P. Underwood1, J. Mira1, M. Hoffman2, D. Hall1, H. Keshava3, K. Olsen4, J. Hardaway5, K. Hawley6, A. Antony4, T. Vasilopoulos4, N. Mouawad7 1University Of Florida,Department Of Surgery,Gainesville, FL, USA 2University Of North Carolina,Department Of Surgery,Chapel Hill, NC, USA 3Cleveland Clinic,Department Of General Surgery,Cleveland, OH, USA 4University Of Florida,Department Of Anesthesiology,Gainseville, FL, USA 5Michigan State University,Department Of Surgery,Lansing, MI, USA 6MedStar Union Memorial Hospital,Department Of Surgery,Baltimore, MD, USA 7Mclaren Bay Region,Department Of Surgery,Bay City, MI, USA
Introduction:
Death from opioid overdoses continues to rise, prompting increased attention towards preventing opioid abuse. A significant portion of previously opioid naïve patients develop persistent opioid use after surgery. The impact of surgical trainees on the opioid epidemic is unclear. There is little data examining the association of surgical trainee education in pain management and opioid prescribing practices.
Methods:
An anonymous, online survey was created by a multidisciplinary team at six institutions. The survey was tested and is reliable based on statistical evaluation of a pilot survey. The survey was distributed to surgical trainee members of the Resident and Associate Society of the American College of Surgeons. The survey covered five themes: education and knowledge, prescribing practices, clinical case scenarios, policy, and beliefs and attitudes. Linear mixed models were used to evaluate the influence of respondent characteristics and case scenarios on reported morphine milligram equivalents (MME) prescribed for four common general surgery clinical scenarios.
Results:
Of the 427 survey respondents, 54% indicated receiving formal training in post-operative pain management during medical school and 66% received training during residency. Only 35% agreed that they had received adequate training in prescribing opioids. There was a significant association between undergoing formal pain management training in medical school and prescribing fewer MME for common outpatient general surgery scenarios (94±15.2 vs 108±15.0; p = 0.003; Figure). Similarly, formal pain management training in residency was associated with prescribing fewer MME in the survey scenarios (92.6±15.2 vs 109±15.2; p = 0.002).
Conclusion:
Data informing general surgery programs on the utility of surgical trainee education in pain management is lacking. In this survey, nearly two-thirds of surgical residents felt that they were inadequately trained in opioid prescribing. Further, our data suggest that improving education may result in increased resident comfort with managing surgical pain and lead to more responsible opioid prescribing. Further studies are needed to inform residency programs on developing educational curricula for opioid prescribing best practices.
