Date of Award

January 2022

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Katheryn Hawk


Most physicians regularly encounter patients with substance use disorder (SUD), yet research suggests that healthcare clinicians feel inadequately trained to care for this population. SUD education in medical school is imperative for training physicians to provide high-quality care. Our objectives were to characterize North American medical student experiences, knowledge and attitudes towards patients with SUD, to facilitate curriculum improvements in medical schools’ SUD curricula, and to report on the current state of medical school SUD disorder curricula. A 39-question anonymous, voluntary, Web-based, cross-sectional survey was administered between February 1 2021 to April 27 2021 via school-specific communication channels to 3rd and 4th year students at 20 medical schools in the United States and Canada through Qualtrics; the survey was released to each collaborating school once the medical school completed its approval survey process for a three-week time period between aforementioned timeframe. Previously validated and novel questions assessed medical student knowledge, attitudes, and perceptions about patients with substance use disorder. We collected had 656 responses, an overall response rate of 11.8% (656/5535) and completion rate of 90% (656/729), with completion of survey defined as participants answering more than 90% of the survey questions. Seventy-three percent (497/674) of students desired more education on SUD; only a slight majority, 57.2% (377/659) reported feeling that they know enough about the causes of addiction. A minority demonstrated comprehensive knowledge about opioid use disorder (OUD): 28.1% (188/669) recognized that clinicians require an X-waiver to prescribe buprenorphine; only 42.2% (282/669) identified buprenorphine as the correct treatment option to manage OUD in a clinical vignette provided. While 78.4% (542/691) reported being on a clinical team that prescribed medication for the treatment of SUD, only 57.1% (394/690) reported seeing/participating in harm reduction, and only 33.6% (225/661) reported feeling comfortable administering and/or teaching patients to administer naloxone. Only 42.6% (281/660) reported feeling comfortable counseling patients with SUD, however a majority, 66.3% (438/661), reported finding working with this population rewarding. The student-reported curriculum review indicates that most schools do not emphasize teachings on addiction medicine: median number of hours of addiction-related teaching was 7.5 hours (mean=9.85, 95% CI [6.7,13]); only 55% (11/20) of medical schools offered addiction electives; few schools, 20% (4/20), require students to have clinical exposure to addiction medicine on clerkships. This exploratory study demonstrates that students may lack core knowledge regarding OUD and harm reduction strategies; our review of medical school curriculum suggests that addiction medicine may not be emphasized sufficiently. To improve student readiness to treat patients with SUD, trainees may benefit from curriculum development that stresses the importance of understanding and treating addiction during medical school and residency training.


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