Table 3 Recommendations for future harm reduction curricula taught in undergraduate and graduate medical education programs
From: Harm reduction in undergraduate and graduate medical education: a systematic scoping review
Recommendation | Corresponding Finding | Rationale |
|---|---|---|
1. Include harm reduction principles in curricula | -Of the 19 distinct curricula reviewed, only six report explicitly teaching harm reduction as a set of principles, theory, or framework -85% of the content taught falls on the introductory side of the Harm Reduction Educational Spectrum (HRES) developed by the authors, before the point where skill progression benefits from an understanding of harm reduction framework | -Harm reduction principles offer the critical thinking skills foundational for understanding and applying more advanced harm reduction strategies -They emphasize the importance of other health principles necessary for working with PWUD [12] -They will help mitigate the lag in medical education that occurs when trying to characterize a fluctuating health crisis because instead of teaching students a set of static practices it encourages students to apply harm reduction as a framework |
2. Include non-opioid (e.g., cocaine, psychostimulant, alcohol) related harm reduction | -None of the reviewed curricula report discussing the importance of harm reduction for substances other than opioids | -With rising rates of fentanyl adulteration in the unregulated drug supply [71, 72], our trainees need to be prepared to discuss opioid-related harm reduction (e.g., overdose identification, naloxone) with patients who use any type of drug -Morbidity and mortality related to stimulant use has increased since 2014 [2] |
3. Include more advanced harm reduction skills | -Of all the discrete content topics taught across 19 distinct curricula, those that fell into the theme of Advanced Harm Reduction Skills (safer injection & fentanyl test strips) were only referenced 7 times; this amounts to 5% of curricula time | -Ensures that trainees are provided with a full picture of harm reduction practices -Adds tools to trainee’s toolbox; trainees cannot practice these skills or refer patients to other locations where they can receive these services without knowing they exist |
4. Prioritize patient engagement through hands-on learning and center the experiences and expertise of PWUD in both content creation and instruction | -Only 4 programs report using patient panels or interviews as a component of their curricula format -No programs explicitly report consulting patients with substance use disorders or community members with lived experience using substances | -Harm reduction necessitates individualization; it is not a one-size fits all approach [10] -Demonstrates the variety of ways harm reduction can be operationalized in different spaces -Ensures the content taught is accurate and relevant -Further humanizes and destigmatizes the opioid epidemic |
5. Prioritize the demonstration of critical application skills with existing public resources and provide trainees with opportunities to practice these skills in harm reduction-based standardized clinical encounters | -The only critical application skill reportedly taught was non-judgmental language which amounted to 5% of curricula time (n = 7) -Four of the 19 distinct curricula utilized standardized simulated clinical encounters/scenarios (e.g., Objective Structured Clinical Encounters/OSCEs, Standardized Patients/SPs, mannequins) | -There are not many positive, non-alienating examples of conversations about substance use given the stigma towards PWUD -Provides trainees with the words they need to have difficult conversations -Gives trainees hands-on practice that will help bridge the gap between knowledge and behavior |
6. Conduct both process and outcome evaluations of curricula, utilize validated measures, collect qualitative and quantitative data, and conduct assessments pre-, post-, and long-term post-intervention | -Of the 17 programs that conducted evaluations of their curricula, 15 focused on comfort/confidence in applying concepts; only 6 of these use validated scales -Quantitative data was collected in only 4 programs (21%) -Only 7 (37%) programs conducted a post-intervention assessment more than 1-month after the intervention | -Validated measures support uniform comparison of curricula and their impact on learners -Qualitative and quantitative data can assess learner knowledge/attitudes/comfort/behavior and downstream patient outcomes -Process evaluations and longitudinal assessment allow for targeted interventions and iterative curricula improvement (e.g., identifying whether learners don’t understand/agree with a topic vs they don’t know how to implement what they have learned) [73, 74] |
7. Publish programs' harm reduction curricula and utilize interdisciplinary expertise | -Only 8 programs (42%) are fully publicly available through the journal of publication or by request of the authors | -Many programs lack content experts in harm reduction, publishing your curricula encourages collaboration and reduces the barrier to entry for programs who want to begin implementing harm reduction education -Truly robust harm reduction curricula are interdisciplinary; public health, social work, and sociology/anthropology are all crucial |