Table 3 Major Themes, Subthemes and Selected Quotes, Attitudes Toward Teaching about Substance and Opioid Disorders, University of Southern California Primary Care Physician Assistant Program, 2021

Education

Enhanced, integrated longitudinal

IM

‘learning compassion and management is something you learn on the job being in the space having a preceptor guide you when you're being exposed.’

203

FM

‘…students experiencing through the eyes of the patient allows them to be in that person's shoes … and takes away judgment …that's important when caring for patients with addiction.….’

215

FM

‘(SUD/OUD education) needs to be longitudinally integrated at every level. First year, students should get addiction and understanding physiologically. The way they learn is with repetition … then the topic should be integrated into clinical.’

211

Redefining success in care of SUD/OUD patients

FM

‘Maybe the patient is not able to give up heroin or fentanyl, but they made sure that there is Narcan around. Preceptors can help students understand that we measure success differently than what they are used to. Preceptors can show students that (the patient) didn't use this morning, or they haven't had any abscesses. Helping people to understand success at different levels is important’

213

SUD/OUD presents challenges when precepting

FM

‘the biggest barrier (is) I don't have enough (patients with SUD/OUD). If you don't see something often it's hard to build your knowledge base because one case is one case and the next case is totally different… just seeing one or two patients doesn't give that broad overview of different stages and complexity.’

214

Treatment in primary care

Site integration and systemic systematic support

FM

‘it is shifting the culture, shifting mindset that takes years… it has to be concerted effort, not just from like the clinical leadership but operational leadership too.’

211

Treatment continuity in primary care

MH

‘Setting the foundation for successful treatment: that's primary care. We don't need to have patients be in a specialized facility to get them started… or getting connected with behavior health. The more we shift our mindset towards (primary care), it's going to be best.’

210

MAT waiver as teaching instrument

Prepares providers

FM

‘Everyone should be trained in (MAT waiver) You're not doing a service to your community, medical students or residents, or your patients (without this training).’

208

Improves employment prospects

AM

(MAT waiver training) makes you more competitive. It's a growing issue in primary care; if you know if you want to work in psych or addiction medicine it definitely makes you more competitive as a provider.'

205

Barriers

FM

‘…I had a hard time finding somebody that was X-waivered that could be my mentor.’

201

MH

“24 h (of training for MAT waiver) is too much time … we focus so much on suboxone but you're also going to see alcohol and meth depending on your setting, or smoking.’

210