Journal of Pain Research (Aug 2018)
Medical students’ perspectives of their clinical comfort and curriculum for acute pain management
Abstract
Uyen Evelyn Tran,1 Janeva Kircher,2,3 Priya Jaggi,2 Hollis Lai,1 Tracey Hillier,1,4 Samina Ali3,5 1Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; 2Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; 3Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; 4Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; 5Women and Children’s Health Research Institute, Edmonton, Alberta, Canada Objectives: Acute pain is a common presenting complaint in health care. Yet, undertreatment of pain remains a prevailing issue that often results in poor short- and long-term patient outcomes. To address this problem, initiatives to improve teaching on pain management need to begin in medical school. In this study, we aimed to describe medical students’ perspectives of their curriculum, comfort levels, and most effective pain teaching modalities. Materials and methods: A cross-sectional, online survey was distributed to medical students at the University of Alberta (Edmonton, Canada) from late May to early July 2015. Data were collected from pre-clerkship (year 1 and 2) and clerkship (year 3 and 4) medical students for demographic characteristics, knowledge, comfort, and attitudes regarding acute pain management. Results: A total of 124/670 (19.6%) surveys were returned. Students recalled a median of 2 (interquartile range [IQR]=4), 5 (IQR=3.75), 4 (IQR=8), and 3 (IQR=3.75) hours of formal pain education from first to forth year, respectively. Clerkship students were more comfortable than pre-clerks with treating adult pain (52.1% of pre-clerks “uncomfortable” versus 22.9% of clerks, p<0.001), and overall, the majority of students were uncomfortable with managing pediatric pain (87.6% [64/73] pre-clerks and 75.0% [36/48] clerks were “uncomfortable”). For delivery of pain-related education, the majority of pre-clerks reported lectures as most effective (51.7%), whereas clerks chose bedside instruction (43.7%) and small group sessions (23.9%). Notably, 54.2%, 39.6%, and 56.2% of clerks reported incorrect doses of acetaminophen, ibuprofen, and morphine, respectively, for adults. For children, 54.2%, 54.2%, and 78.7% of clerks reported incorrect doses for these same medications. Conclusion: Medical students recall few hours of training in pain management and report discomfort in treating and assessing both adult and (more so) pediatric pain. Strategies are needed to improve education for future physicians regarding pain management. Keywords: analgesia, undergraduate, curriculum, medical education, survey
