As medical schools across the country weave addiction medicine into their curriculums in response to our national opioid crisis and pledge to require prescriber education for graduation, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell has taken the call-to-action a step further by introducing a comprehensive program on substance use for third-year medical students amidst their most intense time of training spent in the hospital or office with patients—clinical rotations.
“No matter the specialty, all physicians must be able to recognize the signs of opioid addiction and other substance use disorders—the foundation must begin in medical school,” said director of the four-year longitudinal ‘Addressing Substance Use’ curriculum, Sandeep Kapoor, MD, assistant professor of medicine and emergency medicine at the Zucker School of Medicine and director of Screening, Brief Intervention and Referral to Treatment (SBIRT) at Northwell Health. “Students must understand that substance use, abuse and addiction are not isolated to a specific patient population—it impacts all ages, cultures, and communities.”
Getting real about addiction
The “Opioid Epidemic” themed week-long inter-clerkship experience, held Feb. 5-8, 2018 at the Zucker School of Medicine, began with an in-depth look at the evolution of opioid use to crisis level, including the role of health care and need for sensitivity in treating addiction. A multidisciplinary, cross-institutional effort, the program was facilitated by a 54-member team of health professionals from 20 clinical and non-clinical departments including medical student contributors and most importantly, those who get the grip of opioid addiction—patients and caregivers.
The patient and family perspective of addiction given at the start of the program provided a framework for a series of skills-based workshops, enlightening participants with stories of stigma and judgment, despair and desperation, frustration and fear, help and hope, and a life lost.
“The talks were extremely raw and moving. We heard from a person who hit rock bottom to finally achieve success in treatment and recovery, from a parent of a teen who just entered treatment and their struggle to keep going, and from a mother whose child died despite intervention,” said a student who is about to enter a clerkship in pediatrics. “It hit home as to how addiction is a crisis that impacts everyone—like cancer, we all know of someone who has been there or is fighting it.”
For program facilitator R. Ellen Pearlman, MD, Zucker School of Medicine associate dean for advanced clinical learning, the patient and family perspective drives home how the overall public response is critical to outcomes. “It is important as health care professionals to be an empathic source of strength and support for those dealing with addiction in our communities—we must be part of the solution.”
Putting knowledge into action
Patient and family talks at the start of the workshops were followed by small group sessions where students guided by faculty facilitators discussed such topics as identifying risk factors for opioid addiction, patient counseling, safe prescribing guidelines, recognizing an overdose and administering Naloxone, a medication used to block the effects of opioids and prevent fatal overdoses. Also addressed were differences in situations where an opioid prescription is an appropriate treatment for a pain condition and when it isn’t the best option. Students also engaged in role play using key talking points to learn how to communicate with patients and families about substance use issues. In closing, the students were encouraged to identify health care gaps and areas for change in approaching the opioid epidemic based on quality assessment tools and what they’ve learned.
“We’ve done substance abuse education and outreach with various community groups but not with medical school students,” said Heather Hugelmeyer, LCSW, program director at the Northwell Health Garden City Treatment Center, an outpatient substance abuse clinic of Zucker Hillside Hospital. “We can change the landscape and stigma of how we address the opioid epidemic by teaching the future generation of doctors.”
While the goal of programming in substance use is to enhance knowledge early in professional development, added Dr. Kapoor, it is important to go beyond basic science and psychology when teaching about addiction. “We need to change the socially-driven perception of addiction, from a moral failing or criminal act, to a disease that requires understanding, care, sensitivity, and lifelong management,” said Dr. Kapoor. “People can recover. Aware and compassionate physicians, matched with team-based efforts, can ensure success for those dealing with addiction.”
Confronting crisis with creativity
A timely tie-in to opioid-focused workshops for students, the topic of addiction took center stage at a bioethics/humanities in medicine presentation hosted at the medical school entitled, “Prescription Drug Abuse: Confronting the Opioid Crisis,” sponsored by the Osler Society of the Zucker School of Medicine.
The event featured a dramatic reading from Act III of Eugene O’Neill’s Long Day’s Journey Into Night as performed and directed by members of the Osler Society’s Medicine in Theater Group (pictured above), including medical students Maya Alexandri, Shadae Beale, Justin Pereira, and physician-faculty Fred Smith, MD, Burt Rochelson, MD, and Alex Williamson, MD. The semi-autobiographical, Pulitzer-prize winning play is an honest look into the destructive impact of drug dependency within a family and served as a vehicle for a robust panel and audience discussion about the cycle of addiction.
“Feedback from my classmates conveyed how much they appreciated the combination of the play excerpt with the panel,” said Ms. Alexandri, 2LT, USA and first-year student. “The theater-policy discussion format allowed for deeper and more empathetic engagement.”
Discussion moderator Samuel Packer, MD, professor of medicine and ophthalmology and chief of the Division of Medical Ethics at Northwell, welcomed varied perspectives and interpretations on the performance in connection with the current drug epidemic from nearly 100 people in attendance. The panel included contributions from medical and law students as well as experts Jeffrey Selzer, MD, Zucker School of Medicine associate professor and director of the Physicians’ Resource Network at Northwell Health; Alexandra Trinkoff, JD, vice president in the Office of Legal Affairs at Northwell Health and a member of the Northwell Health Opioid Task Force; and Dr. Kapoor who serves a member of Northwell’s Opioid Management Steering Committee.
“The intersection of ethics, humanities, and medicine is a crucial juncture for all of us to travel if we are to successfully and empathetically approach this current crisis,” said Dr. Kapoor, who also served as a panelist. “Addiction is a complex disease that requires a diversified approach, utilizing a compass of humanism.”
For more information about substance use curriculum and programs, visit Zucker School of Medicine at medicine.hofstra.edu or contact the Northwell Health Opioid Management Steering Committee at firstname.lastname@example.org.
Sandeep Kapoor, MD, Lauren Block, MD, MPH, and Ellen Pearlman, MD. (2018)
Addressing Substance Abuse in Clinical and Educational Settings.
SGIM Forum, Society of General Medicine, Volume 41 (Num 2).
Northwell Health. Spotlight on the opioid crisis, Volume 1.
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