Preparing Healthcare Professionals for Patient Pain Management

Patient-centered pain management is an important part of every health care professional's working day. Dentists, doctors, nurses, physical and occupational therapists, and pharmacists address patient concerns about pain each and every day. In this article, faculty from the University of Toronto (Canada) present the Interfaculty Pain Curriculum (IPC) that they developed to help students in these six disciplines prepare for this part of their clinical practice.

They were aware that pre-licensure preparation was limited and lacking in their own program. So they put together a core group of classes to help students in all areas become more knowledgeable in the area of pain management. They wanted the students to understand how to talk with patients about their pain and work together with other team members to help patients manage their pain.

Over a period of six years, they tested and modified the program. They used students' comments, feedback from the faculty, and suggestions from clinical instructors and supervisors to refine the design, improve the process, and update the content.

The 20-hour curriculum is now presented to all pre-licensure students. The material is covered in one three-and-a-half day period of time. The method of instruction is not just lecture, but also patient cases, large group sessions, and small interprofessional student learning groups. Efforts are made to help students understand the physiology of pain while also seeing the personal side of it from the patient's point-of-view living with chronic pain.

All kinds of pain types are included such as acute pain, chronic pain, pain in children and teens, cancer pain, arthritis pain, phantom pain after amputation, and other types of neuropathic (nerve) pain. Students are taught how to assess and manage pain. There is an emphasis on a team approach. Topics covered vary a bit from year to year based on current research and evidence from published studies.

The faculty has worked hard to create a relevant learning experience for the many different student groups. Keeping the main goal in mind (teaching students patient-centered care using an interprofessional approach), the faculty worked together to create a tight program without gaps in content.

They recognized, discussed, and collaborated on the importance of giving students as much clinical application as possible. Learning by doing with real patient problems is now a key focus of the program. As in real life, the cases involve more than one discipline at a time. The hope is that this will help students early on in their training to see how a team approach benefits the patient.

The faculty was also able to narrow down what kind of resources are helpful to students during this learning experience. They developed a student manual, list of resource readings, and on-line reference materials. The manual has information on scheduling, group assignments, and a list of the resources to guide the student through the process.

And, in an effort to continue refining the curriculum design and content, an evaluation is done each year by all students and involved faculty members. The students fill out several different questionnaires designed to measure their beliefs about pain before and after the program. Another set of tests is completed to find out what the students thought about the program.

As time went on, the faculty was able to find a way to test whether the students were using the knowledge they learned from the course when practicing in the clinic with patients. Transfer of learning can be a difficult concept to measure. This is especially true when there is such a wide range of students.

For any program considering putting together a similar curriculum, the authors of this article included many details of their own process. They created tables to summarize what they found in terms of learning issues and how they revised the design and content of their curriculum. They developed and share with the readers a Comprehensive Pain Management Plan (CPMP). This tool is used to measure effectiveness of the program and transfer of knowledge.

Analysis of the data collected from the participating students suggests that the program is effective. Students report increased awareness of patients' pain, their own unique role in pain management, and an appreciation for what other professionals can offer patients in pain.

The faculty believes that early education is important to promote positive attitudes in students who will eventually be working with chronic pain patients. They report that their program is comprehensive yet realistic. They strongly recommend continuing the problem-based approach. Using the small interprofessional groups to work on, put together, and present case studies helps make the learning process permanent and transferable to the clinic.

The authors conclude the Interfaculty Pain Curriculum (IPC) is a successful interprofessional curriculum model on pain education. It uses a variety of learning tools and keeps abreast of changes in clinical practice for the treatment of pain problems. Future efforts will be made to examine the long-term impact of this program.

Judith Hunter, et al. An Interfaculty Pain Curriculum: Lessons Learned From Six Years Experience. In PAIN. November 15, 2008. Vol. 140. No. 1. Pp. 74-86.



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