Improving safe opioid prescribing among internal medicine residents using an observed structured clinical exam (OSCE) education tool

Abstract

BACKGROUND: Many patients face chronic pain, which can be debilitating and dramatically impair patient's quality of life. These patients often seek treatment from their primary care physicians, who may utilize a wide range of options to manage their chronic pain, including opioids. Opioids provide analgesia while potentially leading to other adverse effects, including misuse, addiction and overdose. Therefore there is a need for clinicians to develop safe opioid prescribing practices. This has been recognized by the development of national guidelines and recommendations to improve the training and education of physicians in this domain. However, a gap in medical education and training for safe opioid prescribing skill exists, creating physicians who may feel ill prepared to treat this patient population. To remedy this problem, an educational intervention was designed that utilized a didactic session with or without an immediate or delayed observed structured clinical exam (OSCE) to improve safe opioid prescribing skills among internal medicine residents at an academic medical center. The specific aims of this thesis are to understand both quantitative and qualitative impacts of this educational intervention, specifically to describe participant characteristics, quantitatively evaluate within and between group changes at 8-months in safe opioid prescribing knowledge, confidence and self-reported practices and qualitatively describe participants' experience of the OSCE as a learning tool. METHODS: Using a quasi-experimental design, 39 internal medicine residents were assigned to either a control or intervention groups. The intervention groups received a didactic session alone, a didactic session and immediate OSCE or a didactic session and a delayed OSCE. Participants were surveyed at baseline, 4- and 8-month follow-up to assess their safe opioid prescribing knowledge, confidence, and self-reported practices. RESULTS: Participants in the didactic followed by immediate OSCE group significantly improved both within group confidence and practices at 8-month follow-up. Additionally, participants in this group improved their confidence at 8-month follow-up significantly compared to the control group. Participants from the other educational intervention groups (didactic followed by delayed OSCE and didactic only) also saw improvements in confidence and practice, but the effect was not as robust. OSCE participants found the OSCE to be a useful learning tool and both participants in the immediate and delayed OSCE groups highlighted the need to receive the didactic session immediately prior to the OSCE session. DISCUSSION: Despite many barriers in safe opioid prescribing facing internal medicine residents including limited faculty mentorship and difficult inherited patients, this educational intervention still improved their safe opioid prescribing knowledge, confidence and practice. The use of OSCEs as an education tool is an innovative approach to develop clinical skills and can be adapted in a variety of ways to accommodate institutional and learners' needs.