K. A. Robinson1, K. Chhabra2, A. Gupta1, T. Kent1, M. M. Aner1, G. Brat1 1Beth Israel Deaconess Medical Center,Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Surgery,Boston, MA, USA
Introduction: Surgeons prescribe opioids at high rates. In academic centers, most of the frontline pain management and opioid prescribing is completed by residents. Yet recent recent research has shown that only 10-20% of surgical residents complete opioid education. Further, graduating medical students heading into their intern year (pre-interns) are expected to start residency with a knowledge base that allows them to write opioid prescriptions. The present study evaluated pre-intern comfort with opioid prescribing and baseline knowledge about opioids as treatment for acute pain.
Methods: An opioid educational curriculum was designed to teach basic pain management skills to pre-interns. All pre-interns took a validated 11 question opioid knowledge assessment with a final question on their comfort in prescribing opioids. Pre-Interns rated their comfort with their own knowledge and readiness to prescribe opiates for acute pain on a scale of 1-10. The survey was presented prior to and after a 75 minute educational session. The post-survey included an additional question to understand if the participant felt that the training would impact their practice. Pre- and post- survey score results were analyzed using a paired t-test after confirming score normality.
Results: There were 58 pre-interns (all beginning a surgical internship) included in the study from April-June 2018 over 3 separate classes. 57 completed both surveys. Prior to the class, 28% of pre-interns could identify an opioid tolerant patient, 37% could identify when to use a long acting opioid, and 51% could correctly identify equianalgesic doses of IV opioids. These numbers rose to 72%, 74% and 86% respectively after the class. The mean percentage of correct answers increased significantly from a prior score of 54% to 69% after the class (p <0.0001 with non-overlapping confidence intervals at 95%). Comfort with opioid prescribing increased from an average score of 2.5 before the class to 4.7 (out of 10) after the class (Figure 1). 98.2% of participants said that the training would impact their practice.
Conclusion: Pre-interns have significant knowledge gaps when tested using a standardized opioid assessment tool. Further, they report feeling uncomfortable with prescribing opioids. Objective knowledge and subjective comfort level increased with a 75 minute educational session. This study demonstrates the need for more education on this topic. Opioids are one of the most common medication classes prescribed by interns; the important safety ramifications of opioid management should encourage educators to expand existing curricula.
