Are U.S. Plastic Surgery Residency Programs Equipping Trainees to Take On the Opioid Epidemic? A National Survey
Banafsheh Sharif-Askary, MD1, Salma A. Abdou, MD1, Tanvee Singh, MPH2, David H. Song, MD, MBA1.
1Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA.
BACKGROUND: The national opioid epidemic is among the century’s most profound threats to public health. Previous literature demonstrated that plastic surgery trainees lack vital practices that promote opioid stewardship. However, it is not understood why this practice gap exists. This is the first study to evaluate the availability and effectiveness of opioid education in U.S. plastic surgery programs. Preliminary data reveals how training may better equip residents to become conscientious and accountable surgeons.
METHODS: A survey designed to explore available opioid prescribing education and its efficacy was anonymously hosted (Qualtrics, Seattle, Washington, USA) and distributed to all 97 plastic surgery training programs. Within the survey, formal opioid training was defined as purposeful teaching (i.e., planned curriculum). Informal training was defined as the, “learn as you go,” method (i.e., experience from observing practice, informal discussions, etc.).
RESULTS: Ninety-one responses were included in the analysis. More than half of respondents received formal training in safe opioid prescribing (59.3%), while nearly all (91.2%) reported having informal training. Of respondents who had both formal and informal training (84.6%), the vast majority (85.7%) found informal training to be more valuable. Almost half of residents reported not knowing how to query prescription drug monitoring databases (47.3%), 70.3% do not know of any preoperative risk assessment tools, and 60.4% do not know protocols for safe opioid disposal. There was no significant difference in knowledge between junior and senior residents (all p-values>0.05). Only 8.0% of junior residents report asking for rationale when they are instructed in opioid prescribing, while only 4.1% of senior residents reported providing rationale. The strong majority of trainees believe that physician residents affect the trajectory of the epidemic (73.6%), while nearly half believe that surgical and medical specialties are equally influential (48.6%).
CONCLUSIONS: Recent work identified surgical residents as lacking essential practices related to opioid stewardship. This study demonstrates that these deficits exist because there is an unmet need for effective opioid education. Trainees notably valued informal training over formal training due to its real-world applicability and delivery by trusted mentors. Furthermore, the severity of the opioid epidemic has not translated into improved trainee education and knowledge over time. This study lays the framework for the, “formalization of informal training.” This paradigm will better train younger generations who believe they are critical stakeholders in combating the ongoing epidemic.
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