A Cancer Pain Structured Clinical Instruction Module (SCIM), with skills stations incorporating actual cancer patients, has been developed to enhance cancer pain education among our medical students. The Cancer Pain SCIM has not been compared with more traditional cancer pain education, thus the purpose of this study was to assess the effectiveness and durability of three educational methods for teaching cancer pain management to medical students compared with a control group. Four consecutive rotations of 32 third-year medical students participated in one of four cancer pain educational strategies: 1) control group with no formal cancer pain education, 2) CD-ROM self-instruction module on cancer pain, 3) a 2-hour Cancer Pain SCIM plus the CD-ROM information, and 4) Cancer Pain SCIM, plus CD-ROM, plus a structured home-hospice patient visit. The effectiveness of the educational interventions was assessed at 4 months post-instruction using a 4-component Cancer Pain Objective Structured Clinical Examination (OSCE). The main findings of this educational study are that: 1) all three educational groups performed better on the Cancer Pain OSCE at 4 months than the control group (P<0.05); 2) medical students receiving structured education on cancer pain management significantly out-performed students at 4 months compared with control or traditional instructional formats; 3) students receiving the Cancer Pain SCIM plus home visit performed highest on the pain management, physical exam, and communication stations of the OSCE; and 4) the SCIM format of education shows durability as assessed at 4 months post-instruction. The Cancer Pain SCIM has a unique potential to substantially improve the quality of cancer pain education.

Background Selecting a measure for oncology distress screening can be challenging. The measure must be brief, but comprehensive, capturing patients’ most distressing concerns. The measure must provide meaningful coverage of multiple domains, assess symptom and problem-related distress, and ideally be suited for both clinical and research purposes. Methods From March 2006 to August 2012, the James Supportive Care Screening (SCS) was developed and validated in three phases including content validation, factor analysis, and measure validation. Exploratory factor analyses were completed with 596 oncology patients followed by a confirmatory factor analysis with 477 patients. Results Six factors were identified and confirmed including (i) emotional concerns; (ii) physical symptoms; (iii) social/practical problems; (iv) spiritual problems; (v) cognitive concerns; and (vi) healthcare decision making/communication issues. Subscale evaluation reveals good to excellent internal consistency, test–retest reliability, and convergent, divergent, and predictive validity. Specificity of individual items was 0.90 and 0.87, respectively, for identifying patients with DSM-IV-TR diagnoses of major depression and generalized anxiety disorder. Conclusions Results support use of the James SCS to quickly detect the most frequent and distressing symptoms and concerns of cancer patients. The James SCS is an efficient, reliable, and valid clinical and research outcomes measure.

The learning experience with the Cancer Pain Structured Clinical Instruction Module (SCIM), a highly structured skills training course for medical students, has been reported favorably. The purpose of this study was to present the Cancer Pain SCIM to registered nurses employed in a hospice setting. The goal of the study was to pilot test a structured cancer pain educational program for hospice nurses and to determine the perceived effectiveness of this course on the participants' cancer pain assessment and management skills. A multidisciplinary Cancer Pain SCIM was presented to 25 hospice nurses to improve their understanding of the management of cancer pain. The development group identified essential aspects of cancer pain management and then developed checklists defining specific station content. During the 2-hour Cancer Pain SCIM, nurses rotated through 8 stations in groups of 3, spending 15 minutes at each station. Eight instructors and 6 standardized patients, 5 of whom were survivors of cancer, participated in the course. All participants (students, instructors, and patients) evaluated the course, using a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). Nurses provided self-assessments of their perceived competence on important aspects of cancer pain management both before and after the SCIM. The self-assessment items used a 5-point scale ranging from 1 (not competent) to 5 (very competent). Twenty-five hospice nurses, averaging 4.1 years (range 1-30 years) postgraduation, participated in the Cancer Pain SCIM. Overall, nurses agreed that they improved on each of the 8 teaching items (P < 0.001). The average (SD) pretest score of 2.8 (0.72) improved to 3.8 (0.58) on the post-test (P < 0.001). Nurses believed that their mastery of specific clinical skills, taught in all 8 stations, improved as a result of participation in the course. Nurses strongly agreed (mean +/- SD) that it was beneficial to use patients with cancer in the course (4.6 +/- 0.82). Faculty members enjoyed participating in the course (4.9 +/- 0.35) and indicated a willingness to participate in future courses (4.7 +/- 0.49). Significant perceived learning among hospice nurses took place in all aspects of the Cancer Pain SCIM. Participating nurses, instructors, and patients with cancer appreciated the SCIM format. Nurses and faculty considered the participation of actual patients with cancer highly beneficial. The SCIM format has great potential to improve the quality of cancer pain education.

Objective. The purpose of this study was to assess the educational value and acceptability of a short CD-ROM course on cancer pain management given to third-year medical students at the University of Kentucky.Methods. Thirty-six medical students were given a short-course CD-ROM on cancer pain assessment and management. The Cancer Pain CD-ROM included textual instruction as well as video clips and a 15-item interactive self-assessment examination on cancer pain management. Students were asked to evaluate the computerized course with an 18-item survey using a Likert scale (1 ϭ strongly disagree; 5 ϭ strongly agree).Results. Twenty-seven medical students completed the course, however, only 11 returned evaluations. In general, the medical students appreciated the CD-ROM material, with the exception of the video clips. Students agreed most strongly (mean Ϯ standard deviation [SD]) that the educational material on the CD-ROM was presented clearly (3.9 Ϯ 1.1), the CD-ROM format was easy to use (4.0 Ϯ 0.8), the CD-ROM course improved knowledge of opioid use for cancer pain (4.0 Ϯ 0.7), and the course improved understanding of opioid-related side effects (4.0 Ϯ 0.7). The self-assessment examination on cancer pain was rated easy to use and felt to be helpful (4.0 Ϯ 0.9) for students to identify cancer pain knowledge deficits. The authors estimate that 150 man-hours were needed to complete production of the CD-ROM without any specialized training in computer skills. Conclusions.A short-course computer format program was developed by the authors to teach the basics of cancer pain management to medical students. A minority of students evaluated the program and agreed the material was clearly presented, improved knowledge of opioid analgesia, and was easy to use.Key Words. Cancer Pain; Education; Medical Student; Computer-assisted Learning IntroductionCancer is a worldwide problem resulting in 10% of all deaths. Medical students graduating and practicing in the next millennium will, therefore, be challenged with managing symptoms prevalent in patients with cancer. At the time of cancer diagnosis, one third of patients will experience moderate-tosevere pain, and, when cancer reaches the advanced stages of the disease, 70% of patients will suffer pain [1]. The majority of cancer patients with pain can, however, achieve excellent pain relief using standard analgesics and adjuvant analgesics given on a regular basis as outlined by the World Health Organization (WHO) treatment guidelines for . Since several studies on the efficacy of the WHO cancer pain guidelines suggest that pain relief is possible in 70%-90% of patients using these simple measures [3][4][5][6], health care professionals must be proficient and expert in the assessment and management of cancer pain.Unfortunately, many physicians and nurses demonstrate little awareness of the problem of cancer pain, with inappropriate concerns about side effects, addiction, and tolerance to standard opioid regimens, and a lack of basic pain management skills [7,8]. An important ta...