Knowledge of and Attitudes towards OUD in Internal and Family Medicine Residents

Introduction:
Of the 2 million individuals in the United States diagnosed with Opioid Use Disorder (OUD), the vast majority are unable to access evidence-based care, in part due to the lack of providers trained to prescribe medication for OUD. Graduate medical education, particularly programs educating front-line primary care providers, may be an ideal setting to educate physicians in OUD care, especially in areas hard hit by the opioid epidemic. Maryland is among the top five states in the incidence of opioid related deaths, yet prior to 2020, there was no longitudinal curriculum on OUD within the Family Medicine (FM) or Internal Medicine (IM) residency programs at the University of Maryland School of Medicine. We developed a pilot educational program, Accelerating Interdisciplinary Resident Education in OUD and Harm Reduction(AIROH) to assess and improve care of OUD for physicians-in-training.

Methods: :
The AIROH program, completed by every first year IM and FM resident, consists of an introductory didactic curriculum reviewing OUD pathophysiology, treatment approach, clinical cases, and DATA 2000 waiver training. All residents complete a “Knowledge of and Attitude towards OUD”(KAO) survey before and after the OUD Primer in order to assess the impact of the intervention on KAO outcomes. Post-intervention data will be available by April 2021.

Results:
A total of 41 residents completed the pre-intervention KAO. Residents had a median age of 28 (range 25-40), were 51% female, with 56% identifying as White, 27% Asian, 7% Black, 7% Middle Eastern, and 2% Hispanic. The majority(43%) attended medical school in the Northeast, while 19%, 17%, 14%, 10% attended medical school in the Mid-Atlantic, Midwest, Southeast, and outside the US, respectively.

Less than half(19,46%) of residents reported adequate OUD education during medical school, and 98% endorsed needing additional education on diagnosis and management of OUD. Specifically, only 22% reported comfort counseling patients on medications for OUD(MOUD), and only 2% reported having enough knowledge to prescribe buprenorphine. The overall mean score on knowledge-oriented questions was 44.4% (95% CI 40.6-48.2). While FM residents reported feeling less prepared to manage OUD(p < 0.0001), or counsel patients on MOUD (p=0.001), there was no statistically significant difference between FM and IM residents in knowledge oriented questions. Additionally, male respondents had a significantly lower mean KAO score than females(p=0.03).

In terms of OUD attitudes and beliefs, the majority of interns believed that patients with OUD have a right to receive MOUD(85%), and that buprenorphine is an important part of primary care(93%). Despite this, there were a minority who felt neutral or did not want to prescribe buprenorphine as part of their practice(27%), and felt that patients should only be prescribed buprenorphine if they’re receiving counseling(24%).

Conclusion
The majority of first year family and internal medicine residents agree with the importance of MOUD, but desire additional training in counseling and treatment of patients with OUD. A minority still hold non-evidence-based attitudes and beliefs around OUD care. To close this learning gap and combat the opioid overdose death crisis, the medical education system must initiate longitudinal and experiential curricula in OUD care.

References: 1. Why Those With Opioid Use Disorder May Not Receive Treatment. Published December 10, 2018. Accessed October 26, 2020. https://pew.org/2L4Rz3r
2. Jones CM, Campopiano M, Baldwin G, McCance-Katz E. National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment. Am J Public Health. 2015;105(8):e55-e63. doi:10.2105/AJPH.2015.302664
3. Hedegaard H, Miniño AM, Warner M. Drug Overdose Deaths in the United States, 1999-2017. NCHS Data Brief. 2018;(329):1-8.