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.
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.
Opioid dependence and treatment with buprenorphine are topics well suited to teach medical students about the role of practicing physicians in substance abuse treatment, complicated multi-disciplinary treatment issues, complex biological and social basis of addictions, and how new treatments are developed and moved into practice. During Phase I of the grant, we developed a curriculum plan for a suite of modules on these issues as they relate to opioid abuse and dependence with input from a focus group of medical school professionals with experience in substance abuse education. The prototype module entitled “Prevalence, Trends and Impact on Health: Opioid Addiction” was developed and underwent usability and pilot testing with medical students in their 2nd through 4th years of study. Usability testing revealed that students enjoyed the online format, found the module well-organized and easy to navigate, and showed an interest in learning more about Buprenorphine. More in-depth pilot testing assessed the impact of the pilot module on the attitudes, self-efficacy, and intendedbehavior of medical students, as well as changes in knowledge and satisfaction with the module material. A retrospective pre/post design was regarding detecting and treating opioid misuse or abuse significantly increased with the completion of the pilot module.