Preceptors' preparedness to teach about substance and opioid use disorder: a qualitative study.

STUDY AIM: Little is known about preceptors' comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors' views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies. METHODS: Participants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant, and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach. RESULTS: Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include need for longitudinal curriculum, redefining 'success' in treatment, and precepting challenges), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors' own training, and need for clinical students to be trained). CONCLUSIONS: Preceptors agreed that treatment of SUD/OUD belongs in primary care and students should learn about SUD/OUD from the start of their medical education. Data analysis enabled the construction of an emerging conceptual framework reflecting a diversity of experiences and opinions of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.

Addressing the Opioid Crisis: Medication-Assisted Therapy Waiver Training for Students.

PURPOSE: Physician assistant (PA) graduates should be prepared to care for patients with substance use disorders. Medication-assisted therapy (MAT) allows PA graduates to provide that care by becoming licensed to prescribe buprenorphine. However, it is unclear how feasible and effective it is to implement online MAT waiver training during PA school. This study examined student knowledge and attitudes after training to assess its impact and perceived value. METHODS: We conducted a 15-question survey after one class of students completed training during clinical rotations. Students self-reported pre/post change in awareness, knowledge, interest, comfort and confidence, perceived usefulness to practice, and assessed quality using 5-point Likert scale (higher scores = more positive) and narrative responses. Data analysis was performed using the Wilcoxon signed rank test and descriptive statistics. Free text comments were analyzed for themes using constant comparison. RESULTS: Fifty-five (100%) students completed training within 6 weeks. The survey response rate was 49/55 (89%). Pre-to-post score changes were significant (p < .05) from +0.39 to +1.35 with the greatest changes seen in knowledge (+1.35), comfort (+1.14), awareness (+1.06), and confidence (+1.08); the lowest change was in interest (score change +0.39). Students reported being satisfied with content organization and quality (mean 3.82) and recommended training to colleagues (3.98); 82% reported they would have preferred 3 months to complete training; 46% would have preferred training prior to the start of clinical rotations. Major themes indicated a desire for better preparation and flexibility of platform, with ambivalence about relevance to practice. CONCLUSION: Online MAT waiver training is feasible and effective. However, students may not be convinced of its relevance to future practice. Faculty should offer adequate preparation and optimize integration into existing curricula.

Inclusion of the homeless in health equity curricula: a needs assessment study.

Exposure to homeless patients is a potential strategy to teach about social determinants of health and health inequities. Little is known about student attitudes and preferences for learning about the homeless in curricula addressing vulnerable populations. A needs assessment to determine student readiness may inform strategies for teaching. A mixed-methods study of one matriculating physician assistant student class, with a cross-sectional survey and 3 focus groups (FG). The validated 19-item Health Professionals' Attitudes Toward Homelessness inventory (HPATHI) and new 7-item Learning Attitudes scale were administered to explore perceptions and preferences about relevance of caring for the homeless to future practice. FGs were conducted to theme saturation. Verbatim transcripts were independently read and coded by 3 researchers using constant comparison. Survey response rate was 100% (N = 60). Overall HPATHI mean score was 3.97 ± 0.04 of 5, indicating positive attitudes toward the homeless. The highest mean score (4.26 ± 0.04) was for the social advocacy subscale; the lowest (3.02 ± 0.06) for personal advocacy. The Learning Attitude scale (Cronbach's alpha 0.89) mean score was 4.47 ± 0.07 out of 5, showing a positive attitude toward curricular exposure. Older students and those with prior experience with the homeless had higher HPATHI scores (p < 0.05). Four major themes emerged: vulnerable patients cannot advocate for themselves; learning about homelessness is relevant to future practice; preference for multiple teaching strategies and adequate preparation for street rotations; and anticipated anxiety about safety. Students recognize the value of learning from homeless patients as part of gaining skills in caring for vulnerable populations. Experiential learning opportunities focusing on this group are seen as an acceptable and valuable way to gain skills applicable to all vulnerable patients. Students express fear and anxiety around non-traditional settings such as the street. Their anxieties should be adequately addressed when designing clinical rotations.