Do we need to rethink how we educate healthcare professionals about pain management?

This week’s EBN Twitter Chat on Wednesday 3rd May between 8-9 pm (UK time) is taking place live from the British Pain Society’s (@BritishPainSoc) Annual Scientific Meeting in Birmingham. The chat will focus on whether we need to rethink how we educate healthcare professionals about pain management. The Twitter Chat will be hosted by Dr Ameila Swift (@nurseswift) and Professor Alison Twycross (@alitwy). This Blog provides some context for the Chat.

Participating in the Twitter Chat

Participating in the chat requires a Twitter account; if you do not have one you can create an account at www.twitter.com. You can contribute to the chat by sending tweets with #ebnjc included within them.

Current approach to pain education

The International Association for the Study of Pain (IASP) have published curricula for pre-registration training for healthcare professionals (see: http://www.iasp-pain.org/Education/CurriculaList.aspx?navItemNumber=647). These consist of lists of topics specifying the knowledge students need to obtain about pain management during pre-registration courses. This reflects the traditional approach to curriculum design where learning outcomes focus on theoretical knowledge and pay little attention to application in practice. Indeed, research in this area has tended to focus on knowledge and curricula deficits (Briggs et al. 2011, Twycross & Roderique 2013). As patients of all ages continue to experience unnecessary unrelieved pain (Twycross & Finley 2013; Meissner et al. 2015) there is a need to explore ways of ensuring knowledge is used in practice. This is timely because the International Association for the Study of Pain (IASP) has named 2018 the Global Year for Excellence in Pain Education (see: http://www.iasp-pain.org/GlobalYear).

Is part of the problem the way we evaluate the education provided?A literature review of research into pain education, conducted for this blog, suggests the impact of educational interventions does not look beyond three months with most studies only assessing pre- and post-intervention knowledge gain. Students and junior staff feel powerless and might ‘shy away from their incompetence’ in treating patients when management is not straightforward (Tellier et al. 2013), demonstrating the gap between increased knowledge and increased competence.

How can we ensure knowledge is applied in practice?

Knowledge translation (KT) initiatives are designed to address the erroneous expectation that increasing knowledge automatically leads to improvements in pain management. Zhu et al. (2012) describe a multi-stranded initiative that begins with addressing the priority that pain was given by the organisational leadership. This was combined with embedding effective pain management in policies, and education of both staff and patients. Three years after implementing their KT strategy decreases in pain prevalence continued, the frequency of severe pain, and the proportion of patients suffering from severe pain.

One of the problems often cited in developing good pain practices is that there are insufficient role models, which means that what students learn in university is not reflected in the real world. Murinson et al. (2011) provide a possible solution to this. A 4-day pain programme for medical students was provided that not only instilled knowledge, but also addressed the affective domain. Students undertook small group discussions with experts, which incorporated artistic and literary depictions of pain. They also produced a structured written portfolio to capture the output of reflection about the affective dimension of pain on themselves and others. The students demonstrated an understanding of what it is to look after people in pain, and how the experts were compassionate, knowledgeable and self-aware. They saw the modelling of best practice and because of this were more confident that they would be able to emulate that.

Is it time for a rethink on how we educate healthcare professionals about pain?

Over the years, several models of education have been tried many of which involve chucking education at the student in the hope it will change practice. These delivery mechanisms often focus on presenting knowledge, and fail to focus on increasing the use of knowledge in practice. The same is true of how we assess pain education – we often focus on the assessment of knowledge to the exclusion of the other components necessary to be an effective practitioner.

Questions to consider before the Twitter chat:

• Do we need to move away from traditional models of (pain) education?
• What methods of pain education successfully support knowledge translation?
• What outcome measures are important to include when we evaluate the impact of a well-designed educational intervention?
• How long should the follow-up period be in a quantitative evaluation of the impact of an educational intervention?
• What methods would you use to include patients in an evaluation of an educational intervention?
• It is time we looked at the ‘system’ – i.e. stop “chucking” knowledge at students without considering whether it will be used in practice?

Dr Amelia Swift, Senior Lecturer (Nursing), University of Birmingham and University Hospital Birmingham NHS Foundation Trust.

Professor Alison Twycross, Head of Department, Children’s Nursing, London South Bank University.

References

Briggs EV, Carr CJ & Whittaker MS (2011): Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. European Journal of Pain 15, 789-795.

Meissner, M., Coluzzi, F., Fletcher, D., Huygen, F., Morlion, B., Neugebauer, E., Perez, AM, & Pergolizzi, J. (2015) Improving the management of post-operative acute pain: priorities for change. Current Medical Research and Opinion, 31(11): 2131-2143

Murinson, B.b., Neonortas, E., Mayer, R.S., Mezei, L., Kozachik, S. Nesbit, S., Haythornthwaite, J.A. & Campbell, J.N. (2011) A new program in pain medicine for medical students: integrating core curriculum knowledge with emotional and reflective development, Pain Medicine, 12(2): 186-195

Tellier, P-P,  Bélanger, E, Charo Rodríguez, C,  Ware, MA & Posel, N. (2013) Improving Undergraduate Medical Education about Pain Assessment and Management: A Qualitative Descriptive Study of Stakeholders’ Perceptions, Pain Research and Management, 18(5), 259-265.

Twycross, A. & G.A. Finley, Children’s and parents’ perceptions of postoperative pain management: A mixed methods study. Journal of Clinical Nursing, 2013. 22(21-22): 3095–3108.

Twycross A. & Roderique L. (2013): Review of pain content in three-year preregistration pediatric nursing courses in the United Kingdom. Pain Management Nursing 14, 247-258.

Zhu, L.M., Stinson, J. Lori Palozzi, L., Weingarten, K., Hogan, M-E., Duong, S., Carbajal, R., Campbell, F., & Taddio, A. (2012) Improvements in pain outcomes in a Canadian pediatric teaching hospital following implementation of a multifaceted, knowledge translation initiative, Pain Research and Management, 17(3): 173-179.