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The treatment of chronic noncancer pain with chronic opioid therapy has increased rapidly, but medicine residents receive little training concerning this therapy. Therefore we conducted a trial to determine if an interactive web-based training focusing on shared decision-making for chronic opioid therapy improves knowledge and competence compared with exposure to practice guidelines.A randomized controlled educational trial of 213 internal medicine residents from 5 medicine residencies participating in the Residency Review Committee for Internal Medicine's Educational Innovations Project comparing access to interactive web-based training (COPE: Collaborative Opioid Prescribing Education) or access to the Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain. Pretraining and immediate posttraining knowledge test; pretraining and 60-day posttraining self-reported competence, satisfaction, patient-centeredness, and selected clinical behaviors were analyzed using t tests, Pearson χ2, and Generalized Estimating Equations.The web training group had greater increase in knowledge with training (χ2=72.06, P<0.00001) and greater self-rated competence in the management of outpatients with chronic pain (χ2=6.48, P=0.01), and specifically in the use of opioids in this management (χ2=5.17, P=0.02). Residents in both groups reported more satisfaction with managing chronic pain care after training (χ2=52.72, P<0.0001), though the web training was superior on subscales concerning training adequacy (χ2=4.94, P=0.026) and relationship quality (χ2=5.79, P=0.016).Exposure to an interactive web-based training focused on shared decision-making and communication skills was more effective than exposure to compatible practice guidelines for knowledge and self-reported competence in the management of chronic noncancer pain.