Original Article

Opioid Education in Obstetrics and Gynecology Training Programs

Authors: Alexis A. Dieter, MD, Marcella Willis-Gray, MD, Erin T. Carey, MD, MSCR

Abstract

Objective: Our primary objective was to assess the current state of pain and opioid education in obstetrics and gynecology (OBGYN) by performing a detailed review of the national educational curricula guiding OBGYN residency and fellowship training programs in the United States.

Methods: From 2019 to 2020 we reviewed seven documents created to guide learning and structure educational training for OBGYN residency and fellowship programs in the United States: the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives Core Curriculum in Obstetrics and Gynecology, the 2016 Educational Objectives-Fellowship in Minimally Invasive Gynecologic Surgery, and the 2018 Guides to Learning in Complex Family Planning, Female Pelvic Medicine & Reconstructive Surgery, Gynecologic Oncology, Maternal Fetal Medicine, and Reproductive Endocrinology and Infertility. Each document was reviewed by two authors to assess for items referring to pain or opioids.

Results: The CREOG educational objectives, used to inform educational curricula for residency programs, were the most comprehensive, mentioning pain and/or opioid educational objectives the highest number of times and including the most categories. The CREOG document was followed by the Guides to Learning for Gynecologic Oncology and for Minimally Invasive Gynecologic Surgery. The Reproductive Endocrinology and Infertility Guide to Learning did not mention pain and/or opioids in the educational objectives.

Conclusions: Our study identifies an opportunity for consistent and appropriate opioid and pain management education in OBGYN training.

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References

1. Rudd RA, Seth P, David F, et al. Increases in drug and opioid-involvedoverdose deaths—United States, 2010- 2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. 2. Centers for Disease Control and Prevention. Wide-ranging online data for epidemiologic research (WONDER). http://wonder.cdc.gov. Published 2017. Accessed February 3, 2020. 3. Centers for Disease Control and Prevention. Prescription painkiller overdoses: a growing epidemic especially among women. https://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html. Published 2013. Accessed February 3, 2020. 4. Badreldin N, Grobman WA, Chang KT, et al. Opioid prescribing patterns among postpartum women. Am J Obstet Gynecol 2018;219:103 e101–e103.e108. 5. Bortoletto P, Prabhu M, Garry EM, et al. Opioid dispensing patterns after oocyte retrieval. Fertil Steril 2018;110:905–909. 6. Buono K, Brueseke T, Wu J, et al. Evaluation of opioid prescriptions after urogynecologic surgery within a large health care organization: how much are we prescribing? Female Pelvic Med Reconstr Surg 2019;25:125–129. 7. Griffith KC, Clark NV, Zuckerman AL, et al. Opioid prescription and patient use after gynecologic procedures: a survey of patients and providers. J Minim Invasive Gynecol 2018;25:684–688. 8. Johnson CM, Makai GEH. A systematic review of perioperative opioid management for minimally invasive hysterectomy. J Minim Invasive Gynecol 2019;26:233–243. 9. Lamvu G, Feranec J, Blanton E. Perioperative pain management: an update for obstetrician-gynecologists. Am J Obstet Gynecol 2018;218:193–199. 10. Madsen AM, Stark LM, Has P, et al. Opioid knowledge and prescribing practices among obstetrician-gynecologists. Obstet Gynecol 2018;131:150–157. 11. Prabhu M, Garry EM, Hernandez-Diaz S, et al. Frequency of opioid dispensing after vaginal delivery. Obstet Gynecol 2018;132:459–465. 12. Holland E, Bateman BT, Cole N, et al. Evaluation of a quality improvement intervention that eliminated routine use of opioids after cesarean delivery. Obstet Gynecol 2019;133:91–97. 13. US Food and Drug Administration. Risk Evaluation and Mitigation Strategies | REMS. https://www.fda.gov/drugs/drug-safety-and-availability/risk-evaluation-and-mitigation-strategies-rems. Published 2019. Accessed March 20, 2020. 14. State requirements for pain management CME. https://knowledgeplus.nejm.org/state-requirements-for-pain-management-cme. Accessed March 20, 2020. 15. Baruch AD, Morgan DM, Dalton VK, et al. Opioid prescribing patterns by obstetrics and gynecology residents in the United States. Subst Use Misuse 2018;53:70–76. 16. CDC Injury Center. Opioid overdose. Understanding the epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html. Published 2018. Accessed January 30, 2020. 17. Knight KR, Kushel M, Chang JS, et al. Opioid pharmacovigilance: a clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use. Soc Sci Med 2017;186:87–95. 18. Thompson JC, Komesu YM, Qeadan F, et al. Trends in patient procurement of postoperative opioids and route of hysterectomy in the United States from 2004 through 2014. Am J Obstet Gynecol 2018;219:484.e1–484.e11. 19. Chiu AS, Healy JM, DeWane MP, et al. Trainees as agents of change in the opioid epidemic: optimizing the opioid prescription practices of surgical residents. J Surg Educ 2018;75:65–71. 20. Olsen KR, Hall DJ, Mira JC, et al. Postoperative surgical trainee opioid prescribing practices (POST OPP): an institutional study. J Surg Res 2018;229:58–65. 21. Swenson CW, Kamdar NS, Seiler K, et al. Definition development and prevalence of new persistent opioid use following hysterectomy. Am J Obstet Gynecol 2018;219:486.e1–486.e7. 22. Wiese HJC, Piercey RR, Clark CD. Changing prescribing behavior in the United States: moving upstream in opioid prescription education. Clin Pharmacol Ther 2018;103:982–989. 23. Yorkgitis BK, Bryant E, Raygor D, et al. Opioid prescribing education in surgical residencies: a program director survey. J Surg Educ 2018;75:552–556. 24. Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. Obstet Gynecol 2017;130:e81–e94. 25. American College of Obstetricians and Gynecologists https://www.acog.org/en/Topics/Opioids. Accessed November 19, 2020. 26. Ruff AL, Alford DP, Butler R, et al. Training internal medicine residents to manage chronic pain and prescription opioid misuse. Subst Abus 2017;38:200–204.