Need for Structured Pain Management Curriculum and Competency-Based Evaluation in GME: An Observational Study in One Internal Medicine Residency Program

Abstract

OBJECTIVES One of the major contributing factors to the opioid crisis, marked by a surge in opioid prescriptions, includes inadequate adherence to guideline-based pain management practices, highlighting the need for a comprehensive curriculum during residency training. In this study, we aim to assess opioid exposure prevalence among hospitalized patients and examine potential associations between disease conditions, patient demographics, and opioid prescriptions during their hospital stay. METHODS In this retrospective cohort study at a southern California county teaching hospital, we analyzed the medical records of 2272 patients admitted to the IM resident inpatient teaching service for 1 year, from September 2017 through September 2018. RESULTS The study found that 44% of patients received opioid prescriptions during their hospital admission, with 23% receiving prescriptions at discharge and 45% having prior opioid exposure. Patients with prehospital opioid exposure had a 2-fold increased risk at discharge (Relative Risk: 2.51; P < .0001). The hypothesis that factors such as gender, certain medical conditions, and previous opioid use influenced opioid prescriptions during hospitalization is disproved. Instead, hospital admission itself was the significant contributing factor to receiving opioids during acute care and at discharge, irrespective of the source of pain. CONCLUSION In conclusion, our study revealed that the primary determinant for opioid exposure during hospitalization is the inpatient admission itself rather than specific patient-related factors. The lack of a structured curriculum in residency training contributes to the default use of opioids for all pain types, highlighting the need for curricular reforms to focus on multimodal pain management principles.