1. Mario Cornacchione MS DO FAAFP David Withers MD Cliff Lyons DO Mark White MD MPH Jenifer Joyce MD FAAFP Mary Triano MSN, CRNP-C Meaghan Godwin PhD Department of Family, Community & Rural Health The Commonwealth Medical College Scranton, Pa

2. The Question Can we positively influence medical student attitudes and knowledge base regarding substance abuse/addiction in medical students and practicing physicians populations? Potential Impacts likelihood of a lifesaving self-disclosure of substance abuse or addiction intervention for a peer intervention for a fellow physician

3. Pilot Project Descriptive analysis to determine and assess areas for improvement and content for delivery of this important topic Goal/outcome: to demonstrate increased short-term knowledge and awareness pre-post contact delivery in standard lecture and large-group discussion format

4. Introduction No published intervention studies 4 years of US medical school 11% met criteria for excessive drinking for at least one 6- month period 1 18% met criteria for alcohol abuse during first 2 years 1 Prevalence varies in other countries Practicing physicians 2,3 10%–14% become chemically dependent at some point in their careers 1. JAMA 257:2921-2926, 1987 2. J. Anesth Analg 2002;95:1024-30 3. JAMA, March 23/30, 2005,Vol 293,No.12,1513

5. Consequences Academic performance, empathy, ethical conduct, relationships, altruism and postgraduate medical errors Isolation & Denial Fostered by silent peers & faculty Reputation, continuation of studies, graduation, residency placement and potential employment Advanced disease

6. Physician Health Programs (PHPs) Anonymous to State Medical Boards, National Practitioner Data Bank Promotes acceptance of early intervention Not punitive Contract Monitoring 75-85% continuous recovery over 5-9 years

7. Impedance to a Rational Intervention Institutional oblivion Lack of a culture promoting self-care of its own faculty and students Fear and denial in faculty since they may need to then confront their own substance abuse/addiction issues Lack of awareness of the prevalence of the problem and its impact on the lives of their students Perceived lack of time available in the curriculum for the intervention

8. Methods Art & Practice of Medicine- MD2 “Addictions/Neurobiology and Peer to Peer Applications” lecture and large group discussion Assistant Medical Director nationally recognized substance abuse treatment center -60 min. program for chemically dependent health professionals neurobiology and behavioral components of addiction data on addiction in medical students and practicing physicians. story of his personal journey of recovery

9. Methods Medical Director PA PHP-20 min. Additional Questions- 10 min. Pre & Post Survey Attendance mandatory, surveys voluntary & anonymous Reminders sent for post survey 14 questions 0-5 Likert Scale open text capture and comments fields as Q15 and 16.

10. Methods Survey questions primarily focus on; changes of attitudes toward addiction in medical student peers and practicing physicians outcomes of addiction in medical students and practicing physicians ability to recognize signs of substance abuse/addiction in peers or later in their career in a fellow practicing physician propensity to intervene for a peer medical student through an appropriate avenue understanding of the PHP programs

11. Analysis 58/69 (84% response rate) pre and post 58 students were analyzed (matched pre/post) two-tailed T test comparing response means pre vs. post for each question intended or expected a priori direction pre vs. post (whether increase or decrease).

12. Results 12/14 questions trended in intended or expected a priori direction pre vs. post (whether increase or decrease).

13. Results Overall trend of equivalence or non-inferiority in aggregate (class of MD2 students as a whole) as well as per item analysis for 10/14 questions. QuestionMean_PreMean_PostMean_DiffMean_Diff_95% CIp Q1 4.334.59+ 0.26 [ 0.013, 0.533 ]0.0619 Q2 4.124.29+ 0.17 [ 0.110, 0.450 ]0.2319 Q3 ‡ 3.724.66+ 0.93 [ 0.663, 1.217 ]0.0001 Q4 2.191.90- 0.29 [ -0.109, -0.689 ]0.1530 Q5 4.454.67+ 0.22 [ 0.026, 0.466 ]0.0796 Q6 2.332.00- 0.33 [ -0.084, -0.744 ]0.1174 Q7 ‡ 2.782.21- 0.57 [ -0.193, -0.947 ]0.0033 Q8 4.334.36+ 0.03 [ 0.214, 0.274 ]0.8080 Q9 * 2.192.21 + 0.02 * [ 0.325, 0.365 ]0.9088 Q10 * 2.312.36 + 0.05 * [ 0.301, 0.401 ]0.7783 Q11 ‡ 3.214.22+ 1.02 [ 0.583, 1.437 ]0.0001 Q12 ‡ 2.413.40+ 0.98 [ 0.518, 1.462 ]0.0001 Q13 2.262.07- 0.19 [ -0.166, -0.546 ]0.2928 Q14 4.214.47+ 0.26 [ 0.036, 0.556 ]0.0849

14. Results 3.)Pennsylvania Medical Society supports a program for physicians with substance abuse / addiction. [MC+ 0.93, mean diff. 95% CI 0.663, 1.217, p=0.0001] 11.) Lifelong abstinence is a necessary goal in the treatment of alcoholism. [MC+ 1.02, mean diff. 95% CI 0.583, 1.437, p=0.0001] 12.) Coercive pressure, such as threat or punishment, is useful in getting healthcare professionals to seek treatment. [MC + 0.98, mean diff. 95% CI 0.518, 1.462, p=0.0001]

15. Limitations and Future Steps Limitations Limited by response rate (58/69 = 84%) Limited by small sample size (n=58) Voluntary pre-survey completion (self-selection bias) Voluntary post-survey completion (self-selection bias) Measuring short-term knowledge, awareness (possibly attitude) retention or change

16. Limitations and Future Steps Next year: 100 students Likert scale of 1-10 rather than 1-5 Evaluate and possibly change content in lecture and discussion regarding Q 9, and 10 Changed in opposite direction of a priori expected direction Analyze MC of those with strong undesired response in pre-survey Examine associations of personal/family experience of substance abuse/addiction with answers

17. Comments Q15 As a medical student or physician, what services are available to you to help a colleague in whom you suspect substance abuse/addiction? PHP Pre 1/39 Post 25/25