In Reply to Manion and Khan

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We are grateful for this positive feedback on our core competencies for medical education about the prevention of prescription drug misuse. We are encouraged by the positive response from medical schools and their curriculum committees about the effectiveness of the core competencies we developed. As educational institutions have unique traditions, cultures, and teaching styles, and may vary in their preexisting approaches to teaching about prescription misuse, one of our essential principles in developing these competencies was to allow each school the flexibility to incorporate the core competencies into their curricular activities in an individualized manner. Given the urgency of the current opioid epidemic, we were pleased to see this flexibility result in rapid adoption at the four Massachusetts medical schools, followed by all of the state’s dental schools, physician assistant programs, and advanced practice nursing programs.
Our focus was on the important balance of the need for pain control with the potential for opioid misuse. We emphasized the need for students to be competent in effectively addressing both acute and chronic pain, while also being able to identify and treat potential substance use disorders. We did not solely emphasize pain management, as we were focused on the intersection of pain management and the potential for substance misuse. We know that many medical schools have pain management training for students, and we applaud the University of Kansas School of Medicine for their focus on pain management and the approach to acute and chronic pain management.
Of note, in our 10 core competencies, competency #1 requires the capacity to evaluate pain using evidence-based tools, and #3 requires the capacity to identify and describe potential pharmacological and nonpharmacological treatment options, including opioid and nonopioid pharmacological treatments for acute and chronic pain management. Given the growing population of patients living with substance use disorder (SUD), we also felt it necessary to include competencies important to a wide range of primary care and specialty providers treating SUD patients with ongoing needs, such as a chronic disease. These competencies attempt to balance those considerations and appropriate primary prevention strategies. The curriculum objectives outlined in the letter from Manion and Khan, and recently instituted by the University of Kansas School of Medicine, are in substantial alignment with these core competencies.
We are encouraged to see medical schools around the country adapting their curricula to address the needs of individuals suffering from pain and substance use disorder. We are hopeful that this collaboration between public health and medical education can continue in order to address critical public health issues of our times.
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