Surgical Trainee Perspectives on the Opioid Crisis: The Influence of Explicit and Hidden Curricula.

Autor: Bleicher J; Department of Surgery, University of Utah, Salt Lake City, Utah. Electronic address: Josh.bleicher@hsc.utah.edu., Johnson JE; Department of Surgery, University of Utah, Salt Lake City, Utah., Cain BT; Department of Surgery, University of Utah, Salt Lake City, Utah., Shaw RD; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Acher AA; Department of Surgery, University of Utah, Salt Lake City, Utah; Department of Surgery, University of Wisconsin, Madison, Wisconsin., Gleason L; Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama., Barth RJ; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Chu DI; Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama., Jung S; Department of Surgery, University of Wisconsin, Madison, Wisconsin., Melnick D; Department of Surgery, University of Wisconsin, Madison, Wisconsin., Kaphingst KA; Department of Communication, Unversity of Utah and Huntsman Cancer Institute, Salt Lake City, Utah., Smith BK; Department of Surgery, University of Utah, Salt Lake City, Utah., Huang LC; Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah.
Jazyk: angličtina
Zdroj: Journal of surgical education [J Surg Educ] 2023 Jun; Vol. 80 (6), pp. 786-796. Date of Electronic Publication: 2023 Mar 07.
DOI: 10.1016/j.jsurg.2023.02.013
Abstrakt: Objective: In order to effectively create and implement an educational program to improve opioid prescribing practices, it is important to first consider the unique perspectives of residents on the frontlines of the opioid epidemic. We sought to better understand resident perspectives on opioid prescribing, current practices in pain management, and opioid education as a needs assessment for designing future educational interventions.
Design: This is a qualitative study using focus groups of surgical residents at 4 different institutions.
Setting: We conducted focus groups using a semistructured interview guide in person or over video conferencing. The residency programs selected for participation represent a broad geographic range and varying residency sizes.
Participants: We used purposeful sampling to recruit general surgery residents from the University of Utah, University of Wisconsin, Dartmouth-Hitchcock Medical Center, and the University of Alabama at Birmingham. All general surgery residents at these locations were eligible for inclusion. Participants were assigned to focus groups by residency site and their status as junior (PGY-2, PGY-3) or senior resident (PGY-4, PGY-5).
Results: We completed 8 focus groups with a total of 35 residents included. We identified 4 main themes. First, residents relied on clinical and nonclinical factors when making decisions about opioid prescribing. However, hidden curricula based on unique institutional cultures and attending preferences heavily influenced residents' prescribing practices. Second, residents acknowledged that stigma and biases towards certain patient groups influenced opioid prescribing practices. Third, residents encountered barriers within their health systems to evidence-based opioid prescribing. Fourth, residents did not routinely receive formal education on pain management or opioid prescribing. Residents recommended several interventions to improve the current state of opioid prescribing, including standardized prescribing guidelines, improved patient education, and formal training during the first year of residency.
Conclusions: Our study highlighted several areas of opioid prescribing that can be improved upon through educational interventions. These findings can be used to develop programs aimed at improving residents' opioid prescribing practices, both during and after training, and ultimately the safe care of surgical patients.
Ethics Statement: This project was approved by the University of Utah Institutional Review Board, ID # 00118491. All participants provided written informed consent.
(Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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