy and goals for future practice were positively influenced.

CONCLUSION

By aligning the thread design with the principals of transformative learning, students developed their critical consciousness toward people with SUD and cultivated a holistic understanding of SUD.

A call for increased addiction psychiatrist engagement in medical student education

BACKGROUND AND OBJECTIVES

Addiction psychiatrists are ideally trained to provide trainees with supervised clinical experiences in caring for patients with co-occurring substance use disorders and other complex psychiatric disorders.

METHODS

This is a call for addiction psychiatrists to step up as clinical champions in medical student education. Our targeted audience is practicing addiction psychiatrists who do not currently have medical students on their clinical services.

RESULTS

We suggest several approaches to incorporating learners into existing addiction psychiatry clinical services both at academic institutions and in the community.

DISCUSSION AND CONCLUSIONS

For medical schools without addiction psychiatrists on faculty, we suggest unique solutions for collaborating with external educational venues.

SCIENTIFIC SIGNIFICANCE

There is limited literature on the role of addiction psychiatrists in providing supervised experiential learning experiences for medical students. There has been no previous publication specifically advocating for increased addiction psychiatrist engagement in the clinical education of medical students.