A total of 90 residents completed the pre-tests, consisting of 27 residents in emergency medicine, 17 in general surgery, and 46 in internal medicine. There were 46 post-test responses from 13 emergency medicine residents, 13 general surgery residents, and 20 internal medicine residents. The response rates between pre and post-tests for emergency medicine, general surgery, and internal medicine were 48%, 76% and 43% respectively. The demographics for the residents are listed in Table 1.
EM residents reported receiving education about opioids from various avenues and stages of training, including personal reading (10 residents [37%]), medical school (16 residents [59.3%]), and residency (22 residents [81.5%]). Regarding training previously received, 4 residents were very satisfied (14.8%), 8 were satisfied (29.6%), 11 were neutral (40.7%), 3 were unsatisfied (11.1%), and 1 was very unsatisfied (3.7%). The EM resident prescribing habits and opioid knowledge are listed in Table 2. After receiving the educational intervention, the attitudes of EM residents to the statement “If I suspect someone is abusing opioids, I do not prescribe opioids to them” significantly changed [p=0.04].
Comparatively, general surgery residents received opioid training from personal reading (5 residents, 29%) medical school (9 residents, 53%), and residency (17 residents, 100%). Regarding prior opioid training, 1 resident felt unsatisfied, 4 residents felt neutral, 9 residents felt satisfied (52.9%), and 3 felt very satisfied (17.6%). Following this educational intervention, 1 resident felt unsatisfied (7.7%), 7 felt satisfied (53.8%), and 5 felt very satisfied (38.5%) with their opioid prescribing abilities. Furthermore, there was significant improvement in prescribing habits following a sleeve gastrectomy (p=0.01) and a laparoscopic cholecystectomy (p=0.002). The GS resident prescribing habits are listed in Table 3.
The internal medicine residents reported receiving opioid training from personal reading (14, 30.4%), medical school (28, 60.9%), residency (33, 71.7%), or in some cases, never received training (4, 8.7%). Regarding their previous opioid training, 1 resident was very unsatisfied (4.3%), 21 residents (45.7%) were unsatisfied, 19 (41.3%) were neutral, 3 (6.5%) were satisfied, and 2 were very satisfied (4.3%). Following the study training, 9 residents were unsatisfied (45%), 9 residents were neutral (45%), and 2 residents were satisfied (10%). Following the educational intervention, there was improvement in responses to multiple treatment scenarios, though none of these reached significance. These included treatment of acute episodic migraines according to American Headache Society 2015 Guidelines (45.7% to 70% prescribing naratriptan, p=0.11), improvement in prescribing habits for joint pain in a patient with a history of osteoarthritis (23.9% to 45%, p=0.14), and an increase in non-opioid management of nephrolithiasis in a patient with no history of GI bleed (62.2% to 70%, p=0.59) [Table 4].
All three groups of residents were asked questions about opioid background knowledge and attitudes. In response to “Which three states have the highest percentage of opioid-related deaths per capita?”, there was significant improvement in general surgery (p=0.001) and internal medicine (p=0.003) responses following the intervention. Furthermore, there was increase in knowledge of the number of drug overdose deaths that occurred from opioids, though it did not reach statistical significance, in both general surgery (41% to 77%, p=0.07) and internal medicine (45.7% to 65%, p=0.15). Lastly, there was significant improvement in all specialties regarding knowledge of the number of deaths that were a result of heroin overdose (general surgery p<0.001, internal medicine p<0.001, emergency medicine p=0.015) [Figure 1].
Regarding the level of satisfaction with prior opioid training, there was a significant difference between specialties (p<0.0001). Almost half of all internal medicine residents felt unsatisfied with their prior opioid training (unsatisfied or very unsatisfied - 47.9%). Comparatively, 5.9% of general surgery residents and 14.8% of emergency medicine residents felt unsatisfied or very unsatisfied with their training. There was also a significant difference across specialties in the initial management of mild pain (p=0.005) and moderate pain (p<0.001). For moderate pain, general surgery residents (35.5%) were more likely to prescribe opioids than their colleagues in internal medicine (2.2%) and emergency medicine (0%).