Few internal medicine residency programs provide clinical opioid-related training
A 2019 survey of members of the Association of Program Directors in Internal Medicine found that while 82% of programs required some training in safe opioid prescribing and opioid use disorder treatment, few programs required clinical experiences.
In a recent survey of internal medicine resident programs, few programs required clinical experiences in safe opioid prescribing and treating patients with opioid use disorder (OUD).
Researchers conducted a cross-sectional, nationally representative survey to assess residents' opioid-related training and identify related barriers. Prior to July 1, 2018, they emailed the 2019 survey to 422 Association of Program Directors in Internal Medicine (APDIM) members in U.S. internal medicine residency programs. The survey asked about program opportunities and challenges to developing or implementing training in safe opioid prescribing, treatment of OUD, and buprenorphine waiver training, as well as perceived effectiveness of the curriculum. Results were published online Nov. 2 by the Journal of General Internal Medicine.
Overall, 293 of 422 (69.4%) participants responded to the survey, representing mainly university-based (35.5%) and community-based, university-affiliated programs (46.1%). Most (81.9%) required some training in safe opioid prescribing and treatment of OUD, and many required didactics in safe opioid prescribing (94.2%) and treatment of OUD (71.7%). Few programs, however, required clinical experiences including addiction medicine clinics (11.7%), inpatient consult services (4.6%), or offsite treatment rotations (3.3%). A minority of respondents reported that their program was “very effective” in teaching safe opioid prescribing (28.1%) or treatment of OUD (15.3%). The majority of respondents (61.5%) reported a lack of trained faculty as a limitation to developing or implementing curricula, and almost 20% of programs did not allow residents to obtain buprenorphine training due to lack of faculty to supervise residents in buprenorphine management. Some programs offered buprenorphine waiver training to residents (29.0%) and faculty (32.9%), with mandated training for residents and faculty in only 11.7% and 5.4% of programs, respectively. Overall, 60 of 19,466 (0.3%) residents completed buprenorphine waiver training. Primary care programs/tracks were more likely than others to offer waiver training to residents (odds ratio, 3.07 [95% CI, 1.68 to 5.60]; P<0.001) and faculty (odds ratio, 1.08 [95% CI, 1.01 to 3.22]; P=0.05).
The survey responses are not necessarily generalizable to the complete population of programs under the Accreditation Council for Graduate Medical Education (ACGME), the study authors noted. They added that the results cannot be extrapolated to represent any curricula changes or opinions since the time of the survey.
The results indicate that many programs do not provide residents with hands-on opioid-related training and thus are “underprepared to combat the opioid epidemic and meet the current and upcoming ACGME requirements,” the authors concluded. “Many educational barriers limited training opportunities, with a lack of trained faculty predominating. Lack of resident and faculty training may have adverse implications for patients, clinicians, and accrediting organizations and society.”
The top story in the September ACP Hospitalist described how hospitalists are becoming waivered to prescribe buprenorphine and treat opioid addiction even without the expertise of an addiction medicine consult service. (ACP membership and Single Sign-On login required for access.)