Medical Schools Address Opioid Epidemic Through Innovations in Curricula and Other Methods, Capitol Hill Briefing Shows

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 School of Medicine at the University of Massachusetts (UMass) 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 prescription drug abuse.

“In about six weeks, we, across the four medical schools, released a set of core competencies that described what we think every practicing physician should know," he said. “As the medical schools and all the practicing physicians, we were saying that we own this problem. We need to have people better trained to try to address it.”

He explained the UMass Medical School’s implementation of the core competencies  and highlighted the school’s new immersive experience for medical students and nurse practitioner students, called Opioid and Safe Prescribing Training Immersion (OSTI). Through OSTI, students receive intense training through interactions with standardized patients, group sessions with patients in recovery, reflective writing, and other activities.

Outlining the Indiana University School of Medicine’s response to the outbreak  and the connection between opioid abuse, injection drug abuse, and HIV, Allen described the ties between injection drug abuse and an outbreak of HIV in the Austin, Indiana area. He discussed the school’s existing offerings in, and additions to, the undergraduate medical education (UME), GME, and continuing medical education (CME) curricula, as well as the Screening, Brief Intervention and Referral to Treatment (SBIRT) training program  that was partially sponsored by a 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) grant . He also mentioned how the school educated students and residents on the legal issues surrounding prescribing opioids, including how to use Indiana’s prescription monitoring program, INSPECT.

“We instituted required training in programs that involve most of our front line—medicine, pediatrics, family medicine, emergency medicine, and psychiatry,” he said, adding that their efforts where enhanced through the involvement of residents in the clinical response.

Like Dean Flotte, Allen emphasized Indiana University School of Medicine’s efforts to promote interprofessional education for health professions trainees beyond physicians.

Holmes, who was awarded a 2014-2015 Clinical Challenge Award by the AAMC for her work with newborns suffering from Neonatal Abstinence Syndrome (NAS), withdrawal symptoms from in utero exposure to opioids, discussed the prevalence of NAS in New Hampshire and neighboring Vermont. At the Children’s Hospital at Dartmouth in 2015, 10 percent of newborns were opioid exposed in utero. To improve care for these newborns and their families, a team of faculty, students, and pediatric staff developed and implemented a new standardized care model that resulted in lower costs, shorter hospital stays, more family involvement, and greater satisfaction with care.

She also talked about how medical students were involved in the work and the lessons in substance abuse and pain management that they took away from their involvement. “Our students were very much involved in this project and in clinical care. Pretty much every single student takes care of a baby with NAS,” she noted.

In October 2015, the AAMC joined the White House and a number of public and private partners in announcing new efforts to address the substance abuse epidemic . As part of this initiative, the AAMC has committed to sharing “professional guidance and best practices to better educate the next generation of health care workers on opioid misuse and substance use disorders." Prior to the announcement of the initiative, the deans of the two medical schools in West Virginia participated in a community discussion with President Obama to discuss the impact of substance abuse.