Program Design: Experience with Opioid Addiction

Experience with Opioid Addiction

Group Members	Roles	Commented On
Samantha McFadden	Introduction, Our Program, Reflection	Group 1
Katye Wormer	Rationale (practical program), tables	Group 2
Dakota Nicley	Rationale (Lit. Review), proofing, references	Group 3
Jennifer Stockton	n/a

Introduction

            Reports from AARP (2018) indicated that approximately 2.7 million Americans over age 50 are currently taking opioids for reasons contrary to or in amounts beyond what was originally prescribed. While there has been a national emphasis to address the opioid crisis, few efforts are currently in place that specifically address the impact of the opioid crisis on adults over age 50 (Orel, 2018). When faced with a social crisis, many times it is up to the local community to implement practices that help to reduce incidents, through the way of education, and to aid in the recovery of those suffering. According to a recent surgeon general statement, many hospitals and people of authority are not trained to help in aiding addicts, neither do they have systems in place to do so (Sharfstein, 2017). Our program will help not only those addicted to opioids, but those in their immediate surroundings with learning how to not only cope but overcome the devastating effects of this epidemic. We use an experiential learning approach that focuses on the four phases of learning: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This program can be easily followed by local churches and larger organizations alike. We have taken some notes from the University of Massachusetts Medical School on how they conduct their opioid education curriculum, and believe by first sharing what the crisis is through the eyes of experts and first-hand users (opioid addicts), then giving the participants in the workshop time to reflect on what they learned through group communication, and allowing practice in situations through role-play, then finally releasing the participants back into their organizations to actively learn by doing, this program will have a profound effect on this social crisis.

Rationale

Ideas from the literature

Experiential learning is a learning theory that postulates that knowledge is created through the transformation of experience (Arnett, Cannon, and Kitchel, 2011; Clark, 2011; Kolb, 1984). Hawtry (2007) characterizes experiential learning by the integration of participatory learning opportunities that actively engage adult learners in their education. Examples of experiential learning can include apprenticeships, intervention and prevention programs, role-playing and simulations, group work, presentations, workshops, volunteering, studying abroad, and so on (Piercy, 2013; UT, 2019). To better conceptualize this theory, Kolb (1984) created a cyclical model that outlined four distinct phases in experiential learning: concrete experience, reflective observation, abstract conceptualization, and active experimentation. In this model seen in Figure 1, concrete experience and abstract conceptualization represent the perception continuum, which focuses on emotional response. Reflective observation and active experimentation represent the processing continuum, which has to do with how an individual may approach a task (Clark, 2011).

                               

One can further break this down to these steps: actively participating in an experience à reflecting on information learned during an experience à assimilating or accommodating new information from the experience with old information à putting what was learned into action (Clark, 2011; Hajshirmohammadi, 2017; Hawtry, 2007). The adult learner can enter the cycle at any of these stages, but the next steps must follow through the corresponding sequence. As suggested by Clark (2011), Kolb’s learning styles has six main characteristics:

1.                  Learning is a process, not in terms of outcomes.

2.                  Learning is a continuous process grounded in experience.

3.                  Learning requires the resolution of conflicts that come from prior experiences, beliefs, values, and attitudes.

4.                  Learning is a holistic process of adaptation to the world.

5.                  Learning involves transactions between the person and the environment.

6.                  Learning is the process of creating knowledge that is the result of the transaction between social knowledge and personal knowledge

After gathering and analyzing the literature and related readings on this learning theory, our proposed program could integrate the experiential learning process into an interactive opioid addiction workshop for adult learners to receive hands-on experience engaging, interacting, and helping opioid addicts in a safe environment. The first step in adapting the process into our program will be figuring out which stage would be appropriate for the adult learner to start in. The program could start in the active experimentation phase and administer a pre-test to adult learners on opioid addiction to measure their prior knowledge, and later have them take a post-test after completing the program to compare before and after results.

Alternatively, our program could start in the concrete experience stage, which would have adult learners interacting with individuals who have/had an addiction to opioids through conversation and vicarious observation along with active listening. This will be achieved in two ways. The program may have guest speakers who have suffered, or are suffering, from addiction share their stories and take questions from an audience. There will also be chances for this population of learners to interact with current and former addicts, as well as other individuals similar to them in a group setting. Setting up the concrete experience portion like this would foster connections between content and experience through real-world interactions and observation between adult learners. The information that is learned during these sessions will be supplemented with handouts and other informational documents about opioid usage, which will be used with teacher guidance in the reflective observation stage.

These documents can include information pertaining to opioid statistics, questions for them to answer, contact information for helplines and specialists, prevention tips, and any other information that they can learn from. It will be important for the teacher to supplement all the handouts with some sort of lecture or other guidance so that they can further make meaning of the information. From here, they can draw upon the information they learned from interacting with these people to help other users. Moving forward, the abstract conceptualization stage would follow this and would be a period of self-reflection on their experience along with a question and answer section. This would align with the function of this stage as this is where learners will assimilate and accommodate new information just learned into existing knowledge. The learners will reflect on their experiences with the opioid users they met, answer questions, and actively engage in what they all learned so they can encode it into their memory for future use. 

Finally, learners will arrive at the active experimentation stage, which involves allowing the students to actively put their knowledge into practice. This can be done through a simple approach such as a post-test, or it can be something like having the adult learners get into groups for a role-play or simulation involving opioid use. This would allow them to apply all this information they just learned into a controlled scenario that simulates the real-world situation, which can give them additional experience to transform into knowledge. This simulation would further add to the layers of knowledge that would allow learners to put knowledge into action when a situation arises. The educator would need to be present to set up and guide the learners along through their scenes so they can better understand what they are doing. 

Having the learners participate in something like an exit interview or a survey would also be a good way to get feedback about the program. We could ask questions pertaining to strengths, weaknesses, and improvements to the program so that we are constantly trying to improve it. This would also allow us to assess how students engaged with the program. We may also infer if they successfully constructed knowledge from the direct experience that they received and can utilize it along their journey of lifetime learning. This would ensure learners are getting a chance to reflect on the experience and translate those experiences into action.

Staying true to this design, I think that experiential learning would benefit this type of program. It aligns with the characteristics of experiential learning, and the steps in this program would logically follow the order of the learning cycle. The adult learners in this program will be responsible for their education. Since the cycle can be entered from any stage it opens up many different possibilities for constructing the framework, which would allow ample opportunities for adult learners to actively engage with what they are learning. Research from Munoz, Miller, and Poole (2016) echoes the importance of engagement in experiential learning. They suggest that engagement increases when educators can facilitate opportunities for learners to be a professional, network, and experience real-world events to apply skills and knowledge to (Munoz, Miller, and Poole, 2016). That is why it will be important for the program to get students to connect to their education through direct experience that can transform into knowledge.

Practical Program

The University of Massachusetts Medical School [UMMS] has created an opioid conscious curriculum called Opioid Safe-prescribing Training Immersion [OSTI^TM] to teach future doctors and nurses enrolled in the graduate program how to prescribe opioids safely and responsibility to patients (Pohle, 2019). Massachusetts Gov. Charlie Baker created the Medical Education Working Group on Prescription Drug Misuse to create 10 core competencies created to guarantee medical students were ready to help prevent and manage prescription drug abuse (“Opioid conscious curriculum”). This group included the University of Massachusetts Medical School, the Massachusetts Department of Public Health, the Massachusetts Medical Society, and the other medical schools in Massachusetts (“Opioid conscious curriculum”). The curriculum is also available for other schools to adopt in their medical programs (“Opioid conscious curriculum”).

What are the purposes and objectives of the programs?

The simulations are designed to grow students' interpersonal skills, cognizance of their thoughts and beliefs, compassion, "equitable care for all patients suffering from substance misuse and dependency, across the broad and diverse range of social demography determinants of health" ("About: More about OSTI^TM”). This program isn’t just for medical students; it brings together graduate-level medical and nursing students who are graduating soon and faculty from the medical and nursing schools at the University of Massachusetts (“About: More about OSTI^TM"). The student is going into each simulated encounter and complete and/or show specific tasks and skills that are used in the career of a medical professional ("About: More about OSTI^TM”). To get the most out of the SP [standardized patient] encounter, learners must adapt to the setting that is being portrayed, engage with the SP as they would a "real" patient and practice, and/or demonstrate the intended skills and competencies, as consistent with the needs of the case (About: More about OSTI^TM). The responsibility to treat these simulations as real is placed on the student. In order for them to learn, they need to treat these experiments as real-world situations, so that they can be prepared for their future work in the medical field.

How are the programs designed?

The program is designed around the 10 core competencies the Medical Education Working Group on Prescription Drug Misuse created (Opioid conscious curriculum). Those 10 core competencies fall under three domains:

                    1. Preventing drug misuse

               2. Treating patients at-risk for use disorders

                      3. Managing substance use disorders as a chronic disease (Governor’s Medical Education Working Group on Prescription Drug Misuse, 2015, p. 5)

The program puts students in hands-on experiences through simulations, which promotes active learning, and includes assessments (About: More about OSTI^TM). The students will see standardized patients in situations that convey realistic interactions with patients that these students will someday encounter (About: More about OSTI^TM). These simulated encounters can occur with groups or individually in an environment where students can make mistakes and learn from them (About: More about OSTI^TM). The curriculum is overseen by "clinician-educators," the medicine and nursing schools, and oversight offices, and it brings in experts in the medical field, community resources, and state resources, such as the Department of Public Health (About: More about OSTI^TM).  "Key to the success of our project is the active engagement of our medical and nursing students in all aspects of this work, including curriculum development, faculty development, and implementation planning" (About: More about OSTI^TM).

What are the main features you identified from these programs (these features should reflect or partially reflect the key points of the theory you reviewed)? 

Kolb’s experiential learning model has four phases: reflective observation, abstract conceptualization, active experimentation, and concrete experience. During these phases, the learner will observe, experience, plan, and do (Sharlanova, 2004, p. 37).  The learner can begin the cycle at any stage, so for the OSTI^TM we will review it beginning with reflective observation (Sharlanova, 2004, p. 37).

The students in this program go through simulations to experience what happens when a person comes in after overdosing (University of Massachusetts Medical School [UMMS], 2017).  To prepare for the simulations, students are to review documents provided to them by professors and through the school website (Student materials). These materials include the paperwork that applies to the needs of the patient they'll be working with, but they also include information to learn about what they'll be incorporating and accomplishing in these simulations (Student materials).  This information falls under the reflective observation portion of Kolb's cycle. The students are reflecting on the information they are receiving and trying to think about how they will be applying it in the future.

Abstract conceptualization can also occur using the materials and during the simulations. During this stage, students will answer those questions they have been thinking about during the reflective observation. They will come up with theories to process and enact their new knowledge. These will be used during the active experimentation phase.

The program outlines different steps for the processes doctors and nurses will go through when dealing with patients with opioid problems. The Opioid rescue in action (simulation) video shows a resuscitation of a person who has overdosed.  The simulation is very realistic, involving people portraying the mother of the patient, the emergency medical technician, social workers, doctors, nurses, and more (UMMS, 2017). In this particular simulation, the patient is a medical dummy, but real people can serve as patients for other simulations. The goal of this simulation and others like it is to provide an experience the students can learn through and take what they’ve learned and apply it to real-world experiences. This simulation falls into the active experimentation stage of Kolb’s experiential learning cycle.

 The final stage of the cycle is concrete experience. These medical students begin the OSTI^TM curriculum when they are about to graduate (About: More about OSTI^TM). Medical students enter their residency after they have completed their third year of medical school, which is right after they would begin this OSTI^TM program (What to expect in medical school).  The students will begin working with real patients at that point, which would put them into the concrete experience stage.

How would you like to incorporate some of these features into your design?

            Our concrete experience stage will occur when adult learners speak to real people who have or have had an addiction to opioids. Using the information they learn, we will design a reflective observation stage they take what they have learned from these real people and supplement it with documents about opioid usage, such as the OSTI^TM program does with the materials presented to students. The materials they receive will include questions for them to ask themselves and areas they can create their own questions. We need to provide a safe place where the learners can make mistakes. We need to provide guidance during the reflection. 

The abstract conceptualization phase could occur just as it does in the OSTI^TM program: during the end of reflective observation and the beginning of active experimentation. As they are reflecting on their experience with real-life people who have had an opioid dependency, they will be answering questions we have asked and will be asking themselves questions about what they have learned. As they begin to answer these questions, they will move into the abstract conceptualization phase. They will need to answer these questions so they can know how to interact with people who misuse opioids in the future. 

The OSTI^TM program puts students into simulations where they can work with actors who have an opioid dependency. We could create role-playing scenarios where members of each group work with a person who previously misused opioids. Each of these people would have key points to go touch on, such as reasons for their usage, how they became users, why they cannot or do not want to stop. Then the rest of the learners would use the concepts and answers they came up within the abstract conceptualization phase to work with these actors to discover if they could help this person overcome and/or prevent misusing opioids. Having people who have overcome opioid dependency would create a level of realness and offer knowledge that regular actors would not have.

Our Program: Opioid Addiction Workshop

            As mentioned before, experiential learning is a process composed of concrete experience, reflective observation, abstract conceptualization, and active experimentation. Our opioid addiction workshop is aimed at better educating the community on addiction, as well as providing information on how to best get help for those suffering from addiction.

Step 1: Concrete Experience

 Guest speakers will kick off our workshop sharing personal as well as professional stories on opioid addiction. These speakers will range in knowledge from book smarts to street smarts and may include professors, social workers, psychologists, and addicts themselves. Participants will be given a schedule to tentatively follow in which speakers will present and time will be given for interactions with current and prior addicts to further answer any questions. To ensure connections are made, we will divide participants into groups to work hands-on with current addicts. All information obtained in these workshops will be supplemented with handouts that refer to the topics at hand, and these can be further utilized once the participants reach the reflection stage of experiential learning.

Step 2: Reflective Observation

 The handouts, which will include information such as statistics, how addiction begins, when and how people cave to try opioids for the first time, likely targets of opioid addiction, and so on. During our program, the instructor will give follow up information to support the handout materials. This will help adult learners to grasp a deeper understanding of the written materials. After receiving the materials and the lecture, the learner will have time to hear from different addicts on their personal experiences with addiction. After this, the learner will be given time to reflect on what they have seen, heard, and takeaways thus far. These ideas will all be documented in their personal notebook, which they will take home with them for further reflection and implementation. 

Step 3: Abstract Conceptualization

            Assimilating and accommodating the new information is an important part of experiential learning and ensuring that social change is possible. After reflecting on their thoughts, the learner will be engaged in a question and answer session with current addicts. Each learner will be encouraged to come with 3-5 questions for the addicts. These questions should be items that challenge the learner's previous knowledge when compared to what was learned from the lectures. For example, one may come to the workshop with a certain stereotype of addicts, but when confronted with a different "type" of an addict at the workshop, they will need to work through their previous thoughts, and open communication may be the best route.

Step 4: Active Experimentation

            The last step in our program will require the adult learner to be motivated to take the information learned during the workshop back home and implement what was taught/experienced. This could look in many ways, depending on the profession. If a pastor came through our program, his/her take away from the program could be the basis of their sermons during service for the next month helping to debunk myths about addicts. For a social worker, their active experimentation may be to take a different approach with their clients which includes open communication to get to the route of their motivation to use the drugs. For an elementary teacher, this information may be stored for a time when a student has a parent addicted to opioids. 

Reflection

Highlights

 Our program is focused on an important social issue in our current society. Since there is limited funding to the education and reduction efforts on this issue, our program is ideal to fit both the financial limits as well as being hands-on so people can gain a deeper knowledge and different perspective on the issue. By utilizing experiential learning we are challenging people to assimilate and accommodate new knowledge, not just within their head, but also by actively engaging in activities during and after the workshop. 

Process

            I think one of the biggest obstacles for our group on this assignment was losing a group member with little time to adjust our plan. We made our group plan a month ago with clear cut goals and timelines to stay the course, and last minute we realized we were down a groupmate. A suggestion is to check the group plan regularly (at least twice a week), to ensure group members are meeting deadlines. Had we not been on top of our group plan, we likely would have missed the opportunity to correct our course before it was too late.

            Our first step in completing this project was to refer to the group plan for responsibilities and the deadline for each section to be completed. Communicating through an email thread really helped to keep each of us up to date on where we were at on our perspective sections. Creating a word document and just attaching it to the email thread as we completed a section to build our document proved helpful.

Tables

Main Themes/Ideas in Literature	Application of main ideas in practice
The experiential learning model.	Our process is based on this cycle.
Learning is a process, not an outcome.	Students would work toward gaining knowledge not a grade.
Concrete experience.	Students will listen to speakers to understand their experiences.
Engaging in reflective observation	Our program will have the educators guide our learners through the reflective process by walking them through the information they have learned and by asking questions of them.

Rationales	Purpose/Objective	Learning Environment	Activities	Methods/Tools/Strategies
Concrete Experience (actively participating in experience)	To create knowledge through a real-world situation	Confidential environment where learners hear from people with real-world experience with addiction.	Lecture, question and answer time, group time with current addicts to discuss their experiences	We will enlist a variety of speakers to discuss their experiences to provide a plethora of viewpoints. We will have a schedule for learners to follow to keep them on task. Group discussions will be used to facilitate openness.
Reflective Observation (contemplation on information learned during prior stage(s))	To allow learners time to process what they have learned	Group discussion and individual reflection on materials handed out by educators	Review handouts, discuss with group, hear from addicts about their personal experiences with addiction	Learners will have a personal notebook for reflection and applying what they have learned to what they have heard. They will receive materials with information about addiction and why opioids are so addictive.
Abstract Conceptualization (combining and possibly replacing the old information with new information)	To make learners take the information they already know and combine it or replace it with the new information they are learning	Group discussion and sometimes one-on-one environments. All questions actively encouraged	Question and answer sessions with addicts	We will encourage each participant to come up with 3-5 questions during the reflection stage that they will then ask during this stage.
Active Experimentation (putting what is learned into action)	To apply what they learned into their jobs and every day lives	Outside of the program, their normal lives	Whatever they will be doing outside of the workshop	We will give them physical materials to take with them to use for reference whenever they are working with people with addiction. We will provide resources (groups, hotlines, websites) they can use whenever they are in the real world.

References

Arnett, E. S., Cannon, G. J., Kitchel, A. (2011). Experiential learning curricular development model for stimulating student interest in green collar careers. Online Journal of Workforce Education and Development, 5(1), 1-23.

Clark, D. (2011). Kolb’s Learning Styles and Experiential Learning Model. Retrieved from http://www.nwlink.com/~donclark/hrd/styles/kolb.html/.

Governor’s Medical Education Working Group on Prescription Drug Misuse. (2015). Medical education core competencies for the prevention and management of prescription drug misuse [PDF file]. Retrieved from http://www.massmed.org/Patient-Care/Health-Topics/Opioids/Medical-Education-Core-Competencies-for-the-Prevention-and-Management-of-Prescription-Drug-Misuse/.

Hajshirmohammadi, A. (2017). Incorporating experiential learning in engineering courses. IEEE Communications Magazine, 55(1), 166-169.

Hawtry, K. (2007). Using experiential learning techniques. The Journal of Economic Education 38(2), 143-152.

Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, New Jersey: Prentice-Hall.

Munoz, L., Miller, R., Poole, M. S. (2016). Professional student organizations and experiential learning activities: What drives student intentions to participate? Journal of Education for Business 91(1), 45-51.

Orel, N. (2018). Impact of opioid crisis on middle-aged and older adults: Addressing through prevention education. Innovation in Aging, 2(1).

 Piercy, N. (2013). Evaluating experiential learning in the business context: Contributions to group-based and cross-functional working. Innovations in Education and Teaching International, 50(2), 202-213.

Pohle, A. (2019). Medical schools look to educate the next generation of doctors on pain. WBUR 90.9. Retrieved from https://www.wbur.org/onpoint/2019/05/28/medical-schools-opioid-addiction-pain-treatment/.

Sharfstein, J. (2017). The opioid crisis from research to practice. The Milbank Quarterly, 95(1), 24-27.

Sharlanova, V. (2004). Experiential learning. Trakia Journal of Sciences, 2(4), 36-39.

The University of Tennessee Knoxville. (2019). Resource Guide [PDF file]. Retrieved from https://experiencelearning.utk.edu/wp-content/uploads/sites/21/2018/04/442930-ELResourceBookUpdate-v2.0accessible-smaller.pdf/.

University of Massachusetts Medical School. [UMass Medical School]. (2017, February 17). Opioid rescue in action (simulation). [Video file]. Retrieved from https://www.youtube.com/watch?v=kuIOltSBOMU&feature=youtu.be/.

University of Massachusetts Medical School. (n.d.). More about OSTI. Retrieved from https://www.umassmed.edu/opioid/about/.

University of Massachusetts Medical School (n.d.). Opioid. Retrieved from https://www.umassmed.edu/opioid/.

University of Massachusetts Medical School. (2019). Student Materials. Retrieved from https://www.umassmed.edu/opioid/students/student-materials/. 

Association of American Medical Colleges (n.d.). What to Expect in Medical School. Retrieved from https://students-residents.aamc.org/choosing-medical-career/article/what-expect-medical-school/.