Interprofessional Substance Use Disorder Education in Health Professions Education Programs: A Scoping Review

Family-Centered Care and Collaboration: A Scoping Review of Medical Guidance for Parental Substance Use

BACKGROUND

A significant proportion of US families are affected by substance use disorders. Both child- and adult- serving systems are called upon to care for families, yet the disciplines involved inherently have different priorities, preventing a true family-centered care model.

OBJECTIVES

The purpose of the scoping review was to explore the alignment of current national guidance related to the medical care of families affected by substance use disorders (SUD). In the review, we examined 1) the quality of the documents, 2) the documents' positions within the continuum of family-centered care and the promotion of multidisciplinary collaboration, and 3) potential gaps in the promotion of services for families.

METHODS

We chose a priori to manually examine the websites of national medical and public health associations for clinical practice and policy recommendations. We included documents published between 2016 and 2023 with selected keywords, totaling seven documents for review. We operationalized and rated each document's recommendations based on their promotion of "family-centered care" and "multidisciplinary collaboration."

RESULTS

The quality of each document varied, with an average score of 5.2 out of 7. The average family-centeredness rating was 3.0 out of 7; five of the seven documents prioritized the parent's care over the child's. The average multidisciplinary collaboration rating was 2.8 out of 7.

CONCLUSIONS

Overall, we found low to moderate family-centered and multidisciplinary collaboration scores. Collectively, these findings suggest that despite these practices emerging as optimal for the care of families affected by SUD, the promotion of these practices has yet to be fully adopted in guidance statements by national medical disciplines.

Effect of E-learning clinical management of substance-dependent pregnant women on the knowledge and clinical skill performance of midwives: a randomized controlled trial

BACKGROUND

Drug use during pregnancy and post-partum undoubtedly significantly affects maternal and infant morbidity. Healthcare providers, especially midwives who care for pregnant and postpartum women, must possess adequate knowledge and clinical skills to manage their patients appropriately. This study aimed to determine the effect of an e-learning intervention on midwives' knowledge and clinical performance skills in caring for substance-dependent pregnant women during labor and post-partum.

METHODS

A randomized controlled trial based on e-learning was conducted in Shiraz, Iran. One hundred midwives working in governmental maternity hospitals were recruited and randomly assigned to the intervention (n = 50) or control (n = 50) group through blocked randomization. The intervention group underwent e-learning for 4 weeks on clinical considerations during labor and post-partum of substance-dependent mothers. The control group received no educational intervention from the research group. Pre-test, post-test, and one-month retention tests included a knowledge assessment questionnaire and an objective structured clinical examination test to assess clinical skill performance in both groups. The data were analyzed using SPSS 16 software at a significance level of P < .05. Analysis of variance with repeated measures was used to compare the mean data between and within the groups.

RESULTS

A total of 93 midwives with a mean age of 36.78 ± 8.06 years were recruited and randomly assigned to the control group (n = 47) and the intervention group (n = 46). Seven midwives dropped out for different reasons. Immediately after and one month after the intervention, both the level of knowledge and the level of clinical skill performance of the midwives in the intervention group increased compared to those before the intervention (P < .001) and compared to those in the control group (P < .001). The knowledge of the intervention group in the one-month retention test was significantly reduced compared to that immediately after the intervention (P < .001), but clinical skill performance in the intervention group at one month after the intervention was not significantly different from that immediately after the intervention (P = 1.00).

CONCLUSIONS

E-learning about clinical considerations during labor and post-partum in substance-dependent mothers can be an effective way to improve midwives' knowledge and clinical skill performance. Although knowledge decreased one month after training, clinical skill performance improved.

TRIAL REGISTRATION

http://www.irct.ir/ , IRCT20180928041164N1 registered November 13, 2018.

Nursing Students' Attitudes Toward Women With Maternal Substance Use Disorders

BACKGROUND

Maternal substance use disorders (SUD) have challenged relationships between women with SUD and their nurses. Nurses have reported biased attitudes toward women with SUD, which can interfere with their care. However, it is not well known how nursing students perceive women with SUD and their infants. This article describes nursing students' attitudes toward women with SUD, which can be used to inform educational strategies.

METHOD

An inductive content analysis was used to analyze 76 reflection papers written by nursing students at a midwestern university.

RESULTS

Three main themes were identified: (1) stigma toward women with SUD; (2) concerns for infants with neonatal abstinence syndrome; and (3) influence of clinical experiences on attitudes toward women with SUD.

CONCLUSION

Nursing students need more evidence-based guidance on managing their biases as well as the biases of nurses who work in maternity settings. [J Nurs Educ. 2024;63(10):659-664.].

PT-IN-MIND: study protocol for a multisite randomised feasibility trial investigating physical therapy with integrated mindfulness (PT-IN-MIND) for patients with chronic musculoskeletal pain and long-term opioid treatment who attend outpatient physical therapy

INTRODUCTION

Many individuals receiving outpatient physical therapy have musculoskeletal pain and up to one-third use prescription opioids. The impact of physical therapist-led mindfulness-based interventions integrated with evidence-based physical therapy (I-EPT) to manage patients with chronic musculoskeletal pain and long-term opioid treatment has not been elucidated. This project evaluates the feasibility of conducting a cluster randomised trial to test the effectiveness of I-EPT.

METHODS AND ANALYSIS

Study 1 aim: Refine and manualise the I-EPT treatment protocol. Our approach will use semistructured interviews of patients and physical therapists to refine an I-EPT training manual. Study 2 aim: Evaluate different intensities of physical therapist training programmes for the refined I-EPT treatment protocol. Physical therapists will be randomised 1:1:1 to high-intensity training (HighIT), low-IT (LowIT) training and no training arms. Following training, competency in the provision of I-EPT (LowIT and HighIT groups) will be assessed using standardised patient simulations. Study 3 aim: Evaluate the feasibility of the I-EPT intervention across domains of the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework. The refined I-EPT treatment protocol will be tested in two different health systems with 90 patients managed by the randomised physical therapists. The coprimary endpoints for study 3 are the proportions of the Pain, Enjoyment of Life and General Activity Scale and the Timeline Followback for opioid use/dose collected at 12 weeks.

ETHICS AND DISSEMINATION

Ethics approval for the study was obtained from the University of Utah, University of Florida and Florida State University Institutional Review Boards. Informed consent is required for participant enrolment in all phases of this project. On completion, study data will be made available in compliance with NIH data sharing policies.

TRIAL REGISTRATION NUMBER

NCT05875207.

Defining a public health approach to substance use: Perspectives from professionals and practitioners across Canada

BACKGROUND

While increasingly referenced in the literature and policy discussions, a "public health approach" (PHA) to substance use has been inconsistently defined or remained undefined. As part of a larger project on building the capacity to implement a PHA to substance use, we aimed to understand how professionals and practitioners across Canada who work with or whose work directly impacts the lives of people who use substances conceptualize a PHA.

METHODS

We conducted a cross-sectional national online survey of public health professionals, public safety professionals, health and social service providers, and other relevant professionals and practitioners. The survey contained closed- and open-ended questions designed to gauge familiarity and comfort with application of a PHA to substance use, and perspectives on an organizational definition of such an approach. Survey recruitment was active between May and July 2021. Data analysis included descriptive statistics and thematic analysis.

RESULTS

A total of 1041 surveys were completed. Most respondents (76 %) reported having heard of a PHA to substance use, as it was defined. Over half (54 %) indicated a high level of comfort with applying such an approach within their work. In relation to defining a PHA to substance use, the following thematic suggestions emerged from respondent's open-ended answers: explicitly recognize people with lived/living experience of substance use; incorporate trauma-informed understanding and acknowledge the varied underlying reasons for substance use; decolonize approaches to substance use and empower communities; and consider a more critical appraisal of a PHA and the terminology in its definition.

CONCLUSION

Empirically unpacking multi-stakeholder understandings of a PHA to substance use can help to inform a more cohesive definition and build the consensus needed for more effective, coordinated, and community-led responses to substance use. Future work, especially qualitative research, will provide richer and more practical understandings of a PHA to substance use.

Outcomes of an Interprofessional Opioid Training Program for Graduate Students in Nursing and Social Work

Social workers and other behavioral health professionals trained to provide prevention, treatment, and recovery services for opioid use disorders (OUD) remain urgently needed in the U.S. particularly in states with widespread health professional shortage areas. To help mitigate this workforce gap, faculty in social work and nursing at a public university in Alabama developed and piloted an innovative HRSA-funded interprofessional traineeship to prepare graduate-level nursing and social work students to assess and treat opioid use disorders (OUD). The yearlong traineeship included specialized coursework on evidenced-based practice in addictions, interprofessional telemedicine and simulation training, and multi-semester field practica in outpatient treatment settings. Impact of the pilot training was evaluated using a pre-experimental one group design. Baseline and post-training surveys assessed knowledge, attitudes, and skills related to OUD and interprofessional practice and perceived program impact. Significant increases were observed for trainees' self-reported knowledge, attitudes, and skills. Moreover, at graduation students reported that the traineeship had improved their abilities to interact with underserved populations, collaborate interprofessionally, and understand ethical issues in SUD treatment as well as enhancing their professional competence, clinical problem-solving, and health workforce skills. Findings suggest that the interprofessional training program may prepare social work and nursing graduate students to effectively serve clients with OUD and help to address a critical workforce gap in medically underserved communities.

Screening, brief intervention, and referral to treatment in oral health settings: A scoping review

OBJECTIVES

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective evidence-based model to provide early intervention and treatment to people with substance use disorders across diverse health settings. Yet, how SBIRT has been implemented within oral health settings and its associated outcomes has not been explored. This scoping review assessed how SBIRT has been implemented in oral health settings in the U.S. and discusses the implications for SBIRT integration in dentistry and oral health research, education and practice.

METHODS

Five scholarly databases were searched using a scoping review methodology for relevant literature, yielding seven articles that met inclusion criteria.

RESULTS

Findings from seven U.S. studies show that SBIRT has been implemented into oral health settings in three distinct ways: through education/training, as an intervention and in one national survey. Findings of this scoping review support the inclusion of SBIRT education for oral health professionals in both practice and clinical environments and offer examples of existing models for future implementation and study.

CONCLUSIONS

The scant literature on SBIRT intervention effects in dental settings-both within and outside of the U.S.-underscores the need for more empirical work to better understand how SBIRT impacts dental providers' knowledge, practices, referrals and ultimately, patient outcomes.

Evaluating attitudes among healthcare graduate students following interprofessional education on opioid use disorder

CONTEXT

Provider-enacted stigma is a barrier for people with substance use disorder (SUD) who interface with the healthcare system, and it has been shown to lead to worse healthcare outcomes. This has given urgency to the need for stigma reduction interventions such as education- and contact-based approaches. The positive effect of interprofessional education (IPE) in reducing graduate health students' stigmatizing attitudes on opioids has been examined before, and we contribute to the existing literature by examining the attitudes across the following four health disciplines-osteopathic medicine, physician assistant (PA) studies and public health, pharmacy, and nursing-following a single half-day IPE event focused on opioid use disorder (OUD).

OBJECTIVES

We aimed to determine whether attitudes could be affected by the IPE event by assessing attitudes utilizing an adapted version of the Alcohol and Alcohol Problems Perceptions Questionnaire (AAPPQ) before and after the IPE event.

METHODS

A total of 647 students across the four previously mentioned health disciplines participated in the IPE event. Attitudes were compared between the pre/post groups utilizing unpaired t tests, and a summative "all-attitudes" score was generated, with higher scores being associated with improved attitudes toward individuals with an OUD. Linear regression was performed controlling for program type, gender, and previous OUD exposure (personal, professional, and education).

RESULTS

We found that the pre/post summative attitudes scores improved an average of 2.81 units (SD 0.87, p=0.001, CI 1.09-4.52) for the entire cohort of graduate health students (56.9 vs. 66.6, p<0.0001) and for all attitudinal subscales (role adequacy, role legitimacy, role support, task-specific self-esteem, and work satisfaction). Students from PA programs had significantly higher attitude scores than other programs, and there were differences in degree type on attitude scores, with an average decrease of 1.89 units in attitude scores (SE 0.38, p<0.0001, CI -2.64 to -1.16). We found that students with previous exposure to OUD had higher pre-IPE event scores than those without, and knowing someone impacted by an SUD was a significant predictor of increased attitude scores, by an average of 3.82 units (SE 0.27, p<0.0001, CI 3.49-4.16). However, students without previous exposure to OUD had equal attitude scores post event to those who had previous exposure to OUD through education, personal experience, or training.

CONCLUSIONS

Our findings suggest that an IPE intervention and panel discussion may improve attitudes toward people with OUD in healthcare trainees, which is consistent with previous research that shows the beneficial effect of education and contact in reducing stigma. Degree type and knowing someone who has been impacted by an SUD are also significant predictors of attitude scores. IPE events are useful in targeting a public health issue by encouraging collaboration between different health professionals at early stages of their training, and preclinical educational efforts can affect therapeutic attitudes.

Better together: utilizing an interprofessional course and escape room to educate healthcare students about opioid use disorder

BACKGROUND

The aim of the present study was to determine the impact of an innovative interprofessional educational activity on healthcare professional students' learning. The educational activity targeted student knowledge of opioid use disorder (OUD) and perceptions of working with an interprofessional team while caring for patients with OUD.

METHODS

Students from nursing, pharmacy, physician assistant, dentistry, social work, and medicine programs were recruited to participate in the interprofessional educational activity. The educational experience included seven asynchronous modules and a virtual synchronous escape room. Prior to the educational programming, participants completed a pre-survey that assessed their knowledge and attitudes towards working on an interprofessional team and perceptions of patients with OUD. The asynchronous modules were required in order to participate in the escape room and each module contained its own pre/post quiz to assess student knowledge.

RESULTS

A total of 402 students participated in the course. Prior to participating in the course, students disagreed that they had extensive educational experience with SUD (2.45 ± 0.79). The students displayed significant improvement in the knowledge based areas after completing the seven asynchronous modules. The largest significant area of knowledge-based improvement was seen in treatment of OUD where on the pre-quiz 65.54 ± 20.21% were answered correctly compared to 95.97 ± 9.61% on the post-quiz. Participation in the escape room significantly changed the students' perceptions of working in interprofessional teams while managing patients with OUD. Of the eleven perception variables assessed, seven showed a significant increase in the post-survey. Following the escape room, participants also strongly agreed that they now would refer patients to colleagues in other disciplines.

CONCLUSIONS

An interprofessional educational experience including both an asynchronous course and virtual synchronous escape room can increase participant knowledge around OUD and may improve student perceptions of working with an interprofessional team and caring for patients with OUD.

US medical school curriculum on opioid use disorder-a topic review of current curricular research and evaluation of winning student-designed opioid curricula for the 2021 Coalition on Physician Education in Substance Use Disorders curricular competition

The opioid crisis in the US severely affected and continues to affect population's health. The opioid crisis was in part fueled by inadequate pain management, which is in part due to the inadequate education in both pain and opioid use disorder (OUD) for health care professionals. In 2021, the Coalition on Physician Education in Substance Use Disorders (COPE) organized a curricular competition soliciting US medical students-designed OUD-related curricula. Twelve winning curricula were identified. Here, we first conducted a topic review regarding current US medical school OUD curricula. Then we evaluated the COPE winning curricula and compared them to the curricula identified in the topic review. For the topic review, ten relevant databases were searched up to December 31, 2021 using a combination of pre-determined keywords. Total of 25 peer-reviewed articles were selected based on the pre-determined criteria, which included 5 articles describing opioid curricular development at the state level (AZ, CA, MA, PA, and RI), 17 research articles evaluating a curriculum developed in a single institution, 2 literature reviews, and 1 article detailing curricular development and validation processes in a single institution. Although vary in organizations and formats, state-level curricula were comprehensive and could be adopted by other states or institutions with necessary local issue-based modifications. Faculty development and critical resources were major challenges for curricular implementation. The 17 research articles exhibited good scientific quality (Medical Education Research Study Quality Instrument (MERSQI) score = 11.94 ± 2.33 (maximal score = 18)). All research articles reported to some extent, the success of respective curriculum, in improving students' knowledge in and/or attitude towards OUD, based on primarily pre- and post- comparisons. Compared to these published curricula, winning students-designed curricula had more specific focuses, diverse learning activities, and varieties in assessment methods. For all curricula, long-term evaluations were lacking. Except for the state level curricula, majority of the other curricula did not emphasize specifically on chronic pain education or the biopsychosocial approach. Interprofessional education approach was also lacking. Our topic review and curricular evaluation highlighted the needs for integrating OUD and chronic pain medical curricula, developing long-term assessment tools, and more OUD curriculum research overall.

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

Interprofessional Education to Address Substance Use among Adults with Persistent Pain: A Pre-Post Program Evaluation

BACKGROUND

Substance use disorders (SUDs) are highly prevalent among adults with persistent pain. Yet, standard competencies for integrating pain and SUD content are lacking across health science student curricula. Additionally, pharmacotherapies to treat SUDs are underutilized.

AIM

To address these gaps, a team of health science faculty created an interprofessional simulation activity using a standardized patient and evaluated learner outcomes related to assessment and treatment of comorbid persistent pain and substance use.

METHODS

A total of 304 health science students representing nursing, medicine, pharmacy, and social work programs attended virtual learning sessions. Interprofessional student teams developed a team-based care plan for an adult with musculoskeletal pain who takes prescribed opioids while using alcohol. Pre- and post-activity surveys assessing knowledge and confidence were matched for 198 students. Descriptive statistics summarized survey data with inferential analysis of paired data.

RESULTS

The largest significant improvements between pre- and post-activity knowledge were observed in items specific to pharmacotherapy options for alcohol and opioid use disorders. Similar gains were noted in students' confidence regarding pharmacotherapies. No significant differences were noted on pre-post-activity knowledge scores between the three main profession groups (medicine, nursing, and pharmacy).

CONCLUSIONS

Students attending this interprofessional simulation demonstrated improved knowledge and confidence, particularly in pharmacotherapies for alcohol and opioid use disorders. Replication of such programs can be used to provide consistent content across health science disciplines to heighten awareness and receptivity to medications available to treat SUDs in people treated for persistent pain. The curriculum is freely available from the corresponding author.

An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients

Introduction

Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction.

Methods

The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys.

Results

Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably.

Discussion

We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.

Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations

BACKGROUND

In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use.

METHODS

This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis.

RESULTS

The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services.

CONCLUSION

Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.

Interprofessional education as a potential foundation for future team-based prevention of alcohol use disorder

BACKGROUND

Effective screening of alcohol use and prevention of alcohol use disorder (AUD) requires the continuous preparation of educated and confident providers across all health professions who will ideally work in close collaboration in their future practices. As one mechanism for achieving this goal, the development and provision of interprofessional education (IPE) training modules for health care students may cultivate beneficial interactions among future health providers early in their formative education.

METHODS

In the present study, we assessed attitudes about alcohol and confidence in screening and AUD prevention in 459 students at our health sciences center. Students represented ten different health professions (audiology, cardiovascular sonography, dental hygiene, dentistry, medicine, nursing, physical therapy, public health, respiratory therapy, and speech language pathology programs). For purposes of this exercise, students were divided into small, professionally diverse teams. Responses to ten survey questions (Likert scale) were collected via a web-based platform. These assessments were collected before and after a case-based exercise that provided information to students on the risks of excessive alcohol use as well as the effective screening and team-based management of individuals susceptible to AUD.

RESULTS

Wilcoxon signed-rank analyses revealed that the exercise led to significant decreases in stigma toward individuals engaging in at-risk alcohol use. We also discovered significant increases in self-reported knowledge and confidence in personal qualifications needed to initiate brief interventions to reduce alcohol use. Focused analyses of students from individual health programs uncovered unique improvements according to question theme and health profession.

CONCLUSION

Our findings demonstrate the utility and effectiveness of single, focused IPE-based exercises to impact personal attitudes and confidence in young health professions learners. While additional longitudinal cohort follow-up studies are needed, these results may translate into more effective and collaborative AUD treatment in future clinical settings.

Using SBIRT (Screen, Brief Intervention, and Referral Treatment) Training to Reduce the Stigmatization of Substance Use Disorders Among Students and Practitioners

Negative attitudes and stigmatization of substance-using patients lead to treatment avoidance and poor physical and health outcomes. Research suggests that training in substance use disorders is a vital tool to abate negative attitudes among health workers. The present longitudinal study trained students and experienced practitioners from various disciplines on the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. The study found significant improvements in the attitudes of students-but not practitioners-who were trained during the program. The paper discusses policy and implementation implications to support and complement sustained impact of training on models such as SBIRT.

Interprofessional Training on Substance Misuse and Addiction: A Longitudinal Assessment of a Brazilian Experience

Although several trainings have been offered to improve professional expertise on alcohol and other drugs, few have used an interdisciplinary approach and evaluated long-term improvements in the professional's work routine. This study aimed to evaluate the outcomes of an interprofessional training program on alcohol and other drugs offered by a Regional Reference Center for Drugs of the Federal University of São Paulo, Brazil.

METHODS

the evaluation was carried out longitudinally using mixed methods (questionnaires (n = 29-177) and semistructured interviews (n = 28)). The participants were current workers from public institutions of health, education, social assistance, justice, and security system who attended the training. Data were collected at the beginning, the end, and one year after the end of the training. Descriptive statistical analyses were performed for quantitative data and thematic content analyses for qualitative data.

RESULTS

professionals who attended the training enhanced their understanding of substance-related issues, reduced stigma, changed their attitude, and improved their networking among the different services providing care to users. The main characteristics related to these outcomes were the interprofessional and biopsychosocial approach, and the experiential activities developed during the training. Most participants reported difficulties in implementing changes in their work routine, but those in managerial roles have reported having more autonomy to carry out such changes.

CONCLUSIONS

the mixed methods converged in terms of their results. The training promoted a better understanding of issues related to substance use disorders, reduced stigma and expanded the repertoire of skills. The interprofessional and biopsychosocial approach and field activities seem to be related to these outcomes. The potential for implementing changes in daily practice was prominent among those occupying a managerial role.

HealthCare educational differences in pain management, adverse childhood experiences and their relationship to substance use disorder education

Background

In order to assist the State of Ohio in the United States in addressing the opioid epidemic, the Ohio Attorney General appointed experts in a variety of academic disciplines to the Scientific Committee on Opioid Prevention and Education (SCOPE). The focus of SCOPE is the application of scientific principles in the development of prevention and educational strategies for reducing substance use disorder (SUD). One area of focus for SCOPE was SUD education of healthcare professionals. The objective of the present was to identify the content and extent to which future healthcare professionals are trained in pain management, SUD, and adverse childhood experiences (ACEs).

Methods

In December of 2019, a survey was distributed to 49 healthcare professional schools in Ohio that included the following disciplines: medicine, pharmacy, advanced practice registered nurse (APRN), physician assistant, dentistry, and optometry. The survey included four domains: initial screening of patients, training in SUD, training in care for patients at high risk for SUD, and education in evaluating patients for ACEs. Descriptive statistics were calculated.

Results

Thirty one of the forty-nine schools completed the survey. Most disciplines indicated that some form of basic training in the principles of SUD were taught in their core curriculum. The training on ethical issues surrounding SUD were not as widely covered (range 0-62.5%). Medicine, APRN, physician assistant, and pharmacy schools had a “moderate” to “great” extent of pharmacologic therapy curriculum integration. Other pain management strategies were “somewhat” to “moderately” integrated. There were variations seen in training on risk of medication misuse based on various contributors to health. At least 67.7% of medicine, APRN, physician assistant, and pharmacy programs included motivational interviewing training. The extent to which schools integrated education regarding ACEs into their curriculum varied from 0 to 66.7%.

Conclusions

The study finding suggests a need for a unified, consistent, and expanded training requirement in the foundations of pain management, SUD, and ACEs in professional healthcare education.

The impact of CARA mandates on nurse practitioner controlled substance prescribing in Oregon: a cohort study

Background

In 2017, the United States Comprehensive Addiction and Recovery Act (CARA) expanded authorization to prescribe buprenorphine for opioid use disorder (OUD) to nurse practitioners (NPs). Compared to physicians, NPs were required to complete 16 additional hours of training on controlled substance prescribing before a buprenorphine waiver application. As this differential additional education mandate was seen as a potential barrier, we evaluated the impact of this requirement on both NP waiver acquisition and prescribing of controlled substances, comparing NPs who obtained waivers to those who had not.

Methods

Through 2016–2018 Oregon Prescription Drug Monitoring Program and linked NP licensure data, we identified factors associated with waiver acquisition at baseline (2016) and evaluated changes in controlled substance prescribing before (2016) and after waiver acquisition (2018). Using chi-square and Mann-Whitney U testing, we calculated and described controlled substance prescribing types, rates, and patient level quantities including co-prescribing of benzodiazepines and opioids by NPs. Multivariable linear regression compared prescribing by waivered and non-waivered NPs for significant changes in non-buprenorphine controlled substance prescribing.

Results

Waivered NPs were more likely to have a psychiatric certification, have prior disciplinary action, and have generally higher levels of non-buprenorphine controlled substance prescribing than their non-waivered counterparts. While there was a significant increase in opioid prescriptions per patient among waivered NPs, following CARA implementation, co-prescribing of benzodiazepines and opioids significantly declined among waivered NPs relative to non-waivered NPs.

Conclusions

Although educational requirements were rescinded in 2021 for most applicants, enhanced opioid prescribing training should be incorporated into professional educational offerings regardless of regulatory mandate. We recommended continued focus on education regarding avoidance of high risk prescribing such as co-prescribing of opioids and benzodiazepines. NPs who acquire waivers may take on higher risk patients already using opioids, and these findings may represent transitions in practice and patient setting.

Assessing Student Readiness to Work with People Who Use Drugs: Development of a Multi-disciplinary Addiction Educational Survey

BACKGROUND

As health profession schools implement addiction curricula, they need survey instruments to evaluate the impact of the educational interventions. However, existing measures do not use current non-stigmatizing language and fail to capture core concepts.

OBJECTIVE

To develop a brief measure of health profession student readiness to work with people who use drugs (PWUDs) and establish its content validity.

METHODS

We conducted a literature review of existing instruments and desired clinical competencies related to providing care to PWUD and used results and expert feedback to create and revise a pool of 72 items. We conducted cognitive interviews with ten pre-clinical health profession students from various US schools of nursing, pharmacy, and medicine to ensure the items were easy to understand. Finally, we used a modified Delphi process with twenty-four health professions educators and addiction experts (eight each from nursing, pharmacy, and medicine) to select items for inclusion in the final scale. We analyzed expert ratings of individual items and interdisciplinary agreement on ratings to decide how to prioritize items. We ultimately selected 12 attitudes and 12 confidence items to include in the REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM). Experts rated their overall assessment of the final scale.

RESULTS

Twenty-two of twenty-four experts agreed or strongly agreed that the attitudes scale measures student attitudes that impact readiness to work with PWUDs. Twenty-three of twenty-four experts agreed or strongly agreed that the confidence scale measures student self-efficacy in competencies that impact readiness to work with PWUDs. Seven of 72 initial items and none of the 24 selected items had statistically significant differences between disciplines.

CONCLUSIONS

The REDUCE-HARM instrument has strong content validity and may serve as a useful tool in evaluating addiction education. Additional research is needed to establish its reliability, construct validity, and responsiveness to change.

Substance use-related continuing education course objectives: Alignment with professional competencies

Background: Novel educational efforts are needed to prepare the current and future interprofessional health care workforce to address the range of substance use-related health problems. A 6-module massive open online course (MOOC) was developed to provide education to health professionals of various disciplines on the fundamentals of substance use-related treatment. The purpose of this project was to match course objectives to substance use-related competencies for 5 disciplines: nurses, pharmacists, physicians, physician assistants (PA), and social workers. Methods: Content expert raters within each discipline determined what Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) core competencies were matched to each objective for the 6 modules of the MOOC. The number of objectives across the 6 modules was summated. Results: All nursing and social work competencies were mapped to the course objectives. For physicians, PAs, and pharmacists, the proportions of knowledge-based competencies that mapped to the course objective were 58%, 76%, and 80%, respectively, and proportions of skill-based competencies that mapped to the course objective were 88%, 83%, and 75%, respectively. For those 3 groups, 100% of attitude-based competencies mapped to the course objective. Conclusions: The competency-based mapping with the MOOC objectives supports the interprofessional design of the course and discipline-specific competencies needed to promote the best outcomes for patients.

Transforming an educational ecosystem for substance use disorders: A multi-modal model for continuous curricular improvement and institutional change

Health professions curricula are created to prepare learners to effectively address health issues affecting individ uals and their communities. Ideally, curricula emphasize the predominant biopsychosocial influences impacting the health of diverse populations. However, despite decades of investment and advances in educational research and design, we have failed to create a health professional workforce capable of equitably meeting the health care needs of the public. Particular communities, geographic regions, and patients with stigmatized diagnoses continue to be underserved, and the potential contributions of multidisciplinary health professionals and advanced practice providers continue to be unrealized within a predominantly physician-centric health care model. Genuine educational transformation requires multidimensional, iterative strategies used to meaningfully evolve traditional classroom curricula, break from the implicit and "hidden" curricula, and enrich the educational ecosystem in which all operate. This manuscript elaborates the construct and process of "educational ecosystem transformation" as a tool for the evolution of the educational ecosystem and its situated curriculum that will eventually drive the enrichment of the healthcare workforce. Drawing from traditional models of curriculum development, recent work on transforming the hidden curriculum, the clinical learning environment, and change management strategies, this new approach uses a health equity and structural competence lens to interrogate and deconstruct a learning system in order to identify opportunities to change, strengthen, and deepen a learner's experience around a specific topic. This process requires an in-depth, multidimensional assessment followed by the identification of key change targets and a stepwise, iterative plan for improvement and transformation. The topic area of substance use disorders (SUD) is used to illustrate how this complex process might be employed to improve the quality of care, realize and amplify the contributions of the entire healthcare team, stimulate interest in addiction medicine as a career, and reduce the stigma and disparities patients with SUDs often experience.

Integration of medication for opioid use disorder training into graduate nursing education

The COVID-19 pandemic has further limited access to treatment for opioid use disorder (OUD). Advanced practice registered nurses can reduce opioid related complications and overdose by obtaining a Drug Enforcement Administration (DEA) regulated X-waiver that allows for prescription of medications for OUD (MOUD) in general medical settings. Graduate nursing education, where advanced practice nurse practitioner (NP) students are educated, has not incorporated this content into standard curricula. We describe an innovative approach to incorporate DEA X-waiver training in a required community health NP in partnership with addiction medicine clinicians. Advanced practice NP students (N = 114) either completed fully online or hybrid (virtual didactic and online) X-waiver training on MOUD. We describe how an interprofessional partnership to incorporate MOUD education into graduate nursing curricula is a feasible method for training students to treat OUD in the context of the pandemic. This approach is responsive to the crucial need for more health care providers to address the opioid overdose crisis.

Medical Student Screening for Naloxone Eligibility in the Emergency Department: A Value-Added Role to Fight the Opioid Epidemic

INTRODUCTION

Opioid overdose education and naloxone distribution (OEND) for use by laypersons are safe and effective at preventing deaths from opioid overdose, but emergency department (ED) implementation is challenging. Curricula addressing OEND could enable students to serve in value-added roles on the clinical team, overcome challenges of naloxone distribution, and improve patient care.

METHODS

We created a 1-hour didactic session on opioid use disorder and OEND for first-year medical students in the emergency medicine elective. During two clinical shifts, students used this knowledge to perform screenings to identify patients at high risk of overdose. If a patient screened positive, students performed patient education and then notified the physician, who ordered a naloxone kit.

RESULTS

Thirty students received the didactic and conducted screening shifts. Of 147 patients screened, 40% (n = 59) were positive for naloxone eligibility, 21% (n = 31) reported that someone close to them used opioids, 18% (n = 26) had witnessed an opioid overdose, 12% (n = 17) had previously overdosed themselves, and 12% (n = 18) previously knew what naloxone was. Fifty-nine naloxone kits were distributed over the 3-month pilot versus 13 naloxone prescriptions for patients discharged from the ED the prior year.

DISCUSSION

Through didactic training and structured patient engagement, medical students gained knowledge of and hands-on experience with addiction medicine, discussed sensitive topics with patients, and identified a high volume of patients eligible to receive naloxone. Medical student screening for OEND in ED patients is feasible and adds significant value to the clinical team.

Interprofessional Education in Child and Adolescent Mental Health: A Scoping Review

To identify elements of effective interprofessional education (IPE) within child and adolescent mental health (CAMH), we conducted a scoping literature review. A search of four databases revealed 32 studies that met inclusion criteria describing IPE interventions regarding CAMH. Studies included a range of medical, mental health, allied health, educational, and community professionals in clinical, school-based, and community-based settings. The majority of studies have focused on autism or general child mental health. Outcomes were generally positive but skewed toward attitudinal and knowledge-based measures. Practice-based interventions tended to support higher levels of educational outcomes, including behavioral, patient-level, or systems-level changes.

Scoping reviews in medical education: A scoping review

OBJECTIVES

Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities.

METHOD

The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review.

RESULTS

One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal.

CONCLUSIONS

Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

A Resident-Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder

BACKGROUND

Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions.

OBJECTIVE

To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance.

DESIGN, SETTING, AND PARTICIPANTS

Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services.

INTERVENTION

We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up.

MEASUREMENTS

The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine.

RESULTS

The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine.

CONCLUSION

Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.

Report of the 2020 Special Committee on Substance Use and Pharmacy Education

EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.