Department of Surgery, University of Utah, Salt Lake City, Utah.
Department of Surgery, University of Utah, Salt Lake City, Utah.
J Surg Educ. 2023 Jun;80(6):786-796. doi: 10.1016/j.jsurg.2023.02.013. Epub 2023 Mar 7.
In order to effectively create and implement an educational program to improve opioid prescribing practices, it is important to first consider the unique perspectives of residents on the frontlines of the opioid epidemic. We sought to better understand resident perspectives on opioid prescribing, current practices in pain management, and opioid education as a needs assessment for designing future educational interventions.
This is a qualitative study using focus groups of surgical residents at 4 different institutions.
We conducted focus groups using a semistructured interview guide in person or over video conferencing. The residency programs selected for participation represent a broad geographic range and varying residency sizes.
We used purposeful sampling to recruit general surgery residents from the University of Utah, University of Wisconsin, Dartmouth-Hitchcock Medical Center, and the University of Alabama at Birmingham. All general surgery residents at these locations were eligible for inclusion. Participants were assigned to focus groups by residency site and their status as junior (PGY-2, PGY-3) or senior resident (PGY-4, PGY-5).
We completed 8 focus groups with a total of 35 residents included. We identified 4 main themes. First, residents relied on clinical and nonclinical factors when making decisions about opioid prescribing. However, hidden curricula based on unique institutional cultures and attending preferences heavily influenced residents' prescribing practices. Second, residents acknowledged that stigma and biases towards certain patient groups influenced opioid prescribing practices. Third, residents encountered barriers within their health systems to evidence-based opioid prescribing. Fourth, residents did not routinely receive formal education on pain management or opioid prescribing. Residents recommended several interventions to improve the current state of opioid prescribing, including standardized prescribing guidelines, improved patient education, and formal training during the first year of residency.
Our study highlighted several areas of opioid prescribing that can be improved upon through educational interventions. These findings can be used to develop programs aimed at improving residents' opioid prescribing practices, both during and after training, and ultimately the safe care of surgical patients.
This project was approved by the University of Utah Institutional Review Board, ID # 00118491. All participants provided written informed consent.
为了有效创建和实施一项教育计划，以改善阿片类药物处方实践，首先考虑处于阿片类药物流行前线的居民的独特观点非常重要。我们旨在更好地了解住院医师对阿片类药物处方、当前疼痛管理实践以及阿片类药物教育的看法，以评估设计未来教育干预措施的需求。
这是一项采用 4 个不同机构的外科住院医师焦点小组的定性研究。
我们使用半结构化访谈指南进行面对面或视频会议焦点小组。选择参与的住院医师培训计划代表了广泛的地理范围和不同的住院医师规模。
我们使用目的性抽样从犹他大学、威斯康星大学、达特茅斯-希契科克医疗中心和阿拉巴马大学伯明翰分校招募普通外科住院医师。这些地点的所有普通外科住院医师都有资格参加。根据住院医师地点和他们是初级住院医师（PGY-2、PGY-3）还是高级住院医师（PGY-4、PGY-5），参与者被分配到焦点小组中。
我们完成了 8 个焦点小组，共纳入 35 名住院医师。我们确定了 4 个主要主题。首先，住院医师在做出阿片类药物处方决策时依赖临床和非临床因素。然而，基于独特机构文化和主治医生偏好的隐藏课程严重影响了住院医师的处方实践。其次，住院医师承认对某些患者群体的污名化和偏见会影响阿片类药物的处方实践。第三，住院医师在其卫生系统中遇到了实施基于证据的阿片类药物处方的障碍。第四，住院医师通常没有接受过疼痛管理或阿片类药物处方的正规教育。住院医师建议采取几种干预措施来改善当前的阿片类药物处方状况，包括标准化处方指南、改善患者教育以及在住院医师培训的第一年进行正式培训。
我们的研究强调了可以通过教育干预措施加以改进的阿片类药物处方的几个方面。这些发现可用于开发旨在改善住院医师阿片类药物处方实践的计划，包括培训期间和培训后，以及最终安全治疗外科患者。
该项目获得了犹他大学机构审查委员会的批准，编号为 00118491。所有参与者均提供了书面知情同意书。
