Author: Brian S McGowan, PhD

Abstract
OBJECTIVES:
Undergraduate medical education about addictive disease can take many forms, but it is unclear which educational methods are most effective at shaping medical students into physicians who are interested in and competent at addressing addiction. The purpose of this study was to evaluate the efficacy of the Betty Ford Institute’s Summer Institute for Medical Students (SIMS), a week-long program aimed at educating medical students about addiction through a combination of traditional didactic and novel experiential sessions.
METHODS:
A written survey assessing beliefs, attitudes, and practices related to addictive disease was administered to physicians who previously participated in SIMS (n = 140) and to physicians matched for year of graduation from medical school who did not participate in SIMS (n = 105).
RESULTS:
Compared with their peers, and controlling for sex, age, year of graduation from medical school, specialty, personal experience with addiction, and training in talking to patients about substance use, physicians who participated in SIMS were more likely to believe that they could help addicted patients, find working with addicted patients satisfying, be confident in knowing available resources for addicted patients, believe that addiction is a disease, and be confident in speaking to patients about substance use. Physicians who participated in SIMS were not more likely to practice addiction medicine or to view talking to patients about substance use as clinically relevant.
CONCLUSIONS:
Undergraduate medical educational interventions combining traditional and experiential programming may render participants better equipped than peers receiving only traditional education to address addiction as physicians.

via Evaluation of an experiential curriculum for ad… [J Addict Med. 2012] – PubMed – NCBI.

Abstract
The US Supreme Court’s 1973 Roe v Wade decision had clear implications for American women’s reproductive rights and physician ability to carry out patient choices. Its effect on physician abortion training was less apparent. In an effort to increase patient access to abortions after Roe, provision shifted from hospitals to nonhospital clinics. However, these procedures and patients were taken out of the medical education realm, and physicians became vulnerable to intimidation. The consequent provider shortage created an unexpected barrier to abortion access. Medical Students for Choice was founded in 1993 to increase abortion-training opportunities for medical students and residents. Its mission ensures that motivated medical students will learn and a growing number of physicians will commit to comprehensive abortion provision.

via Unintended consequences: abortion trainin… [Am J Public Health. 2013] – PubMed – NCBI.

Abstract
BACKGROUND:
The objective of this study was to conduct a comprehensive formative assessment of chronic pain management in a large, multisite community health centre and use the results to design a quality improvement initiative based on an evidence-based practice model developed by the Veterans Health Administration. Improving quality and safety by incorporating evidence-based practices (EBP) is challenging, particularly in busy clinical practices such as Federally Qualified Health Centers (FQHCs). FQHCs grapple with financial constraints, lack of resources and complex patient populations.
METHODS:
The Promoting Action on Research Implementation in Health Services (PARIHS) Framework served as a basis for the comprehensive assessment. We used a range of measures and tools to examine pain care from a variety of perspectives. Patients with chronic pain were identified using self-reported pain scores and opioid prescription records. We employed multiple data collection strategies, including querying our electronic health records system, manual chart reviews and staff surveys.
RESULTS:
We found that patients with chronic pain had extremely high primary care utilisation rates while referral rates to pain-related specialties were low for these patients. Large gaps existed in primary care provider adherence to standards for pain care documentation and practice. There was wide provider variability in the prescription of opioids to treat pain. Staff surveys found substantial variation in both pain care knowledge and readiness to change, as well as low confidence in providers’ ability to manage pain, and dissatisfaction with the resources available to support chronic pain care.
CONCLUSIONS:
Improving chronic pain management at this Community Health Center requires a multifaceted intervention aimed at addressing many of the problems identified during the assessment phase. During the intervention we will put a greater emphasis on increasing options for behavioural health and complementary medicine support, increasing access to specialty consultation, providing pain-specific CME for providers, and improving documentation of pain care in the electronic health records.

via Comprehensive assessment of chronic pain mana… [Qual Prim Care. 2013] – PubMed – NCBI.

Abstract
Beliefs surrounding the use of opioids for chronic noncancer pain have vacillated over time. Concerns regarding long-term efficacy and adverse effects of opioids, along with increases in opioid prescribing, have contributed to many political, regulatory, and clinical responses. The present study was designed to 1) develop a reliable and valid measure (Clinicians’ Attitudes about Opioids Scale [CAOS]) to assess current and evolving beliefs regarding opioids and opioid use in patients with chronic pain; and 2) survey these beliefs in a nationally representative sample of providers from multiple medical specialties throughout the United States. We developed the questionnaire in 3 phases: 1) focus groups and content development; 2) pilot testing and subsequent revisions; and 3) formal survey (N = 1,535) and assessment of stability (N = 251). The resulting 38-item measure assessed 5 domains: 1) Impediments and Concerns; 2) Perceived Effectiveness; 3) Schedule II versus III Opioids; 4) Medical Education; and 5) Tamper Resistant Formulations. No significant differences were identified among geographical regions; however, several differences were observed among medical specialties. Orthopedists were most troubled by impediments/concerns from long-term opioid use and had the least confidence in opioid efficacy, whereas Pain Medicine specialists and Physical Medicine and Rehabilitation specialists were the most confident in efficacy. PERSPECTIVE: This article presents the psychometric properties of a new measure of clinicians’ beliefs surrounding opioid use for chronic pain. Using this measure, beliefs and behaviors of physicians across medical specialties and geographic regions using a nationally representative sample are presented, updating findings from a similar survey conducted 20 years ago.

via Clinicians’ Attitudes and Beliefs About Opioids Surve… [J Pain. 2013] – PubMed – NCBI.

Abstract
INTRODUCTION.: Medical education in sexual health in the United States and Canada is lacking. Medical students and practicing physicians report being underprepared to adequately address their patients’ sexual health needs. Recent studies have shown little instruction on sexual health in medical schools and little consensus around the type of material medical students should learn. To address and manage sexual health issues, medical students need improved education and training. AIM.: This meeting report aims to present findings from a summit on the current state of medical school education in sexual health and provides recommended strategies to better train physicians to address sexual health. METHODS.: To catalyze improvements in sexual health education in medical schools, the summit brought together key U.S. and Canadian medical school educators, sexual health educators, and other experts. Attendees reviewed and discussed relevant data and potential recommendations in plenary sessions and then developed key recommendations in smaller breakout groups. RESULTS.: Findings presented at the summit demonstrate that the United States and Canada have high rates of poor sexual health outcomes and that sexual health education in medical schools is variable and in some settings diminished. To address these issues, government, professional, and student organizations are working on efforts to promote sexual health. Several universities already have sexual health curricula in place. Evaluation mechanisms will be essential for developing and refining sexual health education. CONCLUSIONS.: To be effective, sexual health curricula need to be integrated longitudinally throughout medical training. Identifying faculty champions and supporting student efforts are strategies to increase sexual health education. Sexual health requires a multidisciplinary approach, and cross-sector interaction between various public and private entities can help facilitate change. Areas important to address include: core content and placement in the curriculum; interprofessional education and training for integrated care; evaluation mechanisms; faculty development and cooperative strategies. Initial recommendations were drafted for each.

via Summit on medical school education in sexual healt… [J Sex Med. 2013] – PubMed – NCBI.