A New Program in Pain Medicine for Medical Students: Integrating Core Curriculum Knowledge with Emotional and Reflective Development

Abstract

Objective Improvements in clinical pain care have not matched advances in scientific knowledge, and innovations in medical education are needed. Several streams of evidence indicate that pain education needs to address both the affective and cognitive dimensions of pain. Our aim was to design and deliver a new course in pain establishing foundation-level knowledge while comprehensively addressing the emotional development needs in this area. Setting 118 first year medical students at Johns Hopkins School of Medicine. Outcome measures Performance was measured by multiple choice tests of pain knowledge, attendance, reflective pain portfolios and satisfaction measures. Results Domains of competence in pain knowledge included central and peripheral pain signaling, pharmacological management of pain with standard analgesic medications, neuromodulating agents and opioids; cancer pain, musculoskeletal pain, nociceptive, inflammatory, neuropathic, geriatric, and pediatric pain. Socio-emotional development (portfolio) work focused on increasing awareness of pain affect in self and others and enhancing the commitment to excellence in pain care. Reflections included observations on a brief pain experience (cold pressor test), the multi-dimensionality of pain, the role of empathy and compassion in medical care, the positive characteristics of pain-care role models, the complex feelings engendered by pain and addiction including frustration and disappointment, and aspirations and commitments in clinical medicine. The students completing feedback expressed high levels of interest in pain medicine as a result of the course. Discussion We conclude that a four-day pain course incorporating sessions with pain- specialists, pain medicine knowledge, and design-built elements to strengthen emotional skills is an effective educational approach.

Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

“…Training providers in empathy, a positive aspect of pain care cited in this study, may be especially helpful in CNCP care [42,43]. Novel approaches to training providers and medical students in shared decision making and affective skills improves provider satisfaction, relationships, and interest in caring for patients with pain [44,45]. Providers described feeling rewarded when they were able to alleviate suffering and provide comfort to patients, and see them regain functionality and have improved well-being.…”

Pain Education at the University of Washington School of Medicine

“…25 Recently proposed enriched medical student pain curricula are often limited to a short interval, concentrated intersession or web-based content. 22,29,36 Mezei and Murinson 21 reported an extensive survey of all pain content taught in U.S. medical schools and found a median of just 7 sessions with a range of 1 to 28 and found that only 4% of medical schools have integrated pain material within case-based clinical teaching settings. The British Pain Society in 2009 and Briggs et al 7 have reported 13 hours of median pain curriculum in UK medical school curricula.…”

Canadian Emergency Medicine Residents’ Perspectives on Pediatric Pain Management

“…These include online interactive modules, seminars and didactic teaching over a course of days or weeks, small group teaching, interactive conference series, inter-professional discussions, and use of standardized patients; application of these techniques has yielded mixed results. [36][37][38][39] One undergraduate medical education program in the US found that the integration of elements to strengthen emotional skills is an effective educational approach when teaching students about pain. 37 The investigators in this study reported that learners who used personal, reflective portfolios to build awareness of the affective dimensions of pain demonstrated attainment of foundation knowledge, robust engagement in tasks addressing emotional development, and high levels of learner satisfaction.…”

“…[36][37][38][39] One undergraduate medical education program in the US found that the integration of elements to strengthen emotional skills is an effective educational approach when teaching students about pain. 37 The investigators in this study reported that learners who used personal, reflective portfolios to build awareness of the affective dimensions of pain demonstrated attainment of foundation knowledge, robust engagement in tasks addressing emotional development, and high levels of learner satisfaction. One internal medicine program in the US used a combination of interactive sessions, didactic teaching, provision of pocket reference cards, and emailing of clinical vignettes in their training program.…”