"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead

Original article
peer-reviewed

Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians



Abstract

Objectives: The opioid epidemic is a multifactorial issue, which includes pain mismanagement. Resident physician education is essential in addressing this issue. We aimed to analyze the effects of an educational intervention on the knowledge and potential prescribing habits of emergency medicine (EM), general surgery (GS), and internal medicine residents (IM).

Methods: Resident physicians were provided with educational materials and were given pre-tests and post-tests to complete. Descriptive statistics were used to analyze pre-test and post-test responses. Chi-squared analysis was used to identify changes between the pre-tests and post-tests. A p < 0.05 value was considered statistically significant. 

Results: Following the educational intervention, we observed improvement in correct prescribing habits for acute migraine management among emergency medicine residents (from 14.8% to 38.5%). Among general surgery residents, there was a significant improvement in adherence to narcotic amounts determined by recent studies for sleeve gastrectomy (p= 0.01) and laparoscopic cholecystectomy (p= 0.002). Additionally, we observed a decrease in the number of residents who would use opioids as a first-line treatment for migraines, arthritic joint pain, and nephrolithiasis.

Discussion: Resident physicians have an essential role in combating the opioid epidemic. There was a significant improvement in various aspects of opioid-related pain management among emergency medicine, internal medicine, and general surgery residents following the educational interventions. We recommend that medical school and residency programs consider including opioid-related pain management in their curricula.

Introduction

The United States (US) opioid epidemic is a multifactorial crisis, with prescription opioids identified as a key contributor to opioid misuse and overdose deaths [1]. At the medical provider level, harm reduction techniques have focused on preventing an excess of prescription opioids from circulating in the community. Approaches to this have included legislative limits on prescription amounts for certain patient populations and state-mandated use of prescription drug monitoring programs (PDMPs) to regulate opioid dispensing [2-3]. While recent studies have provided specialty- and procedure-specific opioid prescribing recommendations based on patient consumption patterns and pain relief requirements, no formal prescribing guidelines exist to eradicate the provider uncertainty that stems from the fear of undermanaging patient pain [4-7]. Additionally, medical school and residency program curricula dedicated to key opioid and pain management topics are underwhelming in the context of the severity of the opioid epidemic. This has been attributed partly to a limited pool of faculty who feel qualified to teach these concepts and to a lack of standardized competencies driving curricular design [7,8].

 Accordingly, residents across all medical disciplines are often underprepared to prescribe opioids for patient pain or respond to various opioid-related patient management scenarios [9-11]. The magnitude of this deficit is well-exemplified in a recent study surveying surgical residents at a large academic institution: 90% reported no formal training in best practices of pain management or opioid prescribing, despite reliance on opioids for postoperative pain management [11]. In response to this insufficiency in medical trainee preparation, residency programs have begun to incorporate opioid and pain management material into their curricula. Programs have used various educational models, and some have quantified the effectiveness of these didactics through methods such as survey data collection [11-13]. However, these interventions are typically implemented in a specialty-specific cohort, which limits group knowledge comparisons and the potential to evaluate standardized intervention effectiveness across a variety of medical disciplines. Raheemullah et al. conducted an opioid education intervention using pre-tests and post-tests among internal medicine residents and found improvement in knowledge and prescribing habits [14].

The purpose of this study was to investigate the impact of an educational presentation on resident knowledge and attitudes related to opioid prescribing and pain management, in internal medicine (IM), general surgery (GS), and emergency medicine (EM) residents. By implementing a standardized intervention designed to educate trainees on key concepts such as opioid crisis statistics, opioid prescribing laws, opioid-related complications, and evidence-based opioid prescribing guidelines, we aimed to measure the success of this intervention at content delivery while simultaneously collecting data on the opioid and pain management education of our residents. The goal was to compare the effectiveness of this educational model at improving resident opioid and pain management knowledge, attitudes, and behaviors across several specialties and assess the feasibility of a generalized institutional approach to resident opioid education.

This article was previously posted on Research Square as a Preprint on August 17, 2021.

Materials & Methods

This study was determined to be exempt from institutional review board review by the Review Board of Thomas Jefferson University. A total of 46 IM, 17 GS, and 27 EM residents from all postgraduate years (PGYs) at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, were recruited by email to voluntarily participate in this study. The intervention was designed as a seven-minute pre-recorded lecture with accompanying pre-tests and post-tests. Tests were intended to assess resident opioid and pain management knowledge, attitudes, and behaviors at baseline and upon presentation completion. Lecture content consisted of opioid crisis statistics, opioid prescribing laws, opioid-related complications, and evidence-based opioid prescribing guidelines with practice recommendations modified for each specialty. The pre-tests and post-tests were designed by a team of physicians and medical students. Each test was identical for each group of residents, with differences only in case vignette content and prescribing guidelines between the three cohorts to provide residents with recommendations and scenarios relevant to their specific fields (see Appendix). The post-tests were taken shortly after the pre-tests. The complete pre-tests and post-tests for each specialty are available in the Appendix. The data from the pre-tests and post-tests were organized and we performed descriptive statistics to quantify the responses. We used a Chi-squared analysis to identify resident changes between baseline and completion of the educational intervention using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp, Armonk, New York). Additionally, we generated comparisons of performance measures across the three cohorts to identify specialty-specific trends. A p < 0.05 value was considered statistically significant. 

Results

A total of 90 residents completed the pre-tests; there were 27 residents from EM, 17 from GS, and 46 from IM. There were 46 post-test responses from 13 EM residents, 13 GS, and 20 IM residents. The response rates between pre-test and post-test for EM, GS, and IM were 48%, 76%, and 43% respectively. The demographics for the residents are listed in Table 1.

Emergency Medicine
  Pre-test Post-test
Year in Residency
PGY1 8 (30%) 5 (38%)  
PGY2 8 (30%) 2 (15%)  
PGY3 11 (41%) 6 (46%)  
DEA License
Yes 0 (0%) 0 (0%)  
No 27 (100%) 27 (100%)  
General Surgery
  Pre-test Post-test  
Year in Residency      
PGY1 2 (12%) 0 (0%)  
PGY2 2 (12%) 3 (23%)  
PGY3 3 (18%) 3 (23%)  
PGY4 5 (29%) 4 (31%)  
PGY5 4 (24%) 3 (23%)  
DEA License      
Yes 15 (88%) 13 (100%)  
No 2 (12%) 0 (0%)  
Internal Medicine       
  Pre-test Post-test  
Year in Residency      
PGY1 18 (39%) 9 (45%)  
PGY 2 12 (26%) 8 (40%)  
            PGY3                           16 (35%) 3 (15%)  
DEA License      
Yes 4 (9%) 0 (0%)  
No 42 (91%) 20 (100%)  

EM residents reported receiving education about opioids from various avenues and stages of training, including personal reading (10 residents (37%)), medical school (16 residents (59.3%)), and residency (22 residents (81.5%)). Regarding training previously received, four residents were very satisfied (14.8%), eight were satisfied (29.6%), 11 were neutral (40.7%), three were unsatisfied (11.1%), and one was very unsatisfied (3.7%). The EM resident prescribing habits and opioid knowledge are listed in Table 2. After receiving the educational intervention, the attitudes of EM residents to the statement “If I suspect someone is abusing opioids, I do not prescribe opioids to them” significantly changed (p=0.04).

  Pre-test Post-test P-value
For an adult patient that presents to the emergency room with acute pain, according to current PA state guidelines, what is the maximum duration (days) for which an opioid prescription should be given?
7 days 6 (22.2%) 4 (30.8%) 0.56
For an adult presenting to the ED with acute low back pain, I would typically prescribe:
0-10 tablets of 5mg oxycodone + NSAID 0 (0%) 2 (15.4%)                    0.54
A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence?
Naratriptan 4 (14.8%) 5 (38.5%)                     0.09
I feel comfortable in my knowledge of non-opioid pain management.
Agree 15 (55.5%) 7 (53.8%) 0.06
Strongly agree 5 (18.5%) 3 (23.1%)
If I suspect someone is abusing opioids, I do not prescribe opioids to them. 
Agree 12 (44.4%) 2 (15.4%) 0.04
Strongly agree 7 (25.9%) 2 (15.4%)
For patients experiencing moderate pain, I usually initially prescribe:
Tylenol 5 (18.5%) 5 (38.5%)   0.17
NSAIDs 22 (81.5%) 8 (61.5%)
Opioid 0 (0%) 0 (0%)

Comparatively, GS residents received opioid training from personal reading (five residents, 29%) medical school (nine residents, 53%), and residency (17 residents, 100%). Regarding prior opioid training, one resident felt unsatisfied, four residents felt neutral, nine residents felt satisfied (52.9%), and three felt very satisfied (17.6%). Following this educational intervention, one resident felt unsatisfied (7.7%), seven felt satisfied (53.8%), and five felt very satisfied (38.5%) with their opioid-prescribing abilities. Furthermore, there was a significant improvement in prescribing knowledge following a sleeve gastrectomy (p=0.01) and a laparoscopic cholecystectomy (p=0.002). The GS resident prescribing habits are listed in Table 3.

  Correct responses (%) Incorrect responses (%)  
For a patient being discharged home after a sleeve gastrectomy, I would typically prescribe:
0-10 tablets 5mg oxycodone* 9 (52.9%) 13 (100%) 0.01*
For a patient being discharged home after a laparoscopic cholecystectomy, I would typically prescribe:
0-15 tablets* 1 (5.9%) 7 (53.8%) 0.002*
For a patient being discharged home after an open small bowel resection, I would typically prescribe:
0-15 tablets* 6 (35.3%) 8 (61.5%) 0.16  
For a patient being discharged home after a major hernia repair, I would typically prescribe
0-10 tablets* 4 (23.5%) 9 (69.2%) 0.04*  

The IM residents reported receiving opioid training from personal reading (14, 30.4%), medical school (28, 60.9%), residency (33, 71.7%), or in some cases, never received training (4, 8.7%). Regarding their previous opioid training, one resident was very unsatisfied (4.3%), 21 residents (45.7%) were unsatisfied, 19 (41.3%) were neutral, three (6.5%) were satisfied, and two were very satisfied (4.3%). Following the study training, nine residents were unsatisfied (45%), nine were neutral (45%), and two were satisfied (10%). Following the educational intervention, there was an improvement in responses to multiple treatment scenarios, though none of this reached significance. These included treatment of acute episodic migraines according to American Headache Society 2015 Guidelines (45.7% to 70% prescribing naratriptan, p=0.11), improvement in prescribing habits for joint pain in a patient with a history of osteoarthritis (23.9% to 45%, p=0.14), and an increase in non-opioid management of nephrolithiasis in a patient with no history of GI bleed (62.2% to 70%, p=0.59) (Table 4).

If I suspect someone is abusing opioids, I do not prescribe opioids to them. 
Agree 25 (54.3%) 9 (45%) 0.22
Strongly Agree 8 (17.4%) 9 (45%)
I think that proper pain management is associated with better patient outcomes.
Agree 25 (54.3%) 14 (70%) 0.11
Strongly Agree 20 (43.5%) 6 (30%)
A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence?
Naratriptan* 21 (45.7%) 14 (70%) 0.11
A 65-year-old man returns to the clinic for joint pain in his knees. He has a history of osteoarthritis and states that it is difficult for him to complete daily tasks. His pain was not treated by NSAIDs or weight loss. What should be the next line of treatment?
Tramadol* 11 (23.9%) 9 (45%) 0.14

All three groups of residents were asked questions about opioid background knowledge and attitudes. In response to “Which three states have the highest percentage of opioid-related deaths per capita?”, there was a significant improvement in GS (p=0.001) and IM (p=0.003) responses following the intervention. Furthermore, there was an increase in knowledge of the number of drug overdose deaths that occurred from opioids, though it did not reach statistical significance, in both GS (41% to 77%, p=0.07) and IM (45.7% to 65%, p=0.15). Lastly, there was a significant improvement in all specialties regarding knowledge of the number of deaths that were a result of heroin overdose (GS p<0.001, IM p<0.001, EM p=0.015) (Figure 1).

Regarding the level of satisfaction with prior opioid training, there was a significant difference between specialties (p<0.0001). Almost half of all IM residents felt unsatisfied with their prior opioid training (unsatisfied or very unsatisfied - 47.9%). Comparatively, 5.9% of GS residents and 14.8% of EM residents felt unsatisfied or very unsatisfied with their training. There was also a significant difference across specialties in the initial management of mild pain (p=0.005) and moderate pain (p<0.001). For moderate pain, GS residents (35.5%) were more likely to prescribe opioids than their colleagues in IM (2.2%) and EM (0%).

Discussion

The opioid epidemic in the US has progressively worsened. There are several historical factors that contributed to the rise of the opioid epidemic, including the classification of pain management as a human right [15] and a fifth vital sign [16], pharmaceutical marketing [17], and postoperative pain mismanagement [18]. To combat the epidemic, there has been growth in non-opioid treatments in pain management, such as nerve blocks, non-steroidal anti-inflammatory drugs (NSAIDs), and ketamine [19]. This study aimed to assess the baseline responses and the effect of a brief educational intervention on the knowledge and attitudes of EM, GS, and IM residents at a single institution. 

This study found many significant opportunities for improvement in resident opioid education. Regarding previous opioid knowledge training, 45.7% of IM residents were unsatisfied with the quality of training they had received. This suggests an area of potential collaboration between residents and hospital administration to better equip trainees with the practical information and skills they need to safely and effectively manage pain. 

With this brief intervention, there was an improvement of prescribing habits across all specialties. In EM, we observed a greater percentage of residents indicating knowledge that, per Pennsylvania state guidelines, seven days is the maximum duration of opioids that should be prescribed to an adult patient presenting to the ED with acute pain (22.2% to 30.8%). Additionally, there was an increase in the correct use of naratriptan for acute migraine management in the ED (from 14.8% to 38.5%). This particular scenario represents a key opportunity to reduce opioid use in exchange for a more efficacious medication. A study conducted by Colman et al. found that more than half of all patients presenting with migraines were treated with opioids as first-line therapy across four different hospitals [20]. Focusing on common clinical presentations like this, where treatment algorithms may be ambiguous for many providers, could greatly reduce the unnecessary use of opioids. Additionally, this effort is not meant to create a divide between providers and patients. Patients who have a history of drug misuse should receive the appropriate pharmacotherapy and psychosocial counseling to equip them with the tools to make effective change [21].

From the provider perspective, it is imperative to keep the patient’s best interest in mind when treating someone struggling with drug dependence, without letting biases affect your judgement. We observed a change in perspective among EM residents. Initially, majority of residents would not prescribe opioids to someone who appeared to be misusing drugs (70.3%). After our intervention, the number of residents who agreed with this statement decreased to 30.8% (p=0.04). This change in perspective highlights the multifaceted and individualized approach needed for each patient, considering the dangers of both over and under-prescribing. Walter et al. observed significant improvement in knowledge and management of opioid use disorder among EM residents following an educational intervention [22].

In our study, we observed significant improvement for GS in prescribing habits, better conforming to narcotic amounts determined by recent papers, following common procedures such as sleeve gastrectomy (p= 0.01), and laparoscopic cholecystectomy (p= 0.002) [23,24]. A similar study conducted by Hill et al. found that an educational intervention effectively decreased the number of opioids prescribed to patients following general surgery procedures [25].

Among IM residents, there was a decrease in participants who wanted to use opioids as a first-line treatment for migraines, arthritic joint pain, and nephrolithiasis. While these findings may not reach statistical significance, the increased percentage of correct responses indicates improvement of knowledge. The recommended first-line treatment for acute migraine includes NSAIDs and triptans. Opioid use in migraine treatment has not shown to have significant improvement so they are not recommended as initial treatment [26]; however, studies such as Bigal et al. have found that opioids were commonly used in clinical practice for migraine treatment (20.8%) [27]. A possible solution in this gap between recommendations and clinical practice can be educational interventions such as this study to target specific clinical situations that are confusing for providers or commonly treated inappropriately with opioids when good alternatives exist.

Potential limitations in this study can be attributed to the study design. Since our study focused on survey responses, the data largely depended on completion of both pre-tests and post-tests. There was a discrepancy in response rates between the two tests, likely due to survey fatigue and the demands of residents’ schedules. Additionally, this study took place during the coronavirus disease 2019 (COVID-19) pandemic, which placed considerable stress on resident physicians [28]. In order to boost survey responses, we sent reminders via email, had participating residents from each department make announcements at weekly meetings, and sent other team members to attend departmental conferences. Despite our best efforts, however, we were unable to improve these response rates. Additionally, our data is from survey answers and not real-world clinical actions. Given residents are largely constrained in their medication prescribing practices by the desires and preferences of supervising attendings, we did not feel studying their prescribing behaviors would yield meaningful results. Resident physicians are an integral component in battling the opioid epidemic. With these findings, we encourage medical schools and residency programs to integrate training on the effective use of non-opioid pain treatments into their curricula.

Conclusions

The opioid epidemic is a multifaceted issue that can be attributed to many causes. Resident physicians are a key resource in combating the opioid epidemic. We observed significant improvement in opioid knowledge and prescribing habits among all residents following the specialty-specific educational interventions. Therefore, we recommend that medical school and residency programs consider integrating opioid-related pain management strategies throughout their curricula.


References

  1. Overdose Death Maps | Drug Overdose | CDC Injury Center.. (2022). Accessed: September 8, 2020: https://www.cdc.gov/drugoverdose/deaths/index.html.
  2. Zhang H, Tallavajhala S, Kapadia SN, Jeng PJ, Shi Y, Wen H, Bao Y: State opioid limits and volume of opioid prescriptions received by Medicaid patients. Med Care. 2020, 58:1111-5. 10.1097/MLR.0000000000001411
  3. Manasco AT, Griggs C, Leeds R, Langlois BK, Breaud AH, Mitchell PM, Weiner SG: Characteristics of state prescription drug monitoring programs: a state-by-state survey. Pharmacoepidemiol Drug Saf. 2016, 25:847-51. 10.1002/pds.4003
  4. Wyles CC, Hevesi M, Ubl DS, et al.: implementation of procedure-specific opioid guidelines: a readily employable strategy to improve consistency and decrease excessive prescribing following orthopaedic surgery. JB JS Open Access. 2020, 5:e0050. 10.2106/JBJS.OA.19.00050
  5. Starr MR, Patel SV, Bartley GB, Bothun ED: Impact of standardized prescribing guidelines on postoperative opioid prescriptions after ophthalmic surgery. Ophthalmology. 2020, 127:1454-9. 10.1016/j.ophtha.2020.04.015
  6. Glaser GE, Kalogera E, Kumar A, et al.: Outcomes and patient perspectives following implementation of tiered opioid prescription guidelines in gynecologic surgery. Gynecol Oncol. 2020, 157:476-81. 10.1016/j.ygyno.2020.02.025
  7. Singh R, Pushkin GW: How should medical education better prepare physicians for opioid prescribing?. AMA J Ethics. 2019, 21:E636-641. 10.1001/amajethics.2019.636
  8. Boscoe E, Rodriguez KD, Johnson AP: Opioid prescribing education in surgical training. Perioperative Pain Control: A Practical, Evidence-Based Pocket Guide.. Svider PF, Pashkova AA, Johnson AP (ed): Springer Nature Switzerland AG, Cham, Switzerland; 2021. 29-38. 10.1007/978-3-030-56081-2
  9. Garcia J, Ohanisian L, Sidley A, Ferris A, Luck G, Basich G, Garcia A: Resident knowledge and perception of pain management. Cureus. 2019, 11:e6107. 10.7759/cureus.6107
  10. Huynh V, Colborn K, Christian N, et al.: Resident opioid prescribing habits do not reflect best practices in post-operative pain management: an assessment of the knowledge and education gap. J Surg Educ. 2021, 78:1286-94. 10.1016/j.jsurg.2020.12.014
  11. Chiu AS, Ahle SL, Freedman-Weiss MR, Yoo PS, Pei KY: The impact of a curriculum on postoperative opioid prescribing for novice surgical trainees. Am J Surg. 2019, 217:228-32. 10.1016/j.amjsurg.2018.08.007
  12. Naimer MS, Munro J, Singh S, Permaul JA: Improving family medicine residents’ opioid prescribing: a nurse practitioner-led model. J Nurse Pract. 2019, 15:661-5. 10.1016/j.nurpra.2019.07.002
  13. Warner LL, Warner PA, Eldrige JS: Orthopedic resident education on postoperative pain control: bridging knowledge gaps to enhance patient safety. Int J Med Educ. 2018, 9:72-3. 10.5116/ijme.5a91.2f7f
  14. Raheemullah A, Andruska N, Saeed M, Kumar P: Improving residency education on chronic pain and opioid use disorder: evaluation of cdc guideline-based education. Subst Use Misuse. 2020, 55:684-90. 10.1080/10826084.2019.1691600
  15. Weiner SG, Malek SK, Price CN: The opioid crisis and its consequences. Transplantation. 2017, 101:678-81. 10.1097/TP.0000000000001671
  16. Principles of analgesic use in the treatment of acute pain and chronic cancer pain, 2nd edition. American Pain Society. Clin Pharm. 1990, 9:601-12.
  17. Van Zee A: The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009, 99:221-7. 10.2105/AJPH.2007.131714
  18. Vadivelu N, Kai AM, Kodumudi V, Sramcik J, Kaye AD: The opioid crisis: a comprehensive overview. Curr Pain Headache Rep. 2018, 22:16. 10.1007/s11916-018-0670-z
  19. Jones MR, Viswanath O, Peck J, Kaye AD, Gill JS, Simopoulos TT: A brief history of the opioid epidemic and strategies for pain medicine. Pain Ther. 2018, 7:13-21. 10.1007/s40122-018-0097-6
  20. Colman I, Rothney A, Wright SC, Zilkalns B, Rowe BH: Use of narcotic analgesics in the emergency department treatment of migraine headache. Neurology. 2004, 62:1695-700. 10.1212/01.wnl.0000127304.91605.ba
  21. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. . World Health Organization, Geneva, Switzerland; 2009. http://www.who.int/substance_abuse/publications/opioid_dependence_guidelines.pdf.
  22. Walter LA, Hess J, Brown M, DeLaney M, Paddock C, Hess EP: Design and implementation of a curriculum for emergency medicine residents to address medications and treatment referral for opioid use disorder. Subst Use Misuse. 2021, 56:458-63. 10.1080/10826084.2021.1879144
  23. Hill MV, McMahon ML, Stucke RS, Barth RJ Jr: Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017, 265:709-14. 10.1097/SLA.0000000000001993
  24. OPEN: Opioid Prescribing Recommendations. (2021). Accessed: June 3, 2021: https://michigan-open.org/prescribing-recommendations/.
  25. Hill MV, Stucke RS, McMahon ML, Beeman JL, Barth RJ Jr: An educational intervention decreases opioid prescribing after general surgical operations. Ann Surg. 2018, 267:468-72. 10.1097/SLA.0000000000002198
  26. Casucci G, Cevoli S: Controversies in migraine treatment: opioids should be avoided. Neurol Sci. 2013, 34:S125-8. 10.1007/s10072-013-1395-8
  27. Bigal ME, Borucho S, Serrano D, Lipton RB: The acute treatment of episodic and chronic migraine in the USA. Cephalalgia. 2009, 29:891-7. 10.1111/j.1468-2982.2008.01819.x
  28. Opinion: Covid-19 is pushing doctors to the brink. Medicine needs to recognize they’re human and need help.. (2020). Accessed: June 2, 2021.: https://www.washingtonpost.com/opinions/2020/07/20/covid-19-is-pushing-doctors-brink-medicine-needs-recognize-theyre-....

Appendices

Emergency medicine resident knowledge and attitudes pre-test
Resident background 
Please select your current level of training:
PGY1
PGY2
PGY3
 
Do you hold a DEA License?
Yes
No
 
How satisfied are you with your current level of opioid-prescribing training?
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied 
 
When did you receive your opioid-prescribing training? (Select all that apply)
College
Medical School
Residency
Personal reading
Never received any formal training
 
For the following questions, answer as if you are the prescriber even if you do not currently hold a DEA license. Select only ONE answer unless specified otherwise. 
 
General opioid knowledge
 
What are the three most common chief complaints for adults in the ED that were discharged with opioids? (select three)
Headache
Dental pain
Chest pain
Abdominal pain
Urolithiasis
Back pain
 
Which three states have the highest percentage of opioid-related deaths per capita: (circle 3 states)
Alabama
California
Kentucky
New York
Ohio
Pennsylvania
South Carolina
West Virginia
 
In 2017, how many drug overdose deaths were due to opioids? 
15,000
25,000
45,000
75,000
 
In 2017, how many deaths were a result of heroin overdose? 
15,000
25,000
45,000
75,000
 
Nearly half of all opioid related overdoses are due to valid prescription opioids.
True
False
 
What is the PDMP?
Physician Drug Medical Plan
Prescribing Directory of Medical Providers
Prescription Drug Monitoring Program
Planned Drug Movement Plan
 
How often should the PDMP be referenced?
Once a day
Once a month
Once a year
Anytime an opioid prescription is given.
 
Case-based scenarios
 
For an adult patient that presents to the emergency room with acute pain, according to current PA state guidelines, what is the maximum duration (days) for which an opioid prescription should be given?
0 day
1 day
3 days
7 days
14 days
No limit
 
When prescribing opioids to a minor, according to current PA state guidelines, the provider should: 
Discuss possible risks with both the minor and parent/guardian
Document if the patient is an emancipated minor
Document the consent given
All of the above
 
For an adult presenting with noncancer pain, what should be the first course of action prior to formulating a pain control plan?  (circle only one)
Only non-opioid pain medications
Short acting opioids
Consult the state monitoring program (PDMP)
Extended-released schedule II products
 
For an adult presenting to the ED with acute low back pain, I would typically prescribe: (circle only one)
Only non-opioid pain medications
0-10 tablets of 5mg oxycodone + NSAID
11-20 tablets of 5mg oxycodone + NSAID
21-30 tablets of 5mg oxycodone + NSAID
31-40 tablets of 5mg oxycodone + NSAID
41-50 tablets of 5mg oxycodone + NSAID
Over 50 tablets of 5mg oxycodone
 
A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence?
Chlorpromazine IV 12.5 mg
Celecoxib 400 mg
Codeine/acetaminophen 25/400 mg
Naratriptan 2.5 mg
Codeine 30 mg
 
A 30-year-old male who actively uses IV heroin presents to the ED for a localized skin infection. After several hours, he begins to complain of anxiety and GI upset. You suspect opioid withdrawal and calculate his Clinical Opiate Withdrawal Score (COWS), which at 30 is rated “moderately severe”. How would you treat his current withdrawal symptoms?
NSAIDs
Buprenorphine-naloxone to bridge him to outpatient treatment
Oral morphine
Extended-release oxycodone
Tylenol
 
 
 
For patients experiencing mild pain, I initially prescribe (circle one)
NSAIDs
Tylenol
Opioid
 
For patients experiencing moderate pain, I initially prescribe
(circle one)
NSAIDs
Tylenol
Opioid
 
For patients experiencing severe pain, I initially prescribe
(circle only one)
NSAID
Tylenol
Opioid
 
Resident attitudes
 
Opioids are effective in pain management.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Every patient that presents to the ED with pain should receive opioids.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
I feel comfortable in my knowledge of non-opioid pain management.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
If I suspect someone is abusing drugs, I will not prescribe them short-acting opioids. 
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Patient gender may affect my judgement of a patient's pain intensity
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Patient race may affect my judgement of a patient's pain intensity
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
I ask my patients about the severity of their pain.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
 I include patient-reported pain levels in my notes.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
 
 
 
 
General surgery resident knowledge and attitudes pre-test
Resident background 
Please select your current level of training:
PGY1
PGY2
PGY3
PGY4
PGY5
 
Do you hold a DEA License?
Yes
No
 
How satisfied are you with your current level of opioid-prescribing training?
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied 
 
When did you receive your opioid-prescribing training? (Select all that apply)
College
Medical School
Residency
Personal reading
Never received any formal training
 
For the following questions, answer as if you are the prescriber even if you do not currently hold a DEA license. Select only ONE answer unless specified otherwise. 
 
General opioid knowledge
 
Which three states have the highest percentage of opioid-related deaths per capita: (circle 3 states)
Alabama
California
Kentucky
New York
Ohio
Pennsylvania
South Carolina
West Virginia
 
In 2017, how many drug overdose deaths were due to opioids? 
15,000
25,000
45,000
75,000
 
In 2017, how many deaths were a result of heroin overdose? 
15,000
25,000
45,000
75,000
 
Nearly half of all opioid related overdoses are due to valid prescription opioids.
True False
 
What is the PDMP?
Physician Drug Medical Plan
Prescribing Directory of Medical Providers
Prescription Drug Monitoring Program
Planned Drug Movement Plan
 
How often should the PDMP be referenced?
Once a day
Once a month
Once a year
Anytime an opioid prescription is given
 
 
Resident attitudes
 
Opioids are effective in pain management.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Every patient should receive opioids following surgery.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
I feel comfortable in my knowledge of non-opioid pain management.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
If I suspect someone is abusing opioids, I do not prescribe opioids to them. 
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Patient gender may affect my judgement of a patient's pain intensity
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Patient race may affect my judgement of a patient's pain intensity
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
I ask my patients about the severity of their pain.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
 I include patient-reported pain levels in my notes.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
 
Case-based scenarios
 
For a patient being discharged home after an open appendectomy, I would typically prescribe: (circle only one)
Only non-opioid pain medications
0-10 tablets of 5mg Oxycodone
11-20 tablets of 5mg Oxycodone
21-30 tablets of 5mg Oxycodone
31-40 tablets of 5mg Oxycodone
41-50 tablets of 5mg Oxycodone
Over 50 tablets of 5mg Oxycodone
 
 
For a patient being discharged home after a sleeve gastrectomy, I would typically prescribe: (circle only one)
Only non-opioid pain medications
0-10 tablets of 5mg Oxycodone
11-20 tablets of 5mg Oxycodone
21-30 tablets of 5mg Oxycodone
31-40 tablets of 5mg Oxycodone
41-50 tablets of 5mg Oxycodone
Over 50 tablets of 5mg Oxycodone
 
For a patient being discharged home after a laparoscopic cholecystectomy, I would typically prescribe: (circle only one)
0-5 tablets of 5mg Oxycodone
0-10 tablets of 5mg Oxycodone
0-15 tablets of 5mg Oxycodone
0-20 tablets of 5mg Oxycodone
0-25 tablets of 5mg Oxycodone
Over 25 tablets of 5mg Oxycodone
 
For a patient being discharged home after a laparoscopic Nissen fundoplication, I would typically prescribe: (circle only one)
0-5 tablets of 5mg Oxycodone
0-10 tablets of 5mg Oxycodone
0-15 tablets of 5mg Oxycodone
0-20 tablets of 5mg Oxycodone
0-25 tablets of 5mg Oxycodone
Over 25 tablets of 5mg Oxycodone
 
For a patient being discharged home after an open small bowel resection, I would typically prescribe: (circle only one)
0-5 tablets of 5mg Oxycodone
0-10 tablets of 5mg Oxycodone
0-15 tablets of 5mg Oxycodone
0-20 tablets of 5mg Oxycodone
0-25 tablets of 5mg Oxycodone
Over 25 tablets of 5mg Oxycodone
 
For a patient being discharged home after an open colectomy, I would typically prescribe: (circle only one)
0-5 tablets of 5mg Oxycodone
0-10 tablets of 5mg Oxycodone
0-15 tablets of 5mg Oxycodone
0-20 tablets of 5mg Oxycodone
0-25 tablets of 5mg Oxycodone
Over 25 tablets of 5mg Oxycodone
 
For a patient being discharged home after a major hernia repair, I would typically prescribe: (circle only one)
0-5 tablets of 5mg Oxycodone
0-10 tablets of 5mg Oxycodone
0-15 tablets of 5mg Oxycodone
0-20 tablets of 5mg Oxycodone
0-25 tablets of 5mg Oxycodone
Over 25 tablets of 5mg Oxycodone
 
For patients experiencing mild pain, I usually initially prescribe (circle one)
NSAIDs
Tylenol
Opioid
 
For patients experiencing moderate pain, I usually initially prescribe
(circle one)
NSAIDs
Tylenol
Opioid
 
For patients experiencing severe pain, I usually initially prescribe
(circle only one)
NSAID
Tylenol
Opioid
 
 
 
 
 
 
 
 
Internal medicine resident knowledge and attitudes pre-test
Resident background 
Please select your current level of training:
PGY1
PGY2
PGY3
 
Do you hold a DEA License?
Yes
No
 
How satisfied are you with your current level of opioid-prescribing training?
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied 
 
When did you receive your opioid-prescribing training? (Select all that apply)
College
Medical School
Residency
Personal reading
Never received any formal training
 
For the following questions, answer as if you are the prescriber even if you do not currently hold a DEA license. Select only ONE answer unless specified otherwise. 
 
General opioid knowledge
 
Which three states have the highest percentage of opioid-related deaths per capita: (circle 3 states)
Alabama
California
Kentucky
New York
Ohio
Pennsylvania
South Carolina
West Virginia
 
In 2017, how many drug overdose deaths were due to opioids? 
15,000
25,000
45,000
75,000
 
In 2017, how many deaths were a result of heroin overdose? 
15,000
25,000
45,000
75,000
 
Nearly half of all opioid related overdoses are due to valid prescription opioids.
True False
 
What is the PDMP?
Physician Drug Medical Plan
Prescribing Directory of Medical Providers
Prescription Drug Monitoring Program
Planned Drug Movement Plan
 
How often should the PDMP be referenced?
Once a day
Once a month
Once a year
Anytime an opioid prescription is given.
 
Resident attitudes
 
Opioids are effective in pain management.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Every patient that presents to the office with pain should receive opioids.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
 
I feel comfortable in my knowledge of non-opioid pain management.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
If I suspect someone is abusing opioids, I do not prescribe opioids to them. 
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Patient gender may affect my judgement of a patient's pain intensity
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Patient race may affect my judgement of a patient's pain intensity
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
I ask my patients about the severity of their pain.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
 I include patient-reported pain levels in my notes.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
I think that proper pain management is associated with better patient outcomes.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
 
Case-based scenarios  
 
For an adult presenting with chronic low back pain, I would initially prescribe: (circle only one)
NSAIDs
Tramadol
Duloxetine
Oxycodone
 
A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence?
Chlorpromazine IV 12.5 mg
Celecoxib 400 mg
Codeine/acetaminophen 25/400 mg
Naratriptan 2.5 mg
Codeine 30 mg
 
A 65-year-old man returns to the clinic for joint pain in his knees. He has a history of osteoarthritis and states that it is difficult for him to complete daily tasks. His pain was not treated by NSAIDs or weight loss. What should be the next line of treatment?
0-10 tablets of 5mg Tramadol
0-10 tablets of 5mg Oxycodone
Acetaminophen
Exercise
Continue NSAIDS and weight loss therapy
 
A 35-year-old male presents to the office with nephrolithiasis. His eGFR is >90ml/min and he has no history of GI bleed. How would you initially treat his pain?
No pain medication
NSAIDS
0-10 tablets of 5mg Oxycodone
 
For patients experiencing mild pain, I usually initially prescribe (circle one)
NSAIDs
Tylenol
Opioid
 
For patients experiencing moderate pain, I usually initially prescribe
(circle one)
NSAIDs
Tylenol
Opioid
 
For patients experiencing severe pain, I usually initially prescribe
(circle only one)
NSAID
Tylenol
Opioid
1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. What are the three most common chief complaints for adults in the ED that were discharged with opioids? (select three)  6. Which three states have the highest percentage of opioid-related deaths per capita:  (circle 3 states) 7. In 2017, how many drug overdose deaths were due to opioids?   8. In 2017, how many deaths were a result of heroin overdose?   9. Nearly half of all opioid related overdoses are due to valid prescription opioids.  10. What is the PDMP?  11. How often should the PDMP be referenced? 12. For an adult patient that presents to the emergency room with acute pain, according to current PA state guidelines, what is the maximum duration (days) for which an opioid prescription should be given?  13. When prescribing opioids to a minor, according to current PA state guidelines, the provider should:   14. For an adult presenting with noncancer pain, what should be the first course of action prior to formulating a pain control plan?  (circle only one) 15. For an adult presenting to the ED with acute low back pain, I would typically prescribe: (circle only one) 16. A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence? 17. A 30-year-old male who actively uses IV heroin presents to the ED for a localized skin infection. After several hours, he begins to complain of anxiety and GI upset. You suspect opioid withdrawal and calculate his Clinical Opiate Withdrawal Score (COWS), which at 30 is rated “moderately severe”. How would you treat his current withdrawal symptoms? 18. For patients experiencing mild pain, I initially prescribe (circle one) 19. For patients experiencing moderate pain, I initially prescribe (circle one) 20. For patients experiencing severe pain, I initially prescribe  (circle only one) 21. Opioids are effective in pain management.  22. Every patient that presents to the ED with pain should receive opioids. 23. I feel comfortable in my knowledge of non-opioid pain management.  24. If I suspect someone is abusing drugs, I will not prescribe them short-acting opioids.   25. Patient gender may affect my judgement of a patient's pain intensity 26. Patient race may affect my judgement of a patient's pain intensity 27. If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.  28. I ask my patients about the severity of their pain. 29. I include patient-reported pain levels in my notes.
PGY2 No Neutral Medical School, Residency Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Extended-release oxycodone NSAIDs NSAIDs Opioid Agree Disagree Agree Agree Agree Agree Undecided Agree Undecided
PGY2 No Neutral Never received any formal training Headache, Abdominal pain, Back pain California, New York, Pennsylvania 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Short acting opioids Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs NSAID Agree Strongly disagree Agree Agree Disagree Disagree Agree Strongly agree Strongly agree
PGY2 No Very satisfied Medical School, Residency, Personal reading Headache, Abdominal pain, Back pain New York, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs NSAID Disagree Strongly disagree Strongly agree Agree Agree Agree Agree Strongly disagree Strongly disagree
PGY1 No Neutral Residency Dental pain, Urolithiasis Alabama, Pennsylvania, West Virginia 45,000 45,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Disagree Strongly disagree Agree Disagree Disagree Agree Agree Agree
PGY3 No Unsatisfied Residency, Personal reading Dental pain, Urolithiasis, Back pain Alabama, Kentucky, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Opioid Agree Strongly disagree Undecided Disagree Disagree Disagree Agree Agree Undecided
PGY1 No Unsatisfied Medical School, Residency Dental pain, Urolithiasis, Back pain Kentucky, South Carolina, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 14 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Opioid Agree Undecided Undecided Disagree Agree Strongly agree Agree Agree Agree
PGY3 No Neutral Medical School, Residency, Personal reading Dental pain, Abdominal pain, Back pain Alabama, Kentucky, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Codeine/acetaminophen 25/400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Disagree Agree Undecided Agree Agree Agree Agree Undecided
PGY2 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree
PGY3 No Satisfied Residency Dental pain, Urolithiasis, Back pain Alabama, Kentucky, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs NSAID Undecided Strongly disagree Agree Agree Disagree Disagree Agree Disagree Undecided
PGY3 No Satisfied Personal reading Dental pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Disagree Agree Strongly agree Strongly disagree Strongly disagree Agree Strongly agree Agree
PGY2 No Very satisfied Medical School, Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Naratriptan 2.5 mg Oral morphine NSAIDs NSAIDs NSAID Strongly agree Strongly disagree Agree Strongly disagree Strongly agree Strongly agree Strongly agree Strongly disagree Strongly disagree
PGY2 No Unsatisfied Medical School, Residency Back pain California, New York, Pennsylvania 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs NSAID Strongly agree Disagree Strongly agree Strongly agree Strongly disagree Strongly disagree Agree Strongly agree Agree
PGY3 No Satisfied Medical School, Residency Urolithiasis Kentucky, Pennsylvania, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Strongly agree Agree
PGY3 No Neutral Medical School, Residency Dental pain, Urolithiasis, Back pain Alabama, Pennsylvania, South Carolina 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. No limit All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs NSAID Disagree Strongly disagree Undecided Strongly agree Strongly disagree Strongly disagree Agree Agree Undecided
PGY1 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Strongly agree Strongly disagree Agree Undecided Strongly disagree Strongly disagree Agree Strongly agree Strongly agree
PGY1 No Very unsatisfied Personal reading Dental pain, Abdominal pain, Urolithiasis California, Pennsylvania, West Virginia 45,000 75,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Extended-released schedule II products Only non-opioid pain medications Chlorpromazine IV 12.5 mg Oral morphine Tylenol Tylenol Tylenol Agree Strongly disagree Disagree Disagree Agree Agree Undecided Strongly agree Agree
PGY2 No Neutral Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 25,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 1 day All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs NSAID Agree Disagree Undecided Strongly agree Undecided Undecided Agree Agree Agree
PGY1 No Neutral Medical School Dental pain, Abdominal pain, Back pain Alabama, Pennsylvania, West Virginia 45,000 25,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Agree Agree
PGY1 No Neutral Residency Back pain New York, Delaware, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Tylenol Strongly agree Strongly disagree Strongly agree Strongly agree Strongly disagree Strongly disagree Disagree Strongly agree Strongly agree
PGY1 No Satisfied Medical School, Residency, Personal reading Dental pain, Abdominal pain, Urolithiasis Delaware, Pennsylvania, West Virginia 75,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree
PGY3 No Neutral Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications 31-40 tablets of 5mg Oxycodone + NSAID Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Disagree Undecided Disagree Strongly disagree Strongly disagree Agree Agree Undecided
PGY1 No Neutral Never received any formal training Abdominal pain, Urolithiasis, Back pain Alabama, Kentucky, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Strongly agree Strongly agree
PGY3 No Satisfied Medical School, Residency, Personal reading Abdominal pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree
PGY3 No Very satisfied Residency Dental pain, Abdominal pain, Back pain California, Pennsylvania, South Carolina 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Disagree Agree Agree Strongly disagree Strongly disagree Agree Undecided Agree
PGY2 No Neutral Medical School, Residency Dental pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. No limit All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Strongly agree Agree Agree Strongly agree Strongly agree Agree
PGY3 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Strongly agree Strongly disagree Strongly agree Strongly agree Agree Agree Agree Agree Agree
PGY3 No Very satisfied Medical School, Residency Urolithiasis     75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Tylenol Strongly agree Strongly disagree Strongly agree Strongly disagree Strongly disagree Strongly disagree Agree Agree Agree
1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. What are the three most common chief complaints for adults in the ED that were discharged with opioids? (select three)  6. Which three states have the highest percentage of opioid-related deaths per capita:  (circle 3 states) 7. In 2017, how many drug overdose deaths were due to opioids?   8. In 2017, how many deaths were a result of heroin overdose?   9. Nearly half of all opioid related overdoses are due to valid prescription opioids.  10. What is the PDMP?  11. How often should the PDMP be referenced? 12. For an adult patient that presents to the emergency room with acute pain, according to current PA state guidelines, what is the maximum duration (days) for which an opioid prescription should be given?  13. When prescribing opioids to a minor, according to current PA state guidelines, the provider should:   14. For an adult presenting with noncancer pain, what should be the first course of action prior to formulating a pain control plan?  (circle only one) 15. For an adult presenting to the ED with acute low back pain, I would typically prescribe: (circle only one) 16. A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence? 17. A 30-year-old male who actively uses IV heroin presents to the ED for a localized skin infection. After several hours, he begins to complain of anxiety and GI upset. You suspect opioid withdrawal and calculate his Clinical Opiate Withdrawal Score (COWS), which at 30 is rated “moderately severe”. How would you treat his current withdrawal symptoms? 18. For patients experiencing mild pain, I initially prescribe (circle one) 19. For patients experiencing moderate pain, I initially prescribe (circle one) 20. For patients experiencing severe pain, I initially prescribe  (circle only one) 21. Opioids are effective in pain management.  22. Every patient that presents to the ED with pain should receive opioids. 23. I feel comfortable in my knowledge of non-opioid pain management.  24. If I suspect someone is abusing drugs, I will not prescribe them short-acting opioids.   25. Patient gender may affect my judgement of a patient's pain intensity 26. Patient race may affect my judgement of a patient's pain intensity 27. If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.  28. I ask my patients about the severity of their pain. 29. I include patient-reported pain levels in my notes.
PGY2 No Satisfied Medical School, Residency Dental pain, Urolithiasis, Back pain Delaware, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg NSAIDs NSAIDs NSAIDs Opioid Agree Strongly disagree Agree Strongly agree Agree Agree Strongly agree Agree Agree
PGY3 No Very satisfied Residency Urolithiasis Kentucky, Pennsylvania, West Virginia 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Tylenol Strongly agree Strongly disagree Strongly agree Disagree Strongly disagree Strongly disagree Agree Agree Agree
PGY3 No Very satisfied Residency Urolithiasis Kentucky, Pennsylvania, West Virginia 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol Tylenol Strongly agree Strongly disagree Strongly agree Disagree Strongly disagree Strongly disagree Agree Agree Agree
PGY1 No Satisfied Medical School, Residency, Personal reading Dental pain, Urolithiasis, Back pain Kentucky, Delaware, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Undecided Strongly disagree Strongly disagree Strongly agree Strongly agree Strongly agree
PGY3 No Satisfied Medical School, Residency, Personal reading Dental pain, Abdominal pain, Urolithiasis Delaware, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) 0-10 tablets of 5mg Oxycodone + NSAID Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Disagree Disagree Disagree Agree Agree Agree
PGY2 No Satisfied Medical School, Residency Abdominal pain, Urolithiasis, Back pain California, New York, Pennsylvania 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Strongly agree Strongly disagree Agree Strongly agree Disagree Disagree Agree Strongly agree Strongly agree
PGY1 No Neutral Medical School, Residency, Personal reading Abdominal pain California, South Carolina, West Virginia 25,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Strongly agree Disagree Agree Disagree Disagree Disagree Agree Agree Agree
PGY1 No Neutral Residency Dental pain, Urolithiasis, Back pain New York, Delaware, Pennsylvania 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Consult the state monitoring program (PDMP) Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol Tylenol NSAID Strongly agree Strongly disagree Undecided Undecided Undecided Undecided Agree Agree Agree
PGY3 No Satisfied Residency Dental pain, Urolithiasis, Back pain California, New York, Pennsylvania 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Celecoxib 400 mg Buprenorphine-naloxone to bridge him to outpatient treatment Tylenol NSAIDs Opioid Agree Strongly disagree Agree Agree Strongly agree Strongly agree Agree Disagree Disagree
PGY1   Neutral College Abdominal pain California, Kentucky, New York 15,000 25,000 FALSE Prescribing Directory of Medical Providers Anytime an opioid prescription is given. 3 days All of the above Short acting opioids 0-10 tablets of 5mg Oxycodone + NSAID Codeine/acetaminophen 25/400 mg Tylenol Tylenol Tylenol Tylenol Agree Agree Undecided Undecided Undecided Undecided Undecided Undecided Undecided
PGY1 No Neutral Never received any formal training Dental pain, Abdominal pain, Urolithiasis Kentucky, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Tylenol NSAIDs NSAIDs Opioid Strongly agree Disagree Disagree Agree Disagree Disagree Agree Agree Agree
PGY3 No Satisfied Medical School, Residency Chest pain, Abdominal pain, Back pain Kentucky, Delaware, Pennsylvania 25,000 25,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 3 days All of the above Only non-opioid pain medications Only non-opioid pain medications Chlorpromazine IV 12.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs NSAIDs Opioid Agree Strongly disagree Strongly agree Undecided Strongly disagree Strongly disagree Agree Strongly agree Agree
PGY3 No Neutral Residency Dental pain, Urolithiasis, Back pain Kentucky, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. 7 days All of the above Only non-opioid pain medications Only non-opioid pain medications Naratriptan 2.5 mg Buprenorphine-naloxone to bridge him to outpatient treatment NSAIDs Tylenol Opioid Strongly agree Strongly disagree Agree Disagree Agree Agree Agree Strongly agree Agree
1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. Which three states have the highest percentage of opioid-related deaths per capita:(circle 3 states) 6. In 2017, how many drug overdose deaths were due to opioids?   7. In 2017, how many deaths were a result of heroin overdose?   8. Nearly half of all opioid related overdoses are due to valid prescription opioids.  9. What is the PDMP?  10. How often should the PDMP be referenced? 11. Opioids are effective in pain management.  12. Every patient that presents to the office with pain should receive opioids. 13. I feel comfortable in my knowledge of non-opioid pain management.  14. If I suspect someone is abusing opioids, I do not prescribe opioids to them.   15. Patient gender may affect my judgement of a patient's pain intensity 16. Patient race may affect my judgement of a patient's pain intensity 17. If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.  17. If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.  18. I ask my patients about the severity of their pain. 19. I include patient-reported pain levels in my notes. 20. I think that proper pain management is associated with better patient outcomes.  21. For an adult presenting with chronic low back pain, I would initially prescribe: (circle only one) 22. A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence? 23. A 65-year-old man returns to the clinic for joint pain in his knees. He has a history of osteoarthritis and states that it is difficult for him to complete daily tasks. His pain was not treated by NSAIDs or weight loss. What should be the next line of treatment?  24. A 35-year-old male presents to the office with nephrolithiasis. His eGFR is >90ml/min and he has no history of GI bleed. How would you initially treat his pain? 25. For patients experiencing mild pain, I usually initially prescribe (circle one) 26. For patients experiencing moderate pain, I usually initially prescribe (circle one) 27. For patients experiencing severe pain, I usually initially prescribe (circle only one)
PGY3 No Unsatisfied Never received any formal training Alabama, Kentucky, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Agree Disagree Disagree   Agree Agree Agree Agree NSAIDs Celecoxib 400 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol Tylenol Opioid
PGY2 No Neutral Never received any formal training California, New York, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Disagree Agree Disagree Disagree   Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY3 No Very satisfied Medical School, Residency, Personal reading Alabama, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Strongly agree Agree Disagree Strongly disagree Strongly agree Strongly agree Strongly agree Strongly agree NSAIDs Chlorpromazine IV 12.5 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol NSAIDs NSAIDs
PGY1 No Unsatisfied Medical School, Residency Kentucky, New York, Pennsylvania 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Disagree Agree Agree Agree   Agree Strongly agree Strongly agree Strongly agree NSAIDs Celecoxib 400 mg Acetaminophen NSAIDS Tylenol Tylenol Opioid
PGY3 No Neutral Residency California, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Disagree Agree Strongly agree Disagree Strongly disagree Agree Agree Undecided Agree NSAIDs Naratriptan 2.5 mg Acetaminophen NSAIDS Tylenol Tylenol Opioid
PGY3 No Very satisfied Medical School, Residency, Personal reading Kentucky, South Carolina, West Virginia 45,000 45,000 TRUE Prescribing Directory of Medical Providers Anytime an opioid prescription is given. Disagree Strongly disagree Strongly agree Agree Agree Agree   Agree Agree Disagree Strongly agree NSAIDs Celecoxib 400 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol NSAIDs Opioid
PGY3 No Satisfied Residency New York, Delaware, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Agree Disagree Disagree   Agree Agree Disagree Agree NSAIDs Celecoxib 400 mg Acetaminophen NSAIDS Tylenol Tylenol Tylenol
PGY3 No Unsatisfied Medical School, Residency, Personal reading Pennsylvania, South Carolina, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Agree Undecided   Agree Agree Agree Strongly agree NSAIDs Naratriptan 2.5 mg Exercise NSAIDS Tylenol NSAIDs Opioid
PGY2 No Neutral Medical School, Residency Kentucky, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg Acetaminophen NSAIDS NSAIDs NSAIDs Opioid
PGY2 No Very unsatisfied Medical School California, New York, Pennsylvania 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly disagree Strongly disagree Agree Strongly disagree Strongly disagree Strongly disagree Strongly agree Strongly agree Strongly agree Strongly agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen NSAIDS NSAIDs NSAIDs NSAIDs
PGY2 No Unsatisfied Residency California, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Agree Agree   Agree Agree Agree Strongly agree NSAIDs Naratriptan 2.5 mg Exercise NSAIDS NSAIDs NSAIDs NSAIDs
PGY3 Yes Neutral Residency New York, Pennsylvania, West Virginia 75,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Disagree Agree Agree Agree Undecided   Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg Continue NSAIDS and weight loss therapy 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Medical School Kentucky, Pennsylvania, West Virginia 25,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Agree Agree   Agree Agree Agree Agree NSAIDs Celecoxib 400 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol NSAIDs Opioid
PGY3 No Satisfied Medical School, Residency, Personal reading Delaware, Pennsylvania, West Virginia 75,000 45,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Strongly agree Agree Agree   Agree Strongly agree Strongly agree Strongly agree NSAIDs Chlorpromazine IV 12.5 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Tylenol
PGY1 No Neutral Medical School California, Kentucky, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Disagree Disagree Strongly disagree Strongly agree Strongly agree Strongly agree Strongly agree NSAIDs Naratriptan 2.5 mg Continue NSAIDS and weight loss therapy 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Tylenol
PGY2 No Unsatisfied Residency California, New York, Pennsylvania 75,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Strongly agree Agree Agree   Undecided Agree Agree Agree NSAIDs Celecoxib 400 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY3 No Unsatisfied Medical School, Residency, Personal reading Delaware, South Carolina, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Agree Disagree Disagree   Agree Agree Undecided Agree NSAIDs Celecoxib 400 mg Exercise 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY3 No Neutral Medical School, Residency California, New York, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Undecided Strongly disagree Undecided   Agree Strongly agree Strongly agree Strongly agree NSAIDs Chlorpromazine IV 12.5 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol Tylenol Opioid
PGY2 No Neutral Medical School, Residency, Personal reading Alabama, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Disagree Strongly agree Undecided Undecided   Agree Agree Agree Agree   Chlorpromazine IV 12.5 mg Acetaminophen Tylenol Tylenol Opioid
PGY1 Yes Satisfied Medical School, Residency New York, Delaware, Pennsylvania 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Disagree Undecided Undecided   Agree Strongly agree Agree Agree NSAIDs Celecoxib 400 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol Tylenol Tylenol
PGY2 No Unsatisfied Never received any formal training Alabama, Kentucky, South Carolina 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Disagree Agree Agree Agree Disagree   Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY3 No Neutral Medical School, Residency Alabama, New York, Pennsylvania 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Strongly disagree Strongly disagree Agree Disagree Disagree Agree NSAIDs Naratriptan 2.5 mg Exercise NSAIDS Tylenol Opioid Opioid
PGY1 No Neutral Medical School, Residency Alabama, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Disagree Undecided Strongly disagree Undecided   Agree Agree Agree Strongly agree NSAIDs Celecoxib 400 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol Tylenol Opioid
PGY1 No Neutral Medical School Kentucky, Pennsylvania, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Undecided Agree Undecided   Agree Agree Agree Strongly agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol No pain medication Tylenol NSAIDs NSAIDs
PGY1 No Unsatisfied Medical School Kentucky, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Disagree Strongly disagree Undecided Agree Agree Agree   Strongly agree Agree Disagree Agree NSAIDs Naratriptan 2.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY3 No Neutral Residency California, New York, Pennsylvania 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Disagree Agree Agree Disagree Undecided   Undecided Agree Disagree Agree Duloxetine Celecoxib 400 mg Acetaminophen NSAIDS Tylenol Tylenol Tylenol
PGY1 No Unsatisfied Residency Kentucky, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Disagree Agree Strongly agree Strongly agree Agree Strongly agree Agree Strongly agree NSAIDs Chlorpromazine IV 12.5 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol NSAIDs Opioid
PGY1 No Neutral Medical School New York, Delaware, West Virginia 75,000 75,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Agree Strongly disagree Strongly disagree Agree Strongly agree Agree Agree NSAIDs Naratriptan 2.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Tylenol
PGY1 No Unsatisfied Residency Kentucky, Pennsylvania, West Virginia 15,000 25,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Disagree Strongly agree Strongly agree Agree   Agree Strongly agree Strongly agree Strongly agree NSAIDs Celecoxib 400 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY3 No Neutral Residency New York, Delaware, Pennsylvania 25,000 15,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Undecided Disagree   Agree Agree Agree Agree NSAIDs Celecoxib 400 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol   Opioid
PGY1 No Neutral Never received any formal training California, New York, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Disagree Strongly agree Undecided Disagree   Strongly agree Strongly agree Strongly agree Strongly agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol 0-10 tablets of 5mg Oxycodone NSAIDs NSAIDs Opioid
PGY1 No Unsatisfied Medical School Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Disagree Strongly disagree Disagree Agree Agree Agree   Agree Agree Agree Strongly agree Duloxetine Naratriptan 2.5 mg Exercise 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY3 No Unsatisfied Residency, Personal reading Alabama 45,000 25,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Disagree Undecided Disagree Agree   Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY2 No Neutral Medical School, Residency, Personal reading Alabama, Kentucky, Pennsylvania 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree   Agree Undecided Agree Disagree   Agree Strongly agree Agree Agree NSAIDs Codeine/acetaminophen 25/400 mg Continue NSAIDS and weight loss therapy 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Residency New York, Pennsylvania, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Strongly disagree Agree Disagree Disagree   Strongly agree Agree Agree Strongly agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY1 No Neutral Medical School, Residency California, New York, Pennsylvania 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Undecided Disagree Disagree   Agree Agree Disagree Strongly agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Oxycodone NSAIDS Tylenol Tylenol Tylenol
PGY3 Yes Neutral Medical School, Residency, Personal reading Kentucky, Delaware, West Virginia 75,000 45,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Disagree Undecided Strongly agree Agree Disagree   Strongly agree Disagree Disagree Agree NSAIDs Naratriptan 2.5 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Residency, Personal reading Kentucky, Pennsylvania, West Virginia 75,000 45,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Disagree Strongly disagree Undecided Undecided   Agree Agree Disagree Agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Tylenol
PGY1 No Neutral Medical School, Residency Kentucky, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Strongly agree Undecided Disagree   Undecided Strongly agree Strongly agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Residency   45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Disagree Agree Disagree Disagree   Agree Agree Undecided Strongly agree NSAIDs Naratriptan 2.5 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol Tylenol Tylenol
PGY2 No Unsatisfied Medical School, Residency Alabama, Kentucky, New York 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Disagree Disagree   Agree Agree Agree Strongly agree NSAIDs Celecoxib 400 mg 0-10 tablets of 5mg Tramadol 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY2 No Neutral Medical School, Residency, Personal reading Alabama, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Disagree Disagree Agree Disagree Disagree   Agree Agree Disagree Agree NSAIDs Chlorpromazine IV 12.5 mg Exercise 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY2 No Unsatisfied Medical School, Personal reading Kentucky, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Disagree Agree Undecided Agree Agree   Strongly agree Strongly agree Strongly agree Strongly agree NSAIDs Naratriptan 2.5 mg Acetaminophen NSAIDS Tylenol NSAIDs Opioid
PGY3 Yes Unsatisfied Medical School, Residency, Personal reading Kentucky, New York, Pennsylvania 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Disagree Strongly disagree Disagree Disagree Agree Agree   Agree Agree Undecided Undecided NSAIDs Chlorpromazine IV 12.5 mg Continue NSAIDS and weight loss therapy NSAIDS Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Medical School New York, Pennsylvania, West Virginia 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Disagree Undecided Disagree Disagree   Agree Agree Agree Agree NSAIDs Celecoxib 400 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol Tylenol Tylenol
PGY2 No Unsatisfied Residency, Personal reading Alabama, Kentucky, New York 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Agree Strongly disagree Strongly disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone NSAIDs Tylenol Tylenol
1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. Which three states have the highest percentage of opioid-related deaths per capita:(circle 3 states) 6. In 2017, how many drug overdose deaths were due to opioids?   7. In 2017, how many deaths were a result of heroin overdose?   8. Nearly half of all opioid related overdoses are due to valid prescription opioids.  9. What is the PDMP?  10. How often should the PDMP be referenced? 11. Opioids are effective in pain management.  12. Every patient that presents to the office with pain should receive opioids. 13. I feel comfortable in my knowledge of non-opioid pain management.  14. If I suspect someone is abusing opioids, I do not prescribe opioids to them.   15. Patient gender may affect my judgement of a patient's pain intensity 16. Patient race may affect my judgement of a patient's pain intensity 17. If a patient presents to the ED repeatedly asking for more pain medication, this could be due to a missed diagnosis of the underlying pain source.  18. I ask my patients about the severity of their pain. 19. I include patient-reported pain levels in my notes. 20. I think that proper pain management is associated with better patient outcomes.  21. For an adult presenting with chronic low back pain, I would initially prescribe: (circle only one) 22. A 25-year-old female presents to the office with an acute episodic migraine According to the American Headache Society 2015 Guidelines, what treatment has Level A evidence? 23. A 65-year-old man returns to the clinic for joint pain in his knees. He has a history of osteoarthritis and states that it is difficult for him to complete daily tasks. His pain was not treated by NSAIDs or weight loss. What should be the next line of treatment?  24. A 35-year-old male presents to the office with nephrolithiasis. His eGFR is >90ml/min and he has no history of GI bleed. How would you initially treat his pain? 25. For patients experiencing mild pain, I usually initially prescribe (circle one) 26. For patients experiencing moderate pain, I usually initially prescribe (circle one) 27. For patients experiencing severe pain, I usually initially prescribe (circle only one)
PGY1 No Unsatisfied Medical School, Residency, Personal reading Alabama, Kentucky, Pennsylvania, West Virginia 25,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Agree Agree Agree Agree Agree Agree Strongly agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Oxycodone NSAIDS Tylenol NSAIDs Opioid
PGY2 No Neutral Medical School, Residency Kentucky, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Strongly agree Disagree Disagree Agree Agree Agree Agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY2 No Neutral Medical School, Residency Kentucky, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Undecided Strongly disagree Strongly disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS NSAIDs NSAIDs Tylenol
PGY1 No Unsatisfied Medical School Delaware, South Carolina, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Disagree Agree Agree Agree Agree Strongly agree Strongly agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY3 No Neutral Medical School, Residency Alabama, Kentucky, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Undecided Strongly disagree Agree Strongly agree Strongly disagree Strongly disagree Agree Agree Disagree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS NSAIDs NSAIDs Opioid
PGY2 No Neutral Medical School, Residency Kentucky, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Strongly agree Disagree Disagree Agree Agree Agree Agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY1 No Neutral Medical School Kentucky, Delaware, West Virginia 25,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Disagree Strongly disagree Disagree Strongly agree Disagree Agree Agree Strongly agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Medical School Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Disagree Agree Disagree Disagree Agree Agree Agree Agree Tramadol Naratriptan 2.5 mg Acetaminophen No pain medication Tylenol Tylenol Tylenol
PGY3 No Neutral Residency Delaware, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Undecided Undecided Agree Agree Agree Strongly agree NSAIDs Naratriptan 2.5 mg Exercise NSAIDS Tylenol NSAIDs Opioid
PGY2 No Unsatisfied Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Agree Agree Agree Agree Agree Strongly agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS NSAIDs NSAIDs NSAIDs
PGY2 No Unsatisfied Residency California, New York, Pennsylvania 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Strongly agree Strongly agree Undecided Agree Strongly agree Agree Strongly agree NSAIDs Celecoxib 400 mg Acetaminophen NSAIDS Tylenol Tylenol Opioid
PGY2 No Unsatisfied Residency California, New York, Pennsylvania 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Strongly agree Strongly agree Undecided Agree Strongly agree Agree Strongly agree NSAIDs Celecoxib 400 mg Acetaminophen NSAIDS Tylenol Tylenol Opioid
PGY2 No Neutral Medical School, Residency Kentucky, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Strongly agree Disagree Disagree Agree Agree Agree Agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY1 No Unsatisfied Never received any formal training Kentucky, New York, Pennsylvania 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Disagree Undecided Disagree Disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg Exercise NSAIDS Tylenol Tylenol NSAIDs
PGY1 No Satisfied Medical School, Residency California, Delaware, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY3 No Satisfied Never received any formal training Alabama, Kentucky, West Virginia 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Disagree Strongly disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg Continue NSAIDS and weight loss therapy 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY1 No Neutral Medical School, Residency Alabama, Kentucky, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Strongly agree Undecided Agree Agree Strongly agree Strongly agree Strongly agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY1 No Neutral Medical School Kentucky, Pennsylvania, West Virginia 25,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Strongly agree Strongly disagree Agree Agree Agree Disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS Tylenol NSAIDs Opioid
PGY1 No Unsatisfied Never received any formal training Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Undecided Strongly agree Undecided Undecided Agree Agree Agree Agree NSAIDs Chlorpromazine IV 12.5 mg Acetaminophen NSAIDS Tylenol NSAIDs NSAIDs
PGY2 No Unsatisfied Residency, Personal reading Delaware, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given. Agree Strongly disagree Agree Agree Disagree Disagree Agree Agree Agree Agree NSAIDs Naratriptan 2.5 mg 0-10 tablets of 5mg Tramadol NSAIDS NSAIDs Tylenol Tylenol
1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. Which three states have the highest percentage of opioid-related deaths per capita:(circle 3 states) 6. In 2017, how many drug overdose deaths were due to opioids?   7. In 2017, how many deaths were a result of heroin overdose?   8. Nearly half of all opioid related overdoses are due to valid prescription opioids.  9. What is the PDMP?  10. How often should the PDMP be referenced? 11. Opioids are effective in pain management.  12. Every patient should receive opioids following surgery.  13. I feel comfortable in my knowledge of non-opioid pain management.  14. If I suspect someone is abusing opioids, I do not prescribe opioids to them.   15. Patient gender may affect my judgement of a patient's pain intensity 16. Patient race may affect my judgement of a patient's pain intensity 17. I ask my patients about the severity of their pain. 18. I include patient-reported pain levels in my notes. 19. For a patient being discharged home after an open appendectomy, I would typically prescribe: (circle only one) 20. For a patient being discharged home after a sleeve gastrectomy, I would typically prescribe: (circle only one) 21. For a patient being discharged home after a laparoscopic cholecystectomy, I would typically prescribe: (circle only one) 22. For a patient being discharged home after a laparoscopic Nissen fundoplication, I would typically prescribe: (circle only one) 23. For a patient being discharged home after an open small bowel resection, I would typically prescribe: (circle only one) 24. For a patient being discharged home after an open colectomy, I would typically prescribe: (circle only one) 25. For a patient being discharged home after a major hernia repair, I would typically prescribe: (circle only one) 26. For patients experiencing mild pain, I usually initially prescribe (circle one) 27. For patients experiencing moderate pain, I usually initially prescribe (circle one) 28. For patients experiencing severe pain, I usually initially prescribe (circle only one)
PGY4 Yes Satisfied Medical School, Residency, Personal reading Kentucky, New York, South Carolina 45,000 25,000 TRUE Prescribing Directory of Medical Providers Anytime an opioid prescription is given Agree Disagree Disagree Disagree Undecided Disagree Agree Disagree 0-10 tablets of 5mg Oxycodone 11-20 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY3 Yes Very satisfied Medical School, Residency California, New York, Pennsylvania 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Strongly agree Disagree Strongly agree Disagree Disagree Disagree Strongly agree Disagree 0-10 tablets of 5mg Oxycodone 11-20 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-25 tablets of 5mg Oxycodone 0-25 tablets of 5mg Oxycodone 0-25 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY4 Yes Very satisfied Medical School, Residency, Personal reading New York, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Strongly agree Strongly agree Strongly disagree Strongly disagree Strongly agree Strongly agree 0-10 tablets of 5mg Oxycodone 11-20 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY2 Yes Neutral Residency California, New York, Pennsylvania 25,000 15,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Agree Strongly disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY4 Yes Neutral Residency Alabama, California, New York 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Agree Undecided Agree Agree Strongly agree Undecided 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY4 Yes Neutral Residency Alabama, Kentucky, West Virginia 75,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Strongly disagree Disagree Undecided Undecided Agree Undecided Only non-opioid pain medications Only non-opioid pain medications 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone NSAIDs Tylenol Tylenol
PGY1 No Satisfied Medical School, Residency Alabama, South Carolina, West Virginia 25,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Strongly agree Undecided Undecided Disagree Agree Disagree Strongly agree Agree 11-20 tablets of 5mg Oxycodone 11-20 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Tylenol Tylenol
PGY3 Yes Very satisfied Medical School, Residency Alabama, Pennsylvania, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Strongly agree Strongly disagree Strongly agree Undecided Strongly disagree Strongly disagree Strongly agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone Tylenol Tylenol Tylenol
PGY2 No Satisfied Medical School, Residency, Personal reading New York, Pennsylvania, South Carolina 45,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Undecided Strongly disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY4 Yes Satisfied Residency California, New York, Pennsylvania 45,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Agree Agree Agree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY1 Yes Neutral Residency California, New York, Pennsylvania 25,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Disagree Agree Agree Agree Disagree 0-10 tablets of 5mg Oxycodone 21-30 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY5 Yes Satisfied Medical School, Residency, Personal reading Kentucky, New York, Pennsylvania 45,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Undecided Strongly disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 11-20 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY3 Yes Unsatisfied Medical School, Residency, Personal reading California, New York, Pennsylvania 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Disagree Strongly disagree Undecided Agree Strongly disagree Strongly disagree Strongly agree Strongly agree Only non-opioid pain medications 0-10 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY5 Yes Satisfied Medical School, Residency Alabama, California, New York 45,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Strongly agree Agree Disagree Strongly disagree Agree Disagree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY5 Yes Satisfied Residency Kentucky, Delaware, West Virginia 75,000 45,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Agree Disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-25 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY5 Yes Satisfied Residency California, Delaware, Pennsylvania 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Agree Disagree Disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone NSAIDs NSAIDs Opioid
PGY2 Yes Satisfied Residency California, New York, West Virginia 75,000 75,000 TRUE Prescribing Directory of Medical Providers Anytime an opioid prescription is given Agree Disagree Agree Agree Disagree Disagree Agree Agree Only non-opioid pain medications Only non-opioid pain medications 0-5 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
1. Please select your current level of training: 2. Do you hold a DEA License? 3. How satisfied are you with your current level of opioid-prescribing training? 4. When did you receive your opioid-prescribing training? (Select all that apply) 5. Which three states have the highest percentage of opioid-related deaths per capita:(circle 3 states) 6. In 2017, how many drug overdose deaths were due to opioids?   7. In 2017, how many deaths were a result of heroin overdose?   8. Nearly half of all opioid related overdoses are due to valid prescription opioids.  9. What is the PDMP?  10. How often should the PDMP be referenced? 11. Opioids are effective in pain management.  12. Every patient should receive opioids following surgery.  13. I feel comfortable in my knowledge of non-opioid pain management.  14. If I suspect someone is abusing opioids, I do not prescribe opioids to them.   15. Patient gender may affect my judgement of a patient's pain intensity 16. Patient race may affect my judgement of a patient's pain intensity 17. I ask my patients about the severity of their pain. 18. I include patient-reported pain levels in my notes. 19. For a patient being discharged home after an open appendectomy, I would typically prescribe: (circle only one) 20. For a patient being discharged home after a sleeve gastrectomy, I would typically prescribe: (circle only one) 21. For a patient being discharged home after a laparoscopic cholecystectomy, I would typically prescribe: (circle only one) 22. For a patient being discharged home after a laparoscopic Nissen fundoplication, I would typically prescribe: (circle only one) 23. For a patient being discharged home after an open small bowel resection, I would typically prescribe: (circle only one) 24. For a patient being discharged home after an open colectomy, I would typically prescribe: (circle only one) 25. For a patient being discharged home after a major hernia repair, I would typically prescribe: (circle only one) 26. For patients experiencing mild pain, I usually initially prescribe (circle one) 27. For patients experiencing moderate pain, I usually initially prescribe (circle one) 28. For patients experiencing severe pain, I usually initially prescribe (circle only one)
PGY2 Yes Satisfied Medical School, Residency, Personal reading Delaware, Pennsylvania, West Virginia 75,000 75,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Agree Agree Disagree Strongly disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY5 Yes Satisfied Medical School, Residency, Personal reading Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Agree Strongly disagree Strongly disagree Strongly agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY3 Yes Very satisfied Medical School, Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Strongly agree Disagree Strongly agree Disagree Disagree Disagree Strongly agree Disagree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY4 Yes Very satisfied Medical School, Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Strongly agree Agree Strongly disagree Strongly disagree Strongly agree Strongly agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-20 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY3 Yes Very satisfied Medical School, Residency Delaware, Pennsylvania, West Virginia 75,000 25,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Strongly agree Strongly disagree Strongly agree Agree Strongly disagree Strongly disagree Strongly agree Strongly agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Tylenol Tylenol
PGY4 Yes Very satisfied Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Agree Undecided Strongly disagree Strongly disagree Strongly agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY2 Yes Satisfied Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 FALSE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Agree Undecided Strongly disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol Tylenol Opioid
PGY4 Yes Satisfied Residency Alabama, Kentucky, Pennsylvania, West Virginia 75,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Agree Disagree Disagree Disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone NSAIDs NSAIDs Opioid
PGY4 Yes Satisfied Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Agree Agree Agree Agree Strongly agree Strongly agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone Tylenol NSAIDs Opioid
PGY5 Yes Very satisfied Medical School, Residency Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Agree Agree Disagree Strongly disagree Agree Disagree Only non-opioid pain medications 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY2 Yes Satisfied Medical School, Residency, Personal reading Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Undecided Agree Strongly disagree Strongly disagree Agree Undecided 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY3 Yes Satisfied Medical School, Residency, Personal reading Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Disagree Disagree Agree Strongly disagree Strongly disagree Strongly agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-5 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone Tylenol Opioid Opioid
PGY5 Yes Unsatisfied Residency, Personal reading Delaware, Pennsylvania, West Virginia 45,000 15,000 TRUE Prescription Drug Monitoring Program Anytime an opioid prescription is given Agree Strongly disagree Agree Agree Disagree Strongly disagree Agree Agree 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-15 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone 0-10 tablets of 5mg Oxycodone NSAIDs Tylenol Opioid

Original article
peer-reviewed

Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians


Author Information

Pankti P. Acharya Corresponding Author

Pain Management, Rowan University School of Osteopathic Medicine, Stratford, USA

Brianna R. Fram

Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, USA

Jenna R. Adalbert

Orthopaedic Surgery, Sidney Kimmel Medical College, Philadelphia, USA

Ashima Oza

Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, USA

Prashanth Palvannan

General Surgery, Thomas Jefferson University Hospital, Philadelphia, USA

Evan Nardone

Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, USA

Nicole Caltabiano

Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA

Jennifer Liao

Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA

Asif M. Ilyas

Rothman Opioid Foundation, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, USA


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained or waived by all participants in this study. Thomas Jefferson University issued approval 19E.352. In accordance with Federal-Wide Assurance #00002109 to the U.S. Department of Health and Human Services, this study was determined to be EXEMPT from IRB review on May 9, 2019, pursuant to Title 45 Code of Federal Regulations Part 46.101(b) governing exempted protocol declarations. Board #153 was notified of this exemption status at its May 9, 2019 meeting. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.



Original article
peer-reviewed

Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians


Figures etc.

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