The Perceptions and Attitudes of Medical Students toward Opioid Education: a Qualitative Research Study Restricted; Files Only

Luciano, Angelina (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/st74cr89k?locale=fr
Published

Abstract

Background: A major contributing factor of the opioid epidemic has been the inappropriate, over-prescribing of opioids, resulting in increased occurrences of opioid use, overdoses, and deaths. Some studies suggest that the quality and content of medical school education may affect future opioid prescribing behaviors, and there is a lack of standardization in opioid education instructed throughout medical schools. It is crucial to recognize and explore how aspects of opioid education during medical school may influence opioid prescribing behaviors as medical students graduate and become practicing medical providers.

Objective: The goal of this qualitative study was to explore the perceptions and attitudes of medical students regarding the opioid education they have received while in medical school.

Methods: Medical students were recruited using purposive and snowball sampling strategies to participate in focus groups to discuss their insights and experiences surrounding the opioid education they have received at their respective institution. Three focus groups, with four participants each, were conducted on themes surrounding perceptions and attitudes toward opioids, opioid education, and factors surrounding opioid prescribing. Thematic analysis was used to code and analyze the data in MAXQDA.

Results: Participants in the study emphasized the importance of approaching opioid use with both scientific and humanistic perspectives. Participants reported learning about the pharmacology and side effects of opioids during preclinical semesters and observing their use for pain management in patients during their clinical education . However, participants felt that the quality and quantity of opioid education was lacking in both preclinical and clinical education. Despite concerns about future opioid prescribing, participants expected to receive further education during their training in residency. Overall, the education they received allowed them to understand the various factors affecting opioid prescribing spanning across the socioecological model, from medical providers’ implicit biases to the infrastructure surrounding opioid prescribing in the U.S.

Conclusion: Variations in the quality and types of opioid education encountered during medical school were expressed throughout the focus groups. Increasing the quality of opioid education and standardizing it throughout U.S. medical schools may assist in optimizing opioid prescribing behaviors and reducing the risk of adverse patient outcomes from opioid prescribing.

Table of Contents

CHAPTER 1: INTRODUCTION 1

Introduction and Rationale 1

Problem Statement 2

Theoretical Framework 3

Purpose Statement 3

Research Question 4

Significance Statement 4

Definition of Terms 6

CHAPTER 2: LITERATURE REVIEW 7

Introduction 7

The Emergence of the Opioid Epidemic 7

Consequences of the Opioid Epidemic 10

Opioid Use Disorder and Opioid Overdose 12

Historic and Current Health Equity Trends 13

Health Equity Implications 15

Medical Provider Factors that Drive Opioid Prescribing Variation 18

Medical School Opioid Education during the Opioid Epidemic 22

Opioid Concerns of Medical Students 24

A Discussion of the Theoretical Framework 26

Summary of the Current Problem and Study Relevance 29

POSITIONALITY STATEMENT 31

CHAPTER 3: METHODOLOGY 32

Introduction 32

Population and Sample 32

Procedures 33

Sampling and Recruitment 33

Data Collection 36

Data Coding and Analysis Plan 36

Thematic Analysis 37

Ethics 38

CHAPTER 4: RESULTS 39

Introduction 39

Key Findings 39

Demographics 39

Code Frequency 40

Perceptions and Attitudes toward Opioids 44

I. Changes in Perceptions and Attitudes of Opioids Before versus During Medical School 44

II. The Opioid Prescribing and Pain Management Balancing Act 48

Insight on Opioid Education during Medical School 50

I. Knowledge and Experiences Developed during Preclinical Semesters 50

II. Knowledge and Experiences Developed during Clinical Semesters 53

III. Types and Quality of Support Systems 56

Future Opioid Prescribing 60

I. Current Perceived Preparedness for Future Prescribing 60

II. Anticipated Hesitations, Barriers, and Gaps in Knowledge for Future Practice 61

III. Perceived Factors that Influence Opioid Prescribing 66

IV. Future Hopes about the Opioid Epidemic 70

Summary of Findings 71

CHAPTER 5: DISCUSSION, IMPLICATIONS, AND RECOMMENDATIONS 72

Introduction 72

Summary of Study 72

Discussion of Key Results 72

Strengths and Limitations 74

Strengths 74

Limitations 74

Implications and Recommendations 75

Public Health Implications 75

Recommendations 76

I. Recommendations for Future Research 76

II. Standardization of Opioid Education in US Medical Schools 77

Conclusion 78

REFERENCES 79

APPENDIX A: IPRCE PROTOCOL 90

APPENDIX B: RECRUITMENT MATERIALS AND EMAIL TEMPLATES 105

APPENDIX C: FOCUS GROUP MODERATOR GUIDE 107

APPENDIX D: CODEBOOK 110

APPENDIX E: IRB EXEMPTION FORM 116

APPENDIX F: FOCUS GROUP #1 TRANSCRIPT 118

APPENDIX G: FOCUS GROUP #2 TRANSCRIPT 136

APPENDIX H: FOCUS GROUP #3 TRANSCRIPT 152

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