BETHESDA, MD. – Generalist chief residents who were trained in opioid risk management in immersion programs were more confident in dealing with the risks, showed improvement in their clinical practice skills, and were better prepared and more willing to pass on their knowledge to their trainees than were those who did not receive the training, data from a small study of chief residents show.
Such programs, known as Chief Resident Immersion Training (CRIT) programs, are one way of addressing the need for better physician training in opioid risk management, Dr. Daniel P. Alford said at the annual conference of the Association for Medical Education and Research in Substance Abuse.
Dr. Alford, of Boston University, and his colleagues initially targeted generalist chief residents specializing in internal medicine, family practice, and emergency medicine because providers in those specialties are increasingly prescribing opioids for chronic pain at a time when opioid abuse is becoming a public health problem. However, the access of chief residents to training in risk management is inadequate despite screening and monitoring recommendations from professional bodies.
The researchers expanded the course content in opioid risk management in the 2007 and 2008 CRIT programs in addiction medicine to include addiction-screening tools, controlled substance agreements, and monitoring strategies such as pill counts and urine drug testing. They conducted electronic surveys of the participants about their confidence in dealing with opioid risk management as well as their clinical and teaching practices at baseline (pre-CRIT) and 6 months after they had completed the program (post-CRIT).
The 43 chief residents were from 36 residency programs. Eighty-six percent specialized in internal medicine, 9% in family medicine, and 5% in emergency medicine. All of them completed the baseline survey; 1 did not complete the 6-month follow-up, and 2 of the remaining 42 did not provide complete responses for all of the questions. The changes in confidence, clinical practices, and teaching practices were rated on a 5-point Likert scale, and a P value of .05 was deemed significant.
The changes in confidence from baseline to post-CRIT in identifying substance abuse in chronic pain patients and in treating high-risk patients with chronic pain were significant. Confidence in identifying abuse went from 2.8 at baseline to 3.5 at 6 months (1 = not at all, 5 = very confident) and in treating high-risk patients, it went from 2.2 to 3.7 (P less than .0001 for both). One CR did not complete the post-CRIT confidence questions.
Future research should focus on the impact of the CRIT program on those who are trained by the chief residents, Dr. Alford said.
He and his colleagues had no financial disclosures. The study was funded by the National Institute on Drug Abuse.