Yale Primary Care Residency Program, Yale New Haven Health, Yale University School of Medicine, St. Raphael's Campus, 1450 Chapel Street, Private 304, New Haven, CT, 06511, USA.
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Gen Intern Med. 2022 Aug;37(11):2650-2660. doi: 10.1007/s11606-021-07102-y. Epub 2021 Nov 2.
Training future clinicians in safe opioid prescribing (SOP) and treatment of opioid use disorder (OUD) is critical to address the opioid epidemic. The Accreditation Council on Graduate Medical Education requires all programs to provide instruction and experience in pain management and will mandate addiction medicine clinical experiences for internal medicine trainees.
Assess residents' training in SOP and treatment of OUD and identify training barriers.
Cross-sectional nationally representative survey was emailed in 2019.
Four hundred twenty-two Association of Program Directors in Internal Medicine members in US internal medicine residency programs.
Program opportunities and challenges to developing or implementing training in SOP, treatment of OUD, and buprenorphine waiver training, and perceived curricular effectiveness.
The response rate was 69.4% (293/422). Most programs required didactics in SOP (94.2%) and treatment of OUD (71.7%). Few programs required clinical experiences including addiction medicine clinics (28/240, 11.7%), inpatient consult services (11/240, 4.6%), or offsite treatment rotations (8/240, 3.3%). Lack of trained faculty limited developing or implementing curricula (61.5%). Few respondents reported that their program was "very effective" in teaching SOP (80/285, 28.1%) or treatment of OUD (43/282, 15.3%). Some programs offered buprenorphine waiver training to residents (83/286, 29.0%) and faculty (94/286, 32.9%) with few mandating training (11.7% (28/240) and 5.4% (13/240) respectively). Only 60 of 19,466 (0.3%) residents completed buprenorphine waiver training. Primary care programs/tracks were more likely to offer waiver training to residents (odds ratio [OR], 3.07; 95% CI, 1.68-5.60; P < 0.001) and faculty (OR, 1.08; 95% CI, 1.01-3.22; P = 0.05).
In this nationally representative survey, few internal medicine residency programs provided clinical training in SOP and treatment of OUD, and training was not viewed as very effective. Lack of effective training may have adverse implications for patients, clinicians, and society.
培训未来的临床医生安全开具阿片类药物处方（SOP）和治疗阿片类药物使用障碍（OUD）对于解决阿片类药物流行至关重要。研究生医学教育认证委员会要求所有项目提供疼痛管理方面的指导和经验，并将为内科住院医师提供药物滥用医学临床经验。
评估住院医师在 SOP 和 OUD 治疗方面的培训情况，并确定培训障碍。
2019 年进行了一项全国代表性的横断面调查。
美国内科住院医师培训项目协会计划主任 422 名成员。
SOP、OUD 治疗和丁丙诺啡豁免培训方面的发展或实施培训的机会和挑战，以及感知到的课程效果。
回复率为 69.4%（293/422）。大多数项目都要求进行 SOP（94.2%）和 OUD 治疗（71.7%）的理论教学。很少有项目要求包括药物滥用门诊（28/240，11.7%）、住院会诊服务（11/240，4.6%）或异地治疗轮转（8/240，3.3%）等临床经验。缺乏训练有素的教师限制了课程的发展或实施（61.5%）。很少有受访者表示他们的项目在教授 SOP（80/285，28.1%）或 OUD 治疗（43/282，15.3%）方面“非常有效”。一些项目为住院医师和教师提供丁丙诺啡豁免培训（83/286，29.0%和 94/286，32.9%），但很少有项目强制培训（11.7%（28/240）和 5.4%（13/240））。只有 19466 名居民中的 60 名（0.3%）完成了丁丙诺啡豁免培训。初级保健项目/轨道更有可能为住院医师（优势比[OR]，3.07；95%CI，1.68-5.60；P<0.001）和教师（OR，1.08；95%CI，1.01-3.22；P=0.05）提供豁免培训。
在这项全国代表性调查中，很少有内科住院医师培训项目提供 SOP 和 OUD 治疗方面的临床培训，而且培训效果并不被认为非常有效。缺乏有效的培训可能对患者、临床医生和社会产生不利影响。
