Impact of a stigma-disrupting addiction medicine core curriculum on internal medicine resident attitudes and preparedness: results from a pilot study

Abstract

Amidst the worsening United States drug overdose crisis, the Accreditation Council for Graduate Medical Education (ACGME) instituted requirements for internal medicine (IM) residency programs to provide trainees with core substance use disorder (SUD) instruction and clinical experiences. Negative provider attitudes towards patients with SUDs, however, are a significant barrier to learning and providing standard-of-care treatment. We designed an addiction medicine curriculum for IM residents combining transformative learning methods and core competencies in SUD care with stigma-disrupting learning objectives and messaging strategies. The curriculum was implemented as a five-day core rotation for second year IM residents at a large, urban academic program. Here we report the results of a pilot study evaluating the curriculum’s association with self-reported attitudes towards and preparedness to diagnose and treat patients with SUDs. All participating residents received voluntary pre- and post-experience surveys evaluating self-reported preparedness to diagnose and treat SUDs on a 4-point Likert scale and attitudes towards patients with opioid and alcohol use disorder on the Medical Condition Regard Scale (MCRS). Responses were linked by anonymous unique identifier and analyzed with McNemar’s and paired t-test. The evaluation was approved by the program’s Institutional Review Board. Of residents completing the curriculum, 18 of 46 (39%) also completed both the pre- and post- survey. Of those, preparedness to diagnose SUDs increased over the course of the curriculum from 39% to 100% ( p  < 0.05) and preparedness to treat increased from 22% to 89% ( p  < 0.05). Average MCRS scores also demonstrated significant increases for both opioid (41.9 to 47.2, p  = 0.003) and alcohol use disorders (41.3 to 47.1, p  < 0.001), indicating increased regard for patients with these conditions at curriculum completion. Our findings build on previous work associating stigma-reducing educational strategies with increased preparedness to diagnose and treat SUDs conditions in a non-self-selected core rotation learner cohort. Medical educators should consider incorporating these strategies when developing ACGME-mandated addiction medicine curricula for IM residents.