Background: With support from NIDA (#R44-DA12066) we have developed an online curriculum to educate and further clinical skill development in Year 2 to 4 medical students on buprenorphine treatment for opioid use disorders.

Objective: To educate medical students about treatment of patients with opioid dependence using buprenorphine and impact clinical skills in working with patients with addictive disorders.

Program Description: We are performing a summative evaluation of our curriculum. Each medical student completed a pre/post test effectiveness evaluation of our online curriculum, including pre/post evaluations of clinical skills through a remote live standardized patient (SP) experience. The OSCE style evaluation of the learner's performance during the remote, live SP clinical encounter was assessed by the SP actor and a MA level clinical professional. Measurement was done via: 1) a 9 item Likert scale rating sheet, and 2) a 16 item done/not done checklist. Both modifications were reviewed and approved by two external clinical substance abuse professionals.

Program Evaluation Outcome: Preliminary results (n=25) of this evaluation indicate that the modules have a statistically significantly effect on knowledge and intended behavior related to treatment of patients with opioid dependence (p<.001). Average pre-knowledge score was 68% while the average post-test score was 83% (p<0.001). Attitude and self-efficacy also increased significantly for most modules. Students showed the most improvement in the areas of common comorbidities and pharmacology. Student competency was measured in the following areas: drug detection and screening, comorbid conditions, diagnosis and treatment. Competency (p<0.0007) increased quite significantly from pre to post experience. Competency scores increased an average of 44% from pre to post-interview.

Conclusions: Based on the preliminary results, this curriculum is an effective tool for educating students on buprenorphine and opioid use disorder. The addition of a standardized patient component pre and post curriculum allows the students an opportunity to better demonstrate an increase in competencies and clinical skill in a more true to life situation.

H01 Education–Professional and Lay Online training of primary care providers in pain and addiction T. Tannera, M. Metcalfa, K. Rossiea and M. Coulehana aClinical Tools, Inc, Chapel Hill, NC (173). Available online 2 April 2009. The majority of primary care providers in the pain practice community have not fully incorporated evidence-based and clinical consensus recommendations for preventing, recognizing, and managing addiction in pain patients. Existing interventions based on conferring knowledge or providing prompts are limited in effect. With support from NIDA, we are designing an online training experience for pain management providers that focuses on skills training. We surveyed addiction specialists (n = 9) to better understand the needs and limitations of primary care providers. All addiction specialists identified a need for additional training in: 1) Detecting Substance Use Disorders in Pain Patients at Initial Evaluation, 2) Preventing Substance Use Disorders When Prescribing Opioids to Pain Patients, 3) Managing Addiction Issues in Ongoing Treatment of Chronic Pain Patients, and 4) Preventing and Detecting Diversion of Pain Medications [listed in the respondents' order of priority]. When asked about supplementary disease focused training in addiction issues, they highlighted back pain as the top priority followed by headache, osteoarthritis, and fibromyalgia/neuropathy [tied]. All addiction expert participants expressed interest in participating in features such as an online forum and an “Ask the Expert” forum. A survey of pain specialists (n = 5) ranked the four topics similarly and also identified back pain as the most important topic. A survey of primary care physicians (n = 9) revealed that all would consider taking a course with an Standardized Patient component; the most preferred modality was online chat. Most preferred a short SP experience that would more closely mimic the clinic encounter. With expert and target audience input, we have outlined a skills training experience based on the topics above and which uses virtual (i.e., Internet chat-based) Standardized Patients as well as interactive clinical cases with multiple questions. (This research is funded by NIDA/NIH contract #HHSN271200800012C.)

The majority of primary care providers did not receive adequate training to detect, prevent, and manage patients at the interface of pain and addiction (CASA, 2005). But there are currently little data to guide training development so that it emphasizes the specific areas of greatest need. We surveyed a convenience sample of twenty-seven primary care providers (9 physicians, 9 residents, and 9 nurse practitioners) retrospectively about their training at the interface of treating pain and addiction. They were asked to rate their agreement that their clinical training adequately prepared them in 9 specific areas. The responses were very similar for each of the three groups. Sixty-four percent (64%) of participants disagreed (either strongly disagreed or disagreed) that they were adequately prepared to treat pain in patients in recovery. Sixty percent (60%) disagreed that they were prepared to treat pain in patients with current addictions. And 52% disagreed that they were adequately prepared to treat patients at risk for addiction. Perception of their training to assess pain in the context of addiction issues was more positive. Of the participants, 48% agreed or strongly agreed that they were adequately prepared to recognize addiction in a pain patient; still 28% disagreed. Similarly, 48% agreed or strongly agreed that they were adequately prepared to recognize patients at risk for addiction; but 36% disagreed. Primary care providers do not feel adequately prepared by their training in pain and addiction, especially in the areas of treatment. Training needs related to treatment increase as the risk of addiction increases. Educational curricula are needed to ensure that pain treatment providers have the skills necessary to assess and treat patients at the interface of pain and addiction. Reference: CASA. Under the counter: The diversion and abuse of controlled prescription drugs in the U.S., 2005.

Full title: Evaluation of a Web-based SBIRT Training Curriculum for Primary Care: Providers: Improving Physicians' Competence in Addiction Through Online Training

Bradley Tanner, MD. Clinical Tools, Inc. Chapel Hill, NC, USA.

Introduction: With funding from NIDA (Contract ##HHSN271200900036C ) we created and evaluated a web-based training program for primary care providers that builds skills in substance abuse Screening, Brief Intervention, and Referral to Treatment (SBIRT) . The primary focus is on alcohol and tobacco - other substances of abuse are also included. The experience meets the requirement of AMA PRA Category 1 Credit ™, AAFP Prescribed Credit and NY OASAS.

Methods: We conducted a summative evaluation with 74 primary care physicians. Our goal was to assess the value of clinical skills training including an opportunity to immediately practice the skills learned, complete an assessment, and receive immediate feedback. Subjects were given the choice of evaluating standardized patient cases presented via computer simulation or chat with a live SP actor.

Results: Learners chose to evaluate computer driven simulated patients rather than standardized patients. Learners showed significant improvements pre-training to post-training for the intervention group in scores on knowledge (p >0.009) and clinical skills assessment using a patient record, in comparison to controls. Following training, nearly all participants intended to increase their use of brief interventions regarding tobacco, alcohol and drug use and to follow up with patients after brief interventions or referral. Audience satisfaction with the program was high as was their rating of the educational value of the program.

Conclusion: A web-based skills training curriculum can confer both knowledge and skills necessary to deploy successful SBIRT interventions in primary care. Future studies can assess success for specific providers (e.g., OB/GYN, geriatric, acute care) or patients (by substance used or intensity of use) and guide further tailoring of the curriculum.

Assessing the Impact on Medical Students of an Online Curriculum on Opioid Dependence and Treatment

Mary P. Metcalf, PhD, MPH; T. Bradley Tanner, MD; Susan Wilhelm, PhD

Clinical Tools, Inc. 1506 E. Franklin St, #200, Chapel Hill, NC

Objectives: To develop and assess the impact of an online supplemental curriculum for medical students on various medical knowledge/competency, attitude, and performance measures.

Background: Treatment with buprenorphine is effective and can be conducted in a variety of settings by primary care providers. However, a number of biases exist towards treatment of opioid dependence in primary care. Medical school is an opportune time to addresses -and hopefully decrease – these biases with future physicians.

Methods: An online curriculum of 5 modules for medical students was created, focusing on basic skills of opioid abuse detection and treatment. A convenience sample of 24 volunteer medical students (n=24) at different institutions in years 2-4 completed a OSCE style interview of an SP via chat, completed the educational program, and then re-interviewed the SP. Measures assessed impact on medical knowledge, competency, attitude, and self-efficacy/intended behavior. Clinical skills were assessed using a Communication/Interpersonal Skills rating form and a Clinical Encounter Performance Checklist completed by the SP and an observer.

Results: Medical knowledge/competency increased from a pre-experience average of 68% to an post-test average of 83% ( p<0.05). Average self-efficacy scores increased (p<0.05) and Clinical Encounter Performance Checklist score increased for 84% of participants (p<0.05). Two-thirds of students improved Interpersonal Skills/Communication checklist scores, although the improvement was not statistically significant for this measure. Additional analysis are in process.

Conclusion: Medical student knowledge, competency, self-efficacy and performance were shown to be improved by the educational intervention. Attitude towards treatment of opioid dependence and interpersonal skills related to clinical encounters with possibly substance abusing patients did not show the improvement we had hoped. The intervention is being modified to address these issues more directly.

Talk outline

• Disclosure, Introduction and Outline of Talk
• Two Projects to present: OpioidRisk and SBIRTTraining
• Handouts
• Where are we going? - BupPractice Project, BupPractice.com Usage, Response and Growth
• What are our goals? - Dissemination and Implementation leading to Practice Change and better Patient Outcomes
• How are we going to get there? - Features of the site. This is about CHPD not CME
• OpioidRisk.com Overview: The problem, prescribing "The first general suggestion is to enhance and update clinical teaching and training practices for physicians, nurses, dentists,and pharmacists in the areas of pain management, opioid pharmacology, and abuse/addiction, perhaps through interactive Web-based training. (Curtailing Diversion and Abuseof Opioid Analgesics Without Jeopardizing Pain Treatment Nora D. Volkow, MD, Thomas A. McLellan, PhD  JAMA, April 6, 2011—Vol 305, No. 13)
• SBIRTTraing.com Overview 
• The value of partnerships