What Can We Learn from First-Year Medical Students' Perceptions of Pain in the Primary Care Setting?

Corrigan, Corinne; Desnick, Laurel; Marshall, Susan G.; Bentov, Nathalie; Rosenblatt, Roger A.

doi:10.1111/j.1526-4637.2011.01150.x

Cited by 35 publications

(31 citation statements)

References 22 publications

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“…Medical student dissatisfaction with pain education has been reported among students intending to pursue a primary care specialty. 10 The short survey we report in this article shows that this dissatisfaction extends to all University of Washington medical students. There is evidence that increased time educating medical students results in improved knowledge and attitudes.…”

Section: Discussionmentioning

confidence: 82%

“…They concluded, “There are inarguable links between the undertreatment and the maltreatment of pain and the lackluster state of pain education in medicine.” Watt-Watson et al 33 had previously reported the average veterinarian pain curriculum to be 87 hours, prompting Macleans, a leading popular Canadian publication, to satirically announce on its cover, “Your dog can get better health care than you.” 28 The recently published transformational report of the U.S. Institute of Medicine (IOM) about relieving pain in America 23 confirms the self-report of inadequate pain competence of both actively teaching academics and community-practicing physicians, 20,32 as well as the medical students themselves. 4,10,35 The IOM identified the chief problems in medical school education to be “a lack of breadth in the presentation of the topic, a lack of integration of basic science and clinical knowledge, and a lack of clinical role models—especially specialists treating chronic pain—in most academic medical centers.” 23 An urgent training need exists to understand pain as a chronic disease to prevent ever more patients and medical practices from becoming disabled by the challenges of chronic pain.…”

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confidence: 99%

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Pain Education at the University of Washington School of Medicine

Tauben

Loeser

2013

The Journal of Pain

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Contemporary medical education is inadequate to prepare medical students to competently assess and design care plans for patients with acute and chronic pain. The time devoted to pain education in most medical school curricula is brief and not integrated into case-based clinical experiences, and it is frequently nonexistent during clinical clerkships. Medical student pain curricula have been proposed for over 30 years and are commonly agreed upon, though rarely implemented. As a consequence of poor undergraduate pain education, postgraduate trainees and practicing physicians struggle with both competency and practice satisfaction; their patients are similarly dissatisfied. At the University of Washington School of Medicine, a committee of multidisciplinary pain experts has, between 2009 and 2011, successfully introduced a 4-year integrated pain curriculum that increases required pain education teaching time from 6 to 25 hours, and clinical elective pain courses from 177 to 318 hours. It is expected that increased didactic and case-based multidisciplinary clinical training will increase knowledge and competency in biopsychosocial measurement-based pain narrative and risk assessment, improve understanding of persistent pain as a chronic complex condition, and expand the role of patient-centered interprofessional treatment for medical students, residents, and fellows, leading to better prepared practicing physicians.

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Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 99%

Pain Education at the University of Washington School of Medicine

Tauben

Loeser

2013

The Journal of Pain

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“…Theme One: Inadequacies of training: Studies have shown that PCPs report a lack of knowledge, education, and training in pain management [16,18,19,24] especially in the area of opioid prescribing. Our study describes similar perceptions.…”

Section: Systems Domainmentioning

confidence: 99%

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

Lincoln

Pellico²,

Kerns³

et al. 2013

J Palliative Care Med

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Objectives: Most patients with chronic non-cancer pain (CNCP) are cared for, by primary care providers (PCPs). While some of the barriers faced by PCPs have been described, there is little information about PCPs' experience with factors that facilitate CNCP care. Design:The study design was descriptive and qualitative. Data were analyzed using qualitative content analysis. Krippendorff's thematic clustering technique was used to identify the repetitive themes regarding PCPs' experiences related to CNCP management. Subjects:Respondents were PCPs (n=45) in the VA Connecticut Healthcare System in two academically affiliated institutions and six community based sites.Results: Eleven themes were identified across systems, personal/professional, and interpersonal domains. Barriers included inadequate training, organizational impediments, clinical quandaries and the frustrations that accompany them, issues related to share care among PCPs and specialists, antagonistic aspects of provider-patient interactions, skepticism, and time factors. Facilitators included the intellectual satisfaction of solving difficult diagnostic and management problems, the ability to develop keener communication skills, the rewards of healing and building therapeutic alliances with patients, universal protocols, and the availability of complementary and alternative medicine resources and multidisciplinary care. Conclusion:PCPs experience substantial difficulties in caring for patients with pain while acknowledging certain positive aspects. There is a need for strategies that mitigate the barriers to pain management while bolstering the positive aspects to improve care and provider satisfaction.

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“…For providers and clinic staff repeatedly encountering PDB, consequences may include inefficiency, stress, and compassion fatigue. 9 Ultimately, the supply of primary care physicians may be adversely affected: negative experiences during medical training with patients exhibiting PDB while receiving chronic opioid therapy may discourage students 10 and residents 9 from a career in primary care. For patients-many of whom may be struggling with an opioid use disorder-continuation of opioid prescriptions may reinforce their maladaptive behaviors.…”

mentioning

confidence: 99%

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Grande¹,

Thompson²,

Au³

et al. 2016

The Journal of the American Board of Family Medicine

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Purpose: Problem drug-related behavior (PDB) among patients on chronic opioid therapy may reflect an opioid use disorder. This study assessed PDB prevalence and the relationship between PDB and ongoing prescription of opioids at a primary care clinic that implemented a multifaceted opioid management program.Methods: A chart review of patients in a chronic opioid registry assessed prevalence of different types of PDB over 2 years, and whether opioids were prescribed during the last 3 months of the 2-year study period among patients with different levels of PDB.Results: Among 233 registry patients, 84.1% exhibited PDB; 45.5% exhibited >3 types of PDB. At the end of 2 years, most registry patients were still prescribed opioids, though patients with >3 types of PDB were less likely than those without PDB to be prescribed opioids (62.3% vs. 78.4%, P ‫؍‬ 0.016).Conclusions: PDB was pervasive in this population of patients on chronic opioid therapy. Those with the most PDB, and thus with the greatest likelihood of opioid use disorder and its social and medical consequences, were the least likely to be prescribed opioids by the clinic after 2 years. Given the rising rates of illicit opioid use in the U.S., it is important that clinics work closely with their patients who display PDB, systematically assess them for opioid use disorder, and offer evidence-based treatment.

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What Can We Learn from First-Year Medical Students' Perceptions of Pain in the Primary Care Setting?

Abstract: First-year medical students identified pain as a major concern in their early clinical experience. Students' perceptions of pain-related encounters can inform curriculum design and may ultimately benefit both physicians and the patients.

Cited by 35 publications

References 22 publications

Pain Education at the University of Washington School of Medicine

Pain Education at the University of Washington School of Medicine

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

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

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