Mather Rory Vu, Jack Helen E, Warren Katherine E, Comrie Cameron, Li Sienna, Liu Michael, Lynn-Green Erika, Moore Sydney, Oles William, Saberi Shahin A, Jarvie E J, Koka Anjali, McGuire Patrick, Barreveld Antje M, Connery Hilary S, Griswold Todd
Acad Med. 2025 Jul 1;100(7):790-795. doi: 10.1097/ACM.0000000000006018. Epub 2025 Mar 6.
The opioid overdose crisis had progressed broadly in the United States, with a 21% increase from 2016 to 2017, and specifically in Massachusetts, with a peak rate of 1,374 deaths in 2016. In 2016, students and faculty at Harvard Medical School (HMS) established the Substance Use and Pain Curriculum Committee (SUPCC) to expand substance use and pain education. However, faculty capacity, financial resources, and administrative support were insufficient to implement changes across all phases of the medical school curriculum.
The HMS SUPCC restructured in 2021 to put students at the forefront of curricular development. This restructuring was done through 3 main innovations: (1) establishment of a student-centered committee structure, ensuring that curricular changes are centered on student interests and needs; (2) student-led curricular development and implementation, reducing faculty workload; and (3) focus on clinically relevant teaching and opportunities to practice learned skill sets.
This student-centered structure facilitated the expansion of the addiction and pain medicine curriculum to more than 30 hours of teaching by 2024. Examples of student-driven initiatives include development of an opioid use disorder management practicum equivalent to the Drug Enforcement Agency X-waiver, increased medical student access to naloxone through a hospital partnership, and integration of case-based opioid use disorder and pain medicine didactics into the clerkship year.
Although this work has established a longitudinal curriculum across all medical training stages, more must be done in clerkship rotations to help students apply their substance use and pain education in the clinical setting. The HMS SUPCC is working to incorporate teaching on nonopioid substances, such as alcohol, cannabis, and ketamine; provide longitudinal clinical experiences so students learn to care for patients with substance use disorder and chronic pain from short-term intervention to long-term recovery; and develop surveys to quantitatively and qualitatively measure curriculum outcomes.
阿片类药物过量危机在美国广泛蔓延，2016年至2017年增加了21%，在马萨诸塞州尤为严重，2016年死亡率达到峰值1374人。2016年，哈佛医学院（HMS）的学生和教师成立了物质使用与疼痛课程委员会（SUPCC），以扩大物质使用和疼痛教育。然而，教师能力、财政资源和行政支持不足以在医学院课程的各个阶段实施变革。
HMS的SUPCC在2021年进行了重组，将学生置于课程开发的前沿。这种重组通过三项主要创新实现：（1）建立以学生为中心的委员会结构，确保课程变革以学生的兴趣和需求为中心；（2）由学生主导课程开发和实施，减轻教师工作量；（3）专注于临床相关教学以及实践所学技能的机会。
这种以学生为中心的结构促使成瘾和疼痛医学课程到2024年扩展至超过30小时的教学。学生主导的举措包括开发与美国缉毒局X豁免相当的阿片类药物使用障碍管理实习课程，通过医院合作增加医学生获取纳洛酮的机会，以及将基于案例的阿片类药物使用障碍和疼痛医学教学法融入见习年。
尽管这项工作已经在所有医学培训阶段建立了纵向课程，但在见习轮转中仍有更多工作要做，以帮助学生在临床环境中应用他们的物质使用和疼痛教育。HMS的SUPCC正在努力纳入关于非阿片类物质（如酒精、大麻和氯胺酮）的教学；提供纵向临床经验，以便学生学会从短期干预到长期康复来照顾患有物质使用障碍和慢性疼痛的患者；并开展调查以定量和定性地衡量课程成果。
