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Part of the mission of medical schools and teaching hospitals is to respond to community and public health crises through innovations in medical education, patient care, and research. As communities across the nation face an epidemic of opioid abuse, institutions are responding with new approaches to substance abuse and pain management education.

“The response to the opioid epidemic is still evolving, just as medicine and our education evolves,” said Atul Grover MD, PhD, chief public policy officer at the Association of American Medical Colleges (AAMC) and moderator of a January 28 Capitol Hill Briefing titled "How Medical Schools and Teaching Hospitals are Addressing the Opioid Epidemic.” The briefing, hosted by the AAMC and the Congressional Academic Medicine Caucus, focused on the role of academic medicine in the response to the opioid epidemic and to other related public health issues.

Panel participants included Terence Flotte, MD, dean of the T.H. Chan School of Medicine at the UMass Chan Medical School; Bradley Allen, MD, PhD, senior associate dean for medical school education at the Indiana University School of Medicine; and Alison Holmes, MD, MPH, associate professor of pediatrics and of The Dartmouth Institute, at the Geisel School of Medicine at Dartmouth. Panelists described how training at medical schools and teaching hospitals exposes students and residents to firsthand experiences with innovative clinical care and research efforts aimed at tackling the most pressing community health challenges.

Grover began the briefing with a discussion of the AAMC, academic medicine and how medical schools and teaching hospitals have been leaders in responding to community health issues and the opioid epidemic.

He described the changes many medical schools have made to their curricula and teaching methods. “Virtually all of our schools have integrated content in required and elective courses,” said Grover, referring attendees to examples of ways institutions across the country are enhancing existing curricular content on pain management and substance abuse .

He went on to add, “We have to constantly evolve that curriculum. About 93 percent of schools planned or implemented changes in their curriculum in the last 5 years. They tailor that to accreditation requirements, but it’s also responsive to the needs of the local community.”

He likened the response to the opioid epidemic to one he saw during his own residency. “I trained in San Francisco in the 1990s. When I started my residency, we were dealing with an inner-city population at San Francisco General Hospital that was dying of HIV. By the time I left my residency, the hospices were being emptied. It was the most amazing thing to have experienced. Academic medicine played an important role in that, and we’re trying to play an important role here as well.”

According to Grover, lawmakers can play a role in addressing this challenge through a number of measures including enacting full funding for Title VII programs to support curricular innovations and workforce training in primary care, public health, and mental health, and legislation to lift the Medicare graduate medical education (GME) cap to allow more residents to train, thus combatting the doctor shortage. He also urged policymakers to consider the unique effect of other health policies on academic medical centers (AMCs), such as the buprenorphine cap,  which is especially problematic for faculty at AMCs who supervise multiple residents.

Flotte described the extent of the epidemic in Massachusetts and the efforts of the state’s medical schools to respond, including working with the governor’s office to develop a pioneering set of medical education core competencies  for the prevention and management of prescript

In September, in the face of an unwavering opioid crisis, Governor Charlie Baker called on Massachusetts’ four medical schools to help the state find solutions to the epidemic. Just a few months later, the institutions are rising to the challenge.

“It was clear that each school brought particular expertise to this aspect of the curriculum, but no school’s program encompassed all of the essential elements,” says Scott Epstein, dean for educational affairs at Tufts University School of Medicine (TUSM). “The working group process has allowed us to share best practices.”

At the meeting in September, the four schools—Boston University School of Medicine (BUSM), Harvard Medical School (HMS), UMass Chan Medical School (UMass Chan), and TUSM—collaborated to create 10 “core competencies” related to safely prescribing and handling opioid painkillers. In the months since the meeting, all four of the schools have used those principles to create tangible changes in curriculum.

But Todd Griswold, director of medical student education in psychiatry at HMS, says the efforts go beyond classroom learning.

“More important than the information are the meta-messages,” he says. “The teaching and communication about values, that addiction treatment is a high priority value, that the prescription drug misuse problem is a high priority public health issue, working to combat stigma and correct misconceptions.”

UMass Chan Chancellor Michael Collins says such adaptations are the only way future doctors will ever be equipped to manage—and eventually quell—the crisis.

“If it’s not tackled at the med school level, then it never gets tackled, and all of a sudden you’re in practice and you’re getting all these challenges in front of you,” Collins says. “It’s very important that we teach this.”

Here’s how they’re doing it:

BUSM: The school has incorporated addiction into its entire curriculum, including courses about the biology of addiction, treatment strategies, and live-action simulations of substance abuse and overdose. All fourth-year students are also required to complete BUSM’s SCOPE of Pain program, which helps educate students about how to safely manage patients pain, including proper prescription of opioid pain medication.

HMS: HMS is emphasizing the core competencies in teaching, adding a new class that covers neuroscience, psychiatry, and human development, and revamping the second-year Introduction to Psychiatry course to better address the problem. Hands-on, case-oriented experiences will also be added to the curriculum.

UMass Chan: Effective this academic year, UMass Chan is bringing principles from the core competencies into its curriculum, including hands-on work with simulated patient interactions. The school will use “standardized patients”—actors who portray patients as accurately as possible, unexpected questions and unsavory symptoms included—to help students practice difficult patient relation skills, as well as skills related to the core competencies. The school is focusing on patient communication, safe prescription habits, use of Narcan, and accurate drug use screening, with an end goal of making sure all graduates are “sound prescribers.”

TUSM: TUSM has required first-year students to take an addiction medicine course for decades, but, following unanimous approval of the core competencies from its Curriculum Committee, it’s ramping up its efforts to fit current need. Starting in May 2016, all required third-ye