title: Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination.
abstract: BACKGROUND
  Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.
  
  
  OBJECTIVE
  To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' knowledge, confidence, and self-reported practices.
  
  
  METHODS
  Using a quasi-experimental design, 39 internal medicine residents from an urban academic medical center were assigned to 1 of 4 groups: 1-hour lecture only, lecture followed by immediate OSCE, lecture followed by 4-month delayed OSCE, and control. Safe opioid prescribing knowledge, confidence, and self-reported practices were assessed at baseline and at 8 months.
  
  
  RESULTS
  At 8 months, knowledge, confidence, and self-reported practices improved in the control and in all 3 intervention groups. The immediate OSCE group had the greatest improvements in combined confidence scores within group (0.74, P = .01) compared to controls (0.52, P = .05), using a 5-point scale. This group also had the greatest improvement in self-reported practice changes (1.04, P = .04), while other groups showed nonsignificant improvements-delayed OSCE (0.43, P = .44), lecture only (0.66, P = .24), and control (0.43, P = .19).
  
  
  CONCLUSIONS
  Safe opioid prescribing education that includes a lecture immediately followed by an OSCE had an impact on residents' confidence and self-reported practices greater than those for delayed OSCE or lecture only groups. There was no difference in knowledge improvement among the groups. Lecture followed by an OSCE was highly regarded by residents, but required additional resources.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Alford
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Carney
authors.forename: Belle
authors.initials: B
authors.lastname: Brett
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Parish
authors.forename: Angela H
authors.initials: AH
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation
chemical_list: D000701:Analgesics, Opioid