Pain management in urology training: A national survey of senior residents

Abstract

Introduction: We explore the attitudes and experience of urology residents toward acute and chronic pain management during their training. Method: A convenience sample of Canadian Urology chief residents were invited to complete an anonymous questionnaire involving both open and closed-ended questions using a 5-point Likert scale. Descriptive and quantitative statistics were used to analyze the attitudes toward pain management, including their experience and training issues. Results: The response rate was 97%. Most residents agreed or strongly agreed that more formal training in acute pain (77% agreement, mean 4.03 ± 0.98 SD) and chronic pain (68%, 3.97 ± 0.95) management would be valuable in urology residency with only 1 respondent disagreeing that training should be mandatory. There was a significant difference of training experience in chronic versus acute pain management, with only 13% agreement (2.99 ± 0.67) that their training in chronic pain was adequate. Most residents agreed (74%, 3.84 ± 1.00) that most of their training in pain management came from their senior residents or fellows. Many of the residents (65%, 3.61 ± 0.84) felt that they could manage their patients' acute pain issues independently, even in the absence of an acute pain service, although apparent knowledge of opioids was poor. Conclusions:The results of this survey suggest that urology residents attain their knowledge of pain management experientially with what may be insufficient formal training, particularly in chronic pain. These observations are limited by the relatively small number of respondents and by the nature of a cross-sectional, self-reported survey; however, they would appear to underscore a need to redouble efforts in residency education. IntroductionUrologists see patients in pain daily and must manage acute and chronic pain-related issues in hospital and ambulatory settings.1 Beyond the common issues presenting to the average urologist in the acute surgical setting, up to 6% of outpatient visits will involve pain management in patients with chronic prostatitis/chronic pelvic pain syndrome, interstitial cystitis/bladder pain syndrome, chronic epididymitis and orchiodynia.2 In addition, a urologist's oncologic practice may include chronic cancer-related pain involving multifaceted management strategies. As patients' medical issues become increasingly complex, an in-depth understanding of the options available in pain management by the urologist is required in today's practice. 3A recent survey of medical oncologists in the United States revealed that although they agreed their discipline required expertise in pain management, they felt that their training in this area was fair. 4 Furthermore, a high prevalence of deficits in the knowledge of opioids was evident in this group of specialists. In a similar study, surgeons had the lowest scores in knowledge of cancer-related chronic pain management.5 There is little known regarding the quality of training in pain management for residents in surgery programs in general ...

Analgesic prescribing habits and patterns of Canadian chief urology residents: A national survey

“…Urologists, in particular, manage chronic non-cancer pains such as chronic prostatitis/chronic pelvic syndrome, interstitial cystitis, chronic epididymitis, and orchiodynia, in addition to chronic cancer-related pain, acute renal colic pain, and pain occurring in an acute surgical setting. [21][22][23][24] Similar to other surgical specialties, most opioid prescriptions written in academic centres are written by urologists in training, highlighting the importance of an in-depth understanding of pain management options. [23][24][25][26] However, studies involving medical oncologists and surgeons demonstrated clear knowledge gaps.…”

“…[21][22][23][24] Similar to other surgical specialties, most opioid prescriptions written in academic centres are written by urologists in training, highlighting the importance of an in-depth understanding of pain management options. [23][24][25][26] However, studies involving medical oncologists and surgeons demonstrated clear knowledge gaps. 24,27,28 A recent survey of US surgical program directors found that only 20% of training programs have mandatory opioid prescribing education as part of their curriculum.…”

“…[23][24][25][26] However, studies involving medical oncologists and surgeons demonstrated clear knowledge gaps. 24,27,28 A recent survey of US surgical program directors found that only 20% of training programs have mandatory opioid prescribing education as part of their curriculum. 26,29 Moreover, in a 2013 survey of Canadian urology chief residents, Pace et al found a significant difference of training experience in chronic and acute pain management, and poor apparent knowledge of opioid prescribing.…”

Thinking outside of the pelvis: Managing chronic urological pain

“…In a survey by Pace et al in 2013, chief residents in Canadian training programs had reported very little comfort in managing chronic non-cancer pain, with minimal knowledge of opioid prescribing guidelines. 5 The majority reported that they got most of their knowledge around use of opioid prescribing from their senior residents. These issues need to be addressed by our community and the efforts by the CMPA and our provincial colleges should help.…”

Bending a tree while it is young: Getting pain management training on the academic map

“…4 Less than a quarter of the respondents received formal training during their residency program. Managing pain turns out to be just another "thing to do" and not a main focus of patient care.…”