Quality Improvement Initiative to Prepare Medical Students With Harm Reduction Principles for Substance Use Care

Undergraduate medical education is increasingly incorporating harm reduction (HR). Assessments of HR curricula have focused on skills like overdose reversal. The literature lacks evaluations of curricula that more broadly teach HR-based physician-patient communication.

From academic years 2022 to 2024, a Harvard Medical School student working group collaborated with faculty to take a quality improvement approach to incorporating HR into the substance use interview curriculum. We implemented two Plan-Do-Study-Act cycles. We measured the effectiveness of HR education in the 2023 Substance Use interview session by surveying students on a 5-point Likert scale (ranging from 1 = strongly disagree to 5 = strongly agree). We also conducted a focus group with four students to provide qualitative insights into the curriculum's impact and areas for improvement. We thematically analyzed the focus group session based on Borkan's Immersion/Crystallization methodology.

Thirty-three students completed the pre-survey and post-survey (19.4% response rate). In the survey, self-reported HR understanding improved, from mean 3.6 on the Likert scale to 4.2 (P < .001). Students strongly agreed with being interested in harm reduction before and after the session (mean pre-survey score: 4.3). In the focus group, students identified patient stories as helpful for improving understanding of HR communication. They expressed difficulty understanding the relationship between HR and abstinence-based approaches like Alcoholics Anonymous and recommended more diverse patient perspectives during the session and more HR exposure throughout medical school.

A half-day session on the substance use interview showed promise for teaching HR communication principles. For future HR communication curricula, our results favor retaining an emphasis on patient narratives and ensuring representation of diverse patients. Future research can assess whether harm reduction education translates into improved patient care.