Improved medical training in ethics and prescribing practices may lead to more responsible opioid prescribing among new physicians, according to study results published in the AMA Journal of Ethics.
Researchers reported that opioid overprescribing is a key contributor to the current opioid crisis. Presently, medical schools lack a standardized ethics curriculum, with approximately 50% of medical schools educating students on 6 of 19 key concepts deemed important for ethics: informed consent, health care delivery, confidentiality, quality of life, death and dying, and euthanasia. Researchers also noted that medical schools often report lacking adequately experienced faculty to teach proper ethics and prescribing practices and to properly assess learning progress.
In this study, researchers presented improvement strategies that may prepare future physicians to appropriately and ethically prescribe opioids. First, medical schools should implement a series of multilevel interventions that include clinical simulations, case-based learning, time with trained clinicians in the field, and clinical exposure to real patients. When used within the Anne Arundel Medical Center, these interventions reduced opioid overprescribing by 38% relative to the mean baseline prescribing level.
Second, medical students should be properly tested on their ability to manage pain, write prescriptions, and address ethically relevant factors. Assessment and testing should be overseen by a faculty team composed of nurses, pharmacists, and pharmacologists to reinforce the importance of ethical prescribing methods of all addictive substances including opioids.
Third, medical schools should implement a higher number of courses on drug dependence and addiction to illustrate how these may influence opioid prescribing methods. The researchers cite a previous study that found that few patients with a history of substance abuse received any form of screening, early intervention, or adequate care related to the use of addictive substances.
Lastly, medical schools should adopt a longitudinal curriculum that focuses on opioid prescribing to better enhance preparedness in medical students. Through this curriculum, students should gain an opportunity to speak with patients about varying levels of pain, substance abuse history, and addiction status.
The researchers concluded that medical students will be better equipped to deal with the ethical implications of opioid prescribing when medical schools improve teaching methods surrounding ethics and appropriate opioid prescribing.
Singh R, Pushkin GW. How should medical education better prepare physicians for opioid prescribing? AMA J Ethics. 2019;21(8):E636-E641.