Filling a Gap in Opioid Education

The Ontario Pain Management Resources is a group of health system agencies intent on ensuring physicians have the support they need to feel more confident caring for patients with pain. Over the last several issues of Dialogue, we have taken a closer look at the different contributions of the health system agencies involved. In this issue, the last in the series, we examine the online educational resources available.

To work best, the approach, formula, amount and timing have to be right. That’s true for medication and education.

Among the continuing professional development (CPD) programs on opioids are two online offerings from McMaster University and the University of Toronto. They fill a need, and not just in increasing reach through e-Learning modules. Many clinicians face challenges in reducing the risks and harms of opioids, and simply managing patients with chronic pain.

“These are major holes in medical curricula, right from the beginning of medical school,” says Dr. Abhimanyu Sud of the University of Toronto’s Faculty of Medicine.

Dr. Sud is an Assistant Professor in the Department of Family and Community Medicine, and Director of the Safer Opioid Prescribing program in CPD. Why the relative lack of emphasis on chronic pain education? Dr. Sud says the topic doesn’t align with how doctors typically think.

“Chronic pain falls by the wayside because it doesn’t easily fit the biomedical model in the way diseases do,” he says. “Pathways of pain are understudied, and don’t account very well for the experience of patients. Our tendency is to focus on the larger model of how health and diseases happen.”

Perhaps the biggest knowledge gap? “The complicated intersection between chronic pain and opioid use disorder,” says Dr. Jennifer Wyman, Academic Lead for McMaster’s Opioids Clinical Primer project.

She continues, “We want to help clinicians assess their patients more carefully, and recognize when opioid prescriptions have moved to levels where there’s problematic use.”

The goal was to make these very accessible, where people can do them on their own time, at their own pace

Modules ease access

McMaster’s Division of e-Learning Innovation (DeLI) partnered in the design of the Opioids Clinical Primer. The online program drew on input from subject matter experts at Ontario’s six medical schools.

The primer is also integrated with the Ontario Pain Management Resources, which is a partnership that includes Health Quality Ontario, CPSO, the Ontario College of Family Physicians, CAMH and others.

The self-directed courses comprising the primer currently include:

• Strategies
  for Managing Chronic Pain: Moving Beyond Opioids;
• Mental
  Health, Chronic Pain, and Substance Use: Addressing the Connections;
• Safer
  Opioid Prescribing Strategies; Managing Patients with Opioid Use Disorder in
  Primary Care with Buprenorphine; and
• Opioid
  Use Disorder in Primary Care: Principles of Assessment and Management.

Dr. Wyman says the curriculum aims to help doctors put into practice some principles from the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Many doctors are curious about these topics. Yet they haven’t explored them in depth, or decided if they want to invest the time or cost of an in-person course for their CPD.

“The goal was to make these very accessible, where people can do them on their own time, at their own pace,” says Dr. Anthony Levinson, Project Lead and Director of DeLI.

The modules take about 1-2 hours on average, and include a lot of multimedia and interactivity. The appeal of e-Learning is obvious, in allowing for so many educational elements and offering convenience. Yet Dr. Levinson says organizations should still be deliberate in creating e-Learning, and users should be discerning in signing up.

“The principles of instructional design, whether online or face-to-face, are the most important thing in determining effectiveness,” says Dr. Levinson.

Webinars and workshop combine

Dr. Sud, who contributed to one of the McMaster modules, agrees that sound design and clear objectives should be at the forefront of any CPD, regardless of the format.

The University of Toronto’s Safer Opioid Prescribing Program includes a three-part webinar series, followed by an in-person skill development workshop. The sessions: 1) Assessing Chronic Complex Pain; 2) Prescribing Opioids in Chronic Pain; and 3) Addressing Opioid Challenges.

While the series is available to all, Dr. Sud wants to reach primary family physicians in rural and remote communities. That’s where there’s disproportionate harm from opioids, and less access to CPD. “We see this as a public health intervention,” he says.

Many e-Learning programs are asynchronous, i.e. study on your own with no interactions with other learners. The University of Toronto program is synchronous, meaning everyone participates at the same time. It creates a community of learning.

There are benefits to both approaches, says Dr. Sud. It all depends on the learning goals. In this case, the blended program focuses on practical applications through the webinars, and higher order skills in the workshop.

“It’s one thing to know the diagnostic criteria for opioid addiction, and another to communicate that diagnosis in a clinical encounter. Those are different skills, and harder to simulate online,” says Dr. Sud.

He says a review of the series reveals a wide audience and a strong completion rate (80%). There’s also a high uptake of best practices, such as urine drug screens and opioid treatment agreements, and integration of practice tools like the Opioid Manager.

Dr. Sud says many doctors tend to struggle in two areas. One is helping people who’ve been on high-dose opioids for a long period, and who may be having complications or side effects (or may be at elevated risk). The second is arriving at feasible alternative treatments, from medication to physical therapy to cognitive behavioural therapy.

The webinar series covers multi-modal approaches to complex chronic pain, opioid use disorder, and initiating/managing safer and effective opioid therapy.

Helping clinicians acquire such skills to improve pain and opioid management is a priority. The University of Toronto and McMaster programs show that the right e-Learning offers an effective prescription for progress.