Medical School Opioid Prescribing Training: Better Late Than Never

All graduating doctors and advanced practice nurses at the University of Massachusetts Medical School (UMMS), in Worcester, have participated in the school’s interprofessional Opioid and Safe Prescribing Training Immersion (OSTI) program. This opioid training program, which is a requirement for graduation, is a direct result of Gov. Charlie Baker’s Opioid Addiction Working Group. In the fall of 2015, the task force proposed 10 core competencies for best practices for opioid prescribing. Those competencies were reviewed and adapted by the Advanced Practice Nursing Practice Consensus Group for implementation in the school’s nursing curriculum. “At the time, actual content about pain management and prescribing opioids in medical schools, nurse practitioner programs and physician assistant programs was very limited,” said Susan Feeney, DNP, FNP-BC, NP-C, assistant professor of nursing at the Graduate School of Nursing at UMMS. Part of the curriculum is five patient cases reflecting specific opioid use scenarios. Dr. Feeney was a member of the standardized (simulated) patient (SP) committee, which collaborated with the school’s patient simulation program to ensure that the simulations were medically authentic.

Each case is portrayed by a trained SP; groups of four students engage the SP in a simulated case, with a faculty facilitator in the room to assist as needed and then to debrief after the encounter. Besides the case studies, students engage in a panel discussion with those recovering from substance use and with family members of those affected by substance use. The 10 core competencies consist of three for primary prevention, three for secondary prevention and four for tertiary prevention. “ “Primary prevention entails evaluating a patient’s pain and determining what type of treatment is most appropriate for the type of pain, as well as a very thorough risk assessment of opioid misuse using validated tools to determine that,” Dr. Feeney said. Alternative treatments also should be considered for patients who are at high risk for misuse. Secondary prevention involves screening thoroughly to determine whether individuals are using medications appropriately, whereas tertiary prevention includes a conversation with patients who are being managed long term with these medications to find out whether such medications are an appropriate and realistic treatment for pain.

A survey of June 2016 nursing graduates was conducted in February 2017 to ascertain whether any of the taught information was being applied in their practices. All of the graduates who responded indicated they had encountered patients with similar OSTI case presentations. “The respondents also felt comfortable with the tools and truly felt they had a method to assess people’s risk and to prescribe safely,” Dr. Feeney said. She noted that the greatest hurdle in offering an immersion program such as the OSTI program is the expense. “Using standardized patients can be very costly,” she said. She recommends that schools close to each other geographically establish partnerships to share resources. “There is no need for schools to work in silos,” she said. A virtual tool like a webinar is also feasible. “I would really love to help other schools use something similar to our immersion program,” said Dr. Feeney, who is currently working as a program facilitator. “The students really appreciate the immersive type of learning experience.” In addition, by being interprofessional, “each profession appreciates each other’s point of view and each other’s skill set,” Dr. Feeney said. “In practice, this should translate into mutual respect and a better team approach to care, which we know leads to better patient outcomes.”

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