Trainees' knowledge, attitudes, and practices towards caring for the substance-exposed mother-infant dyad

ABSTRACT

Background: As rates of substance use disorder during pregnancy rise, pediatric trainees are increasingly caring for infants with neonatal abstinence syndrome (NAS). This study evaluated the knowledge, attitudes, and practices of trainees caring for substance-exposed newborns and their families, comparing differences by level and type of training, and personal experience with addiction or trauma. Methods: A cross-sectional survey of medical students and pediatric, medicine/pediatric, and family medicine residents in 2015–2106. Measures included knowledge about NAS, attitudes towards mothers who use drugs, and practices around discussing addiction and trauma with families. Descriptive and bivariate analyses were conducted. Results: The overall response rate was 70%, with 229 trainees included in the final sample (99 students, 130 residents). Fifty percent of trainees endorsed personal experience with addiction, 50% with trauma, and 35% with both addiction and trauma. Increasing years of pediatric training was associated with greater comfort in managing symptoms of NAS but decreased comfort discussing addiction and trauma. Family medicine and medicine/pediatric residents were more comfortable discussing addiction and trauma than categorical pediatric residents (P < .01). Twenty-two percent of trainees felt confident that mothers would disclose illicit drug use, 39% felt that they would actively care for their infants with NAS, and 43% felt that mothers would not make unreasonable demands. Personal experience with addiction or trauma did not significantly impact trainees' attitudes towards women with substance use disorder. Conclusions: Trainees may benefit from educational interventions focused on developing a 2-generational model of trauma-informed care to improve attitudes and ultimately the care of substance-exposed infants and their families.

KEYWORDS:

• Neonatal Abstinence Syndrome
• opioid use disorder
• trainees' attitudes
• perinatal substance use

Acknowledgments

The authors thank Mardge Cohen for her critical review of an earlier version of the manuscript.

The authors declare that they have no conflicts of interest.

Funding

Dr. Schiff is supported by Health Resources & Services Administration (HRSA) Training Grant T32HP10028. This project was funded by the Arnold P. Gold Foundation Picker-Gold Graduate Medical Education Challenge Grant. Granting agencies had no role in the study design, data collection, analysis, and interpretation of the data; writing the report; or the decision to submit the manuscript for publication.

Author contributions

Dr. Schiff conceptualized and designed the study, performed the analyses, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Zuckerman conceptualized the initial study, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. Wachman provided assistance in study development, critically reviewed the manuscript, and approved the final manuscript as submitted. Dr. Bair-Merritt helped revise the design of the study, supervised the analysis, critically reviewed the manuscript, and approved the final manuscript as submitted.