Baker Jennifer E, Luketic Karla, Niziolek Grace M, Freeman Christopher M, Grannan Kevin J, Pritts Timothy A, Paquette Ian M, Goodman Michael D
University of Cincinnati, Department of Surgery, Cincinnati, Ohio.
Providence Medical Group, Department of Surgery, Everett, Washington.
J Surg Educ. 2021 Mar-Apr;78(2):579-589. doi: 10.1016/j.jsurg.2020.08.015. Epub 2020 Aug 22.
Over 67,000 individuals died in the United States due to drug overdose in 2018; the majority of these deaths were secondary to opioid ingestion. Our aim was to determine surgeon perceptions on opioid abuse, the adequacy of perioperative and graduate medical education, and the role surgeons may play. We also aimed to investigate any differences in attending and resident surgeon attitudes.
Anonymous online survey assessing surgeons' opioid counseling practices, prescribing patterns, and perceptions on opioid abuse, adequacy of education about opioid abuse, and the role physicians play.
Two Accreditation Council for Graduate Medical Education accredited general surgery programs at a university-based tertiary hospital and a community hospital in the Midwest.
Attending and resident physicians within the Departments of Surgery participated anonymously.
Attending surgeons were more likely than residents to discuss posoperative opioids with patients (62% vs. 33%; p < 0.05), discuss the potential of opioid abuse (31% vs. 6%; p < 0.05), and check state-specific prescription monitoring programs (15% vs. 0%; p < 0.05). Surgeons and trainees feel that surgeons have contributed to the opioid epidemic (76% attending vs. 88% resident). Overall, attending and resident surgeons disagree that there is adequate formal education (66% vs. 66%) but adequate informal education (48% vs. 61%) on opioid prescribing. However, when attending physicians were broken down into those who have practiced ≤5 years vs. those with >5 years experience, those with ≤5 years experience were more confident in recognizing opioid abuse (61% vs. 34%) and fewer young faculty disagreed that there is adequate formalized education on opioid prescribing (45% vs. 84%).
Patient education should be improved upon in the preoperative setting and should be treated as an important component of preoperative discussions. Formalized opioid education should also be undertaken in graduate surgical education to help guide appropriate opioid use by resident and attending physicians.
2018年美国有超过6.7万人死于药物过量；其中大多数死亡是由阿片类药物摄入所致。我们的目的是确定外科医生对阿片类药物滥用的看法、围手术期和毕业后医学教育的充分性，以及外科医生可能发挥的作用。我们还旨在调查主治医生和住院医生态度上的差异。
通过匿名在线调查评估外科医生的阿片类药物咨询实践、处方模式，以及对阿片类药物滥用的看法、关于阿片类药物滥用教育的充分性，和医生所起的作用。
中西部地区一所大学附属三级医院和一家社区医院的两个经毕业后医学教育认证委员会认证的普通外科项目。
外科各科室的主治医生和住院医生匿名参与。
与住院医生相比，主治医生更有可能与患者讨论术后阿片类药物使用情况（62%对33%；p<0.05）、讨论阿片类药物滥用的可能性（31%对6%；p<0.05），以及查询各州特定的处方监测项目（15%对0%；p<0.05）。外科医生和实习医生认为外科医生助长了阿片类药物流行（76%的主治医生对88%的住院医生）。总体而言，主治医生和住院医生都认为在阿片类药物处方方面，正规教育并不充分（66%对66%），但非正规教育是充分的（48%对61%）。然而，当将主治医生分为执业年限≤5年和>5年的医生时，执业年限≤5年的医生在识别阿片类药物滥用方面更有信心（61%对34%），并且较少有年轻教员认为在阿片类药物处方方面没有充分的正规教育（45%对84%）。
应在术前环境中加强患者教育，并应将其视为术前讨论的重要组成部分。还应在毕业后外科教育中开展正规的阿片类药物教育，以帮助指导住院医生和主治医生合理使用阿片类药物。
