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Effects of Stigmatizing Language on Trainees' Clinical Decision-Making in Substance Use Disorders: A Randomized

Neeral K Sheth1, Adam B Wilson2, James C West3

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Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
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PubMed
Summary

Stigmatizing language negatively impacts medical trainees' clinical decisions for patients with substance use disorder (SUD). Increased SUD education in undergraduate medical education (UME) improves decision-making but does not alter attitudes toward patients with SUD.

Keywords:
AddictionAttitudesBiasOpioid withdrawalUndergraduate medical education

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Area of Science:

  • Medical Education
  • Addiction Psychiatry
  • Health Psychology

Background:

  • Substance use disorder (SUD) is a highly stigmatized condition in the US.
  • Stigmatizing language from healthcare professionals can perpetuate bias among medical trainees.
  • This bias may negatively affect clinical decision-making for patients with SUD.

Purpose of the Study:

  • To investigate the impact of stigmatizing language on medical trainees' clinical decisions for patients with SUD.
  • To examine the influence of undergraduate medical education (UME) curricula on these decisions.
  • To assess the relationship between trainees' attitudes and their clinical choices.

Main Methods:

  • Medical students were randomized to read either a stigmatizing or neutral clinical vignette about opioid withdrawal.
  • Participants made treatment decisions, completed attitude assessments (MCRS), and reported on SUD education and personal experiences.
  • Statistical analyses explored the influence of vignette type, attitudes, and curriculum on treatment choices.

Main Results:

  • Exposure to stigmatizing language resulted in less effective treatment decisions for opioid withdrawal (p=0.027).
  • Greater SUD education during UME correlated with more effective clinical decision-making (p<0.001).
  • SUD education did not correlate with trainees' attitudes toward patients with SUD (p=0.231).

Conclusions:

  • Stigmatizing language significantly influences clinical decision-making in treating patients with SUD.
  • Enhancing SUD education within UME curricula is a potential strategy to mitigate this bias.
  • Further research may explore interventions to improve attitudes alongside decision-making skills.