Chung Dana H, Slat Stephanie, Rao Aditi, Thomas Jennifer, Kehne Adrianne, Macleod Colin, Madden Erin F, Lagisetty Pooja
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
University of Michigan Medical School, Ann Arbor, MI, USA.
Subst Use. 2024 Feb 29;18:11782218241234808. doi: 10.1177/11782218241234808. eCollection 2024 Jan-Dec.
Stigma and lack of knowledge are barriers to clinicians when caring for individuals with opioid use disorder (OUD). In 2018, only about 15 out of 180 American medical schools had comprehensive addiction programs. The AAMC reports that institutions are increasingly incorporating competencies to address the OUD and opioid epidemic. There have been few evaluated curriculums focused on reducing stigmatizing attitudes. This study evaluated whether a 4-hour case-based curriculum focused on improving stigmatizing attitudes toward patients with OUD could reduce medical student perceptions around viewing addiction as a punitive condition and other substitution-based misconceptions around opioid agonist-based medication.
Medical students completed a 4-hour curricular workshop which included learning objectives focusing on barriers to healthcare/stigmatizing attitudes, effective behavioral therapy options, and appropriate use of opioid medications. We measured changes in knowledge and attitudes using validated scales on stigma. Non-parametric repeated measure tests determined statistically significant differences between pre and post assessments between OUD related perceptions and a control condition (diabetes).
Of 135 eligible participants, 99 (76%) students completed both pre- and post-surveys. Mean scores across knowledge questions improved (60%-81%, < .001) and stigmatizing attitudes regarding perceived violence of people with OUD decreased (2.04-1.82, = .016). There was significant improvement in mean scores for OUD-related opinions including desire to work with and effectively treat patients with OUD (3.58-3.88, < .001) while no significant concurrent change was observed in mean opinion scores of a non-OUD comparator, diabetes (3.88-3.97, = .201).
Results indicate that the workshop was associated with measurable changes in knowledge and attitudinal forms of OUD stigma. With recent policy changes eliminating the X-waiver, healthcare institutions are eager to design curriculum around OUD management and treatment. This study provides a blueprint for an effective curriculum that improves clinician knowledge and reduces stigmatizing attitudes.
耻辱感和知识匮乏是临床医生在照料患有阿片类药物使用障碍（OUD）的个体时面临的障碍。2018年，180所美国医学院校中只有约15所设有全面的成瘾项目。美国医学协会（AAMC）报告称，各机构越来越多地纳入相关能力培训，以应对OUD和阿片类药物流行问题。针对减少耻辱态度的课程评估较少。本研究评估了一门为期4小时的基于案例的课程，该课程旨在改善对患有OUD患者的耻辱态度，是否能减少医学生将成瘾视为一种惩罚性状况的认知，以及其他围绕基于阿片类激动剂药物的基于替代疗法的误解。
医学生参加了一个为期4小时的课程工作坊，其中包括围绕医疗保健障碍/耻辱态度、有效的行为治疗选择以及阿片类药物的合理使用等学习目标。我们使用经过验证的耻辱感量表来衡量知识和态度的变化。非参数重复测量测试确定了OUD相关认知与对照状况（糖尿病）在前后评估之间的统计学显著差异。
在135名符合条件的参与者中，99名（76%）学生完成了前后两次调查。知识问题的平均得分有所提高（60%-81%，P<0.001），对OUD患者的暴力感知的耻辱态度有所下降（2.04-1.82，P=0.016）。与OUD相关意见的平均得分有显著提高，包括与患有OUD的患者合作并有效治疗他们的意愿（3.58-3.88，P<0.001），而在非OUD对照疾病糖尿病的平均意见得分方面未观察到同时期的显著变化（3.88-3.97，P=0.201）。
结果表明，该工作坊与OUD耻辱感在知识和态度方面的可测量变化相关。随着近期政策变化取消了X豁免，医疗机构急于围绕OUD管理和治疗设计课程。本研究为有效课程提供了蓝图，该课程可提高临床医生的知识水平并减少耻辱态度。
