We implemented a pain assessment and management (PAM) curriculum for second year medical students and evaluated long-term skills retention compared to the prior year's class which did not receive the curriculum. The curriculum included pain pathophysiology, assessment and treatment instruction plus feedback on PAM practice with standardized patients. Both cohorts underwent a required end-of-third-year clinical skills examination. Intervention and control group performance on three pain cases (acute, chronic and terminal) was compared. The PAM curriculum was implemented 1.5years before the intervention cohort participated in the clinical skills exam. More intervention students (134/159, 84.3% response rate) obtained basic (87.2% vs. 76.0%, p=.028) and comprehensive (75.2% vs. 60.9%, p=.051) descriptions of acute pain than control students (n=129/174, 74.1% response rate). Intervention students demonstrated superior skills for terminal pain, including: more often asking about impact on functioning (40.7% vs. 25.8%, p=.027), advising change of medication (97.3% vs. 38.7%, p<.001), and providing additional medication counseling (55.0% vs. 27.0%, p<.001). Virtually all students obtained basic descriptions of chronic (intervention vs. control, 98.1% vs. 96.1%, p=.367) and terminal (92.9% vs. 91.7%, p=.736) pain. Surprisingly, more control than intervention students obtained a comprehensive description of chronic pain (94.6% vs. 77.8%, p<.001) and asked about current pain medication in the terminal case (75.6% vs. 55.0%, p=.004). Exposure to the curriculum resulted in durable increases in students' ability to perform PAM skills in patients with acute and terminal pain.

With HRSA support, a focused, innovative program evolved which has already met each of the six recommendations for future innovation of the Alliance for Academic Internal Medicine Education Redesign Task Force. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

The continuity clinic experience 5 influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.

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