Junior doctor-led ‘near-peer’ prescribing education for medical students

Aims

Prescribing errors are common and inadequate preparation of prescribers appears to contribute. A junior doctor-led prescribing tutorial programme has been developed for Edinburgh final year medical students to increase exposure to common prescribing tasks. The aim of this study was to assess the impact of these tutorials on students and tutors.

Methods

One hundred and ninety-six tutorials were delivered to 183 students during 2010–2011. Each student completed a questionnaire after tutorial attendance which explored their previous prescribing experiences and the perceived benefits of tutorial attendance. Tutors completed a questionnaire which evaluated their teaching experiences and the impact on their prescribing practice. Student tutorial attendance was compared with end-of-year examination performance using linear regression analysis.

Results

The students reported increased confidence in their prescribing knowledge and skills after attending tutorials. Students who attended more tutorials also tended to perform better in end-of-year examinations (Drug prescribing: r = 0.16, P = 0.015; Fluid prescribing: r = 0.18, P = 0.007). Tutors considered that participation enhanced their own prescribing knowledge and skills. Although they were occasionally unable to address student uncertainties, 80% of tutors reported frequently correcting misconceptions and deficits in student knowledge. Ninety-five percent of students expressed a preference for prescribing training delivered by junior doctors over more senior doctors.

Conclusions

A ‘near-peer’ junior doctor-led approach to delivering prescribing training to medical students was highly valued by both students and tutors. Although junior doctors have relatively less clinical experience of prescribing, we believe that this can be addressed by training and academic supervision and is outweighed by the benefits of these tutorials.     

General practitioners’ management of psychostimulant drug misuse: Implications for education and training

Aims: To provide baseline data regarding GPs’ knowledge, experience, and attitudes toward the management of PsychoStimulant Drug Misuse (PSDM) patients to inform future education and training initiatives.

Methods: A structured cross-sectional postal questionnaire was developed following initial content setting interviews, piloted then sent to a sample of 250 GPs in north east Scotland.

Findings: A 52.13% response rate was achieved after two reminders. Over 42% of GPs expressed uncertainty about their knowledge regarding PSDM. The majority were aware that some patients were using psychostimulant drugs (61.5%), and 62.7% thought this was increasing. More than half the GPs did not have experience in managing PSDM. Although 57% of respondents agreed that GPs should be involved over half (54.1%) were not personally willing to do so.

Conclusion: GPs are aware of the rise in PSDM prevalence in their communities, but chose to keep their involvement minimal. The majority thought that the most suitable way to manage PSDM patients was primarily by specialist services with minimum input from them. A change in attitudes, education and guidance are necessary to encourage GPs to be more involved in the management of PSDM patients.     

MSWs with and without long‐term substance abuse training: Agency,community, and personal outcomes

Behavioral outcomes in agency, community, and personal arenas were examined for 81 social workers with Masters degrees (MSWs) who completed a clinical postgraduate substance abuse (SA) training program (trainees) and a matched group of 78 MSWs not enrolled in such a program (comparison subjects). Subject self‐report data was collected via telephone interviews of 30–40 min. With little or limited prior SA training, trainees took this clinical training to a broader level: they were significantly more likely than comparison subjects to provide agency SA training, receive SA training and supervision outside the agency, engage in SA community service, present SA papers at conferences, and intervene with their SA‐troubled significant others. With more MSW students now receiving SA training in their graduate programs, the impact of such postgraduate education is likely to be even greater.     

A national survey of clinicians’ views of evidence-based therapies for PTSD and substance abuse

This study was a nationwide survey of 205 Veterans Affairs (VA) staff on their views of 11 psychotherapy models for posttraumatic stress disorder (PTSD), substance use disorder (SUD), or comorbid PTSD/SUD. For each model, staff rated four key areas: level of implementation, helpfulness overall, helpfulness for PTSD/SUD, and desire for training on it. They also provided quantitative and qualitative information on general questions related to PTSD/SUD treatment. Results indicated that most respondents were already using one or more models, and they reported significantly different ratings of the models in each of the four key areas addressed, with some models quite consistently appearing at the top or bottom of the list. Furthermore, the more the clinicians had implemented a particular model, the more helpful they found it. A factor analysis of the models indicated four factors that appeared related to their content, rather than to how much they were liked. Finally, qualitative comments emphasized a desire for more training on PTSD/SUD topics and models, a broader array of psychotherapies to be implemented in VA, and more guidance on the use of PTSD models in the context of SUD. Results are discussed in terms of methodology, the need for replication, how ratings may have been affected by lack of experience with particular models, and the need for further research on adoption of evidence-based practice models.     

Health professionals’ attitudes towards AOD-related work: Moving the traditional focus from education and training to organizational culture

Aim: This article presents a critical review of research on health professionals’ attitudes towards alcohol and other drug (AOD)-related work relevant to both researchers and practitioners. It moves beyond education and training programs to examine the relevance of organizational culture in influencing attitudes.

Method: A review of research conducted on health professionals’ attitudes towards AOD-related work, and strategies to develop positive attitudes was undertaken.

Findings: 12 evidence-based tenets were identified in regard to attitudes towards AOD-related work. Key findings include the importance of professional attitudes related to confidence and perceived legitimacy of responding, and personal attitudes related to social justice concerns. Education/training and role support were identified as important evidence-based strategies to develop and support positive attitudes.

Conclusion: To foster development of positive attitudes and effective responses in regard to AOD-related work a focus that extends beyond the individual worker is required. Education and training are a necessary, but not sufficient, condition to ensure health professionals’ capacity and willingness to respond to AOD issues. Research on organizational culture provides valuable insight into the types of organizational and systems factors likely to influence AOD-related attitudes and work practice. Key strategies to develop an organizational culture supportive of AOD-related work and future research areas are highlighted.     

Expedited partner therapy: Investigating pharmacists’ awareness and training needs in the Northeastern United States

BackgroundSexually transmitted infections (STIs) in the United States are at an all-time high. Expedited partner therapy (EPT) has been endorsed by the Centers for Disease Control and Prevention to prevent reinfection of patients and their partners. Although this practice is permissible in 46 states, including all of New England and New York, it is underutilized by prescribers and pharmacists.ObjectivesTo collect and analyze data on pharmacists’ knowledge of EPT using a Web-based survey and to determine the best methods to deliver EPT continuing pharmacy education and related resources.MethodsA link to a 26-question survey was sent through e-mail listservs, social media, and newsletters to members of pharmacists’ associations in 6 New England states and New York. In addition to demographic information, the questions assessed pharmacists’ familiarity with and awareness of EPT, their roles in using this clinical service, and options for type, length, and location of related training plus types of information resources that would be most helpful for them.ResultsA total of 133 pharmacists completed the survey. Only 50% overall were familiar with EPT as a concept, and more than 80% of pharmacists did not know which STIs are covered by their state EPT regulations. However, 85% of pharmacists responded they believed they played a potential role in EPT. A majority responded that a less than 2-hour live webinar would be the best format for EPT education, in addition to other resources distributed from their respective state boards of pharmacy.ConclusionPharmacists in the Northeastern United States lack overall awareness of EPT and how it is regulated. With continuing pharmacy education delivered in their preferred format, augmented by State Board of Pharmacy resources, pharmacists can play a critical role to facilitate access for patient and partner treatment of STIs.     

Pharmacy education instruction: Preference and practices,Saudi students’ perception

Aim/Background

The methods of instruction in pharmacy education are crucial and meant to suit the professional development and encompass the advanced variety of services and functions provided by the pharmacists to serve individual patients. The aim of this study was to determine the students’ opinions on the adopted and preferred methods of instruction in pharmacy colleges in Kingdom of Saudi Arabia.

Methods

Opinions of Saudi pharmacy students regarding the adopted methods of learning were measured using a pretested questionnaire combined with Likert-type scales.

Results

Three hundred pharmacy students were interviewed. Direct type of lecturing was dominant (53.7%). The most frequently used language of instruction was combined English and Arabic (48.8%), that was mostly preferred by 52.5% of the students. Handouts were the most adopted post-lecture learning method (48.3%), while only 5.9% used student’s self-written notes. A cocktail of traditional and electronic aids was used as admitted by 68.7% and 59.3% of the students who preferred this lecture delivery method. Almost half (49.3%) of the students agreed of having a routine fair guidance and support when referring to their lecturers.

Conclusion

The study outcomes had revealed a practical guidance to be considered for instituting preferred modes of instruction to upgrading students’ capacities for better understanding and acquiring academic and professional skills.     

Training community‐based clinicians in screening and brief intervention for substance abuse problems: Translating evidence into practice

Screening and brief intervention in general health care settings are efficacious but have not been widely adopted. Our objective was to assess the effect of an educational intervention on clinicians’ substance abuse‐related clinical practices. The study was a telephone survey of practicing physicians, nurses, psychologists, physician's assistants, and social workers who attended a half‐day continuing education course on one of four occasions. The course covered the stages of behavioral change and motivational counseling, using primarily role play with standardized patients. Of 87 course attendees, 70 (80%) completed the interview. Months to years after the course, most (91%) reported that the course made an impact on their practice. Most (78%) of respondents reported that they frequently or always asked new patients who drank alcohol a formal screening questionnaire such as the CAGE, and 94% frequently or always assessed their substance abusing patients’ readiness to change. Most respondents reported that since taking the course they were more likely (1) to screen patients for alcohol or drug related problems (86%) and (2) to ask patients about their substance abuse on a follow‐up visit (96%). After exposure to an active‐learning half‐day continuing education course, clinicians reported improvement with and high rates of desirable substance abuse‐related clinical practices up to 5 years later. Continuing education efforts that incorporate active learning directed toward practicing clinicians show promise for improving rates of brief intervention for alcohol and other drug abuse.     

The Trouble with Training: substance misuse education in British medical schools revisited. What are the issues?

My 1987 survey of substance misuse education in British medical schools highlighted inadequacies in the quality of undergraduatesubstance misuse training. The continuing difficulty in engaging generalists in the care of substance misusers suggested it was time to revisit the issue. Deans, Heads of Departmentsof Psychiatry and 13 other specialities in 23 medical schools were surveyed. The response rate from Deans and Heads of Psychiatry was 70%. Psychiatry provided a mean of 6.7 (range 2-14) hours formal training (lectures/seminars),excluding one model department which provided 30 hours and co-ordinated an additional 30 hours of undergraduate substance misuse education. In 10 (45.5%) schools training is very limited, while 10 (45.5%) schools provide average (three) or above average (seven) training hours. Average or above average undergraduate training was found in schools with an academic department of addiction behaviour. These centres were associated with the most comprehensiveservices and the most postgraduate substance misuse training opportunities. These findings may partially explain why most doctors are ill-equipped to deal with substance problems. Since 1987, psychiatry has doubled input, but this is offset by diminished input from other departments. The establishment of academic departments of addiction studies in medical schools would influence decision making within university and services, promote scientific credibility and benefit communities.     

Exploring influences on pharmacists’ and students’ ethical reasoning in a changing practice landscape in Australia

International Journal of Clinical Pharmacy - Background Practising pharmacists continuously develop their ethical reasoning skills, which evolve with practice experience and exposure to challenging...     

Multisite effectiveness trials of treatments for substance abuse and co-occurring problems: Have we chosen the best designs?

Multisite effectiveness trials such as those carried out in the National Drug Abuse Treatment Clinical Trials Network (CTN) are a critical step in the development and dissemination of evidence-based treatments because they address how such treatments perform in real-world clinical settings. As Brigham et al. summarized in a recent article (G. S. Brigham, D. J. Feaster, P. G. Wakim, & C. L. Dempsey C. L., 2009), several possible experimental designs may be chosen for such effectiveness trials. These include (a) a new treatment intervention (Tx) is compared to an existing mode of community based treatment as usual (TAU): Tx versus TAU; (b) a new intervention is added to TAU and compared to TAU alone: Tx + TAU versus TAU; or (c) a new intervention is added to TAU and compared to a control condition added to TAU: Tx + TAU versus control + TAU. Each of these designs addresses a different question and has different potential strengths and weaknesses. As of December 2009, the primary outcome paper had been published for 16 of the multisite randomized clinical trials conducted in the CTN, testing various treatments for drug abuse, HIV risk behavior, or related problems. This paper systematically examines, for each of the completed trials, the experimental design type chosen and its original rationale, the main findings of the trial, and the strengths and weaknesses of the design in hindsight. Based on this review, recommendations are generated to inform the design of future effectiveness trials on treatments for substance abuse, HIV risk, and other behavioral health problems.     

Engagement with medical cannabis information from online and mass media sources: Is it related to medical cannabis attitudes and support for legalization?

BackgroundThe legalization of medical and recreational cannabis is a topic of continued debate in countries around the world. It has been suggested that medical cannabis legalization influences cannabis legalization for recreational purposes through increased media attention toward the positive health effects of cannabis. However, the nature of media coverage is likely to vary across mass media and online sources (internet and social media). In addition, effects of information engagement on attitudes may vary depending on whether information was actively sought or obtained incidentally during patterns of regular media use (scanned).MethodsThis study uses data from an online survey of Israeli adults (N = 554) to test the association between information seeking and scanning about medical cannabis (from mass media and online sources) and attitudes toward medical cannabis. Furthermore, we test indirect effects of media engagement on attitudes toward cannabis legalization through medical cannabis attitudes.ResultsSeeking and scanning for information about medical cannabis from online sources, but not from mass media sources, were associated with positive attitudes toward medical cannabis. Engagement with medical cannabis information from online sources was also indirectly associated with greater support for cannabis legalization, through positive attitudes related to medical cannabis.ConclusionThe results suggest that one mechanism through which medical cannabis legalization is associated with cannabis legalization for all purposes is public engagement with information about medical cannabis in the media, particularly from the internet and social media channels. As increasingly more jurisdictions are expected to legalize medical cannabis, with resulting increase in media attention, support for recreational cannabis legalization may be expected to grow.     

‘Everyone wants a community’: a qualitative investigation of the challenges and service needs among college students in recovery

Background: Problem drinking and illicit drug use is prevalent among college students, which can pose challenges for students in recovery from substance use disorders (SUDs). Collegiate recovery programs (CRPs) are emerging across the U.S. in order to provide support services for these students. Yet the population of college students in recovery still remains understudied. The objectives of this research were to explore (1) perceived service needs, and (2) opinions about the logistics of a CRP among a sample of college students in recovery.

Methods: Semi-structured interviews were conducted with 13 students who self-identified as being in recovery from SUDs. Interviews were transcribed and coded using content analysis.

Results: The sample of students was slightly older than traditional college students (M=?25 years). Due to age and lifestyle differences, such as sobriety, these students often felt isolated and unable to relate to the wider student body. Students also felt limited in their options for recovery support services and they expressed the desire for a formalized on-campus community, such as a CRP. Most stressed that a CRP should have flexibility in program acceptance and maintenance in order to serve all students in need.

Conclusions: The results suggest the need to for college campuses, both in the US and abroad, to conduct assessments of the perceived need for recovery support services among students. While substance abuse services may be available, students may not feel they are adequate to support their unique needs as both as a student and in recovery from SUDs.     

“A scarlet letter”: Stigma and other factors affecting trust in the health care system for women seeking substance abuse treatment in a community setting

Background: Trust in health care has been shown to influence health care utilization, perceptions of fair treatment, and health outcomes in the general population. The literature on trust in health care in individuals with a history of substance use disorder (SUD) is more limited, primarily examining the patient-provider relationship. Women seeking substance abuse treatment in community-based programs have higher rates of prior trauma and health disparities compared with male counterparts and the general population. With higher rates of prior trauma, this population is theoretically at high risk of decreased interpersonal trust and altered interpersonal relationships. Objective: This study sought to identify factors influencing trust in the health care system for women seeking substance abuse treatment in a community-based residential treatment program. Methods: Six client focus groups (n?=?30), 1 provider focus group (n?=?7), and 2 individual clinical administrator interviews (n?=?2) were conducted between November 2016 and August 2017. Focus groups and interviews were audio recorded and transcribed. Coding and coding reconciliation were conducted by 2 independent coders. Themes were extracted and analyzed from sorted and coded quotes. Results: Six themes emerged. Factors that influence trust in the health care system in this population include (1) prior experiences with diagnosis, treatment, and outcomes; (2) stigma of addiction; (3) payment and reimbursement structure; (4) patient rights and protections; (5) efficiency-driven care; and (6) the health care system's role in causing and/or enabling addiction. Conclusions: These themes demonstrate a general distrust of the health care system by women in this population. Distrust is influenced by a perception of a health care system providing care that is variable in quality, often stigmatizing, unaffordable, efficiency driven, and often influencing individuals’ SUD. This aligns with and extends prior literature around trust of health care in individuals with SUD. Future directions in research include formally assessing the impact of trust on health outcomes such as treatment entry and retention.