Oral Presentations


O-6: Mind the Gaps: An e-learning pilot project improving residents’ perceived preparedness for guideline-recommended opioid tapering in family practice

Marion Che, M.D.,
Scott Foley,
M.D.,
David Ritcey,
M.D.


McMaster University
Centre for Family Medicine

Key Words: Medical Education, Opioids

Background
Amidst the ongoing opioid crisis, the release of the CFPC 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain formalized recent evolution of opioid prescribing practices and established stringent new professional standards. As a result, we suspect there is now a gap in the residency curriculum, which is likely inadequately addressed by clinical training. We sought to characterize and address this gap, using a scalable educational module that provides residents the knowledge and resources necessary for best practice in this new context.

Methods
Using the PDSA methodology, we used a resident needs assessment to design a clinically relevant educational module that also familiarized residents with available practice resources. We then piloted the module and administered a post-intervention survey to assess its utility and inform subsequent module iterations. Future PDSA cycles can be used to refine and ultimately scale the module to a broader topic range and audience.  

Results
Of reported training gaps, tapering chronic opioid prescriptions was the most significant, with up to 56% of 25 initial respondents reporting feeling unprepared for tapering in practice. Reported need for further training (92%) and interest in a tutorial on the subject (96%), as well as free availability of a comprehensive practice resource (clinical guide and template), supported creating a 15 minute pilot module on opioid tapering. 26 residents viewed the module in a group setting, and a post-intervention survey completed immediately following showed significant reduction in perceived training gap. Residents said they knew the steps involved in an opioid taper (92.3%) and what to address at an opioid taper follow up appointment (92.3%). The majority endorsed the intervention module and the presented practice resource as useful tools for their future practice (84.6%, 80.7%).

Conclusion
It seems many residents feel unprepared to meet important CFPC expectations for managing opioids in the setting of chronic non-cancer pain, in particular attempting to taper patients to safer doses. However, this pilot project suggests this and perhaps other perceived training gaps can be improved in as little as 15 minutes using an online module making use of freely-available clinical resources.