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      Development, implementation and evaluation of a pain management and palliative care educational seminar for medical students

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          Abstract

          One of the best ways to improve pain management for patients with chronic pain is to increase the emphasis on this topic during the education of health care professionals. The authors of this study developed a seminar that was presented to medical students at the University of Toronto (Toronto, Ontario). The utility of the seminar was assessed using a test administered both before the seminar, immediately after the seminar and up to one year later.

          Abstract

          BACKGROUND:

          Despite calls for the development and evaluation of pain education programs during early medical student training, little research has been dedicated to this initiative.

          OBJECTIVES:

          To develop a pain management and palliative care seminar for medical students during their surgical clerkship and evaluate its impact on knowledge over time.

          METHODS:

          A multidisciplinary team of palliative care and pain experts worked collaboratively and developed the seminar over one year. Teaching methods included didactic and case-based instruction, as well as small and large group discussions. A total of 292 medical students attended a seminar during their third- or fourth-year surgical rotation. A 10-item test on knowledge regarding pain and palliative care topics was administered before the seminar, immediately following the seminar and up to one year following the seminar. Ninety-five percent (n=277) of students completed the post-test and 31% (n=90) completed the follow-up test.

          RESULTS:

          The mean pretest, post-test and one-year follow-up test scores were 51%, 75% and 73%, respectively. Mean test scores at post-test and follow-up were significantly higher than pretest scores (all P<0.001). No significant difference was observed in mean test scores between follow-up and post-test (P=0.559), indicating that students retained knowledge gained from the seminar.

          CONCLUSIONS:

          A high-quality educational seminar using interactive and case-based instruction can enhance students’ knowledge of pain management and palliative care. These findings highlight the feasibility of developing and implementing pain education material for medical students during their training.

          Translated abstract

          HISTORIQUE :

          Malgré des demandes pour élaborer et évaluer des programmes de formation sur la douleur au début du parcours des étudiants en médecine, peu de recherches ont porté sur le sujet.

          OBJECTIFS :

          Élaborer un séminaire sur la gestion de la douleur et les soins palliatifs à l’intention des étudiants en médecine pendant leur stage en chirurgie et en évaluer les répercussions sur leurs connaissances au fil du temps.

          MÉTHODOLOGIE :

          Une équipe multidisciplinaire d’experts en soins palliatifs et en gestion de la douleur ont collaboré pendant un an pour préparer le séminaire. Les méthodes d’enseignement incluaient des cours didactiques et axés sur des cas, ainsi que des discussions en petits et grands groupes. Au total, 292 étudiants en médecine ont assisté à un séminaire pendant leur stage de troisième ou quatrième année. Ils ont répondu à un test de dix questions sur les connaissances relatives aux soins de la douleur et aux soins palliatifs avant le séminaire, immédiatement après le séminaire et au suivi un an plus tard. Ainsi, 95 % des étudiants (n=277) ont rempli le test après le séminaire et 31 % (n=90), le test de suivi.

          RÉSULTATS :

          Les indices moyens du test avant et après le séminaire et au suivi d’un an s’établissaient à 51 %, à 75 % et à 73 %, respectivement. Les indices moyens du test après le séminaire et au suivi étaient considérablement plus élevés que les indices du test avant le séminaire (tous P<0,001). On n’a pas observé de différence significative dans les indices moyens des tests au suivi et après le séminaire (P=0,559). Les étudiants conservaient donc les connaissances acquises pendant le séminaire.

          CONCLUSIONS :

          Un séminaire de formation de haute qualité faisant appel à des enseignements interactifs et fondés sur des cas peut améliorer les connaissances des étudiants sur la gestion de la douleur et les soins palliatifs. Ces résultats font ressortir la faisabilité d’élaborer et d’adopter du matériel de formation sur la gestion de la douleur à l’intention des étudiants en médecine pendant leur formation.

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          Most cited references32

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          The impact of chronic pain in the community.

          Chronic pain is known to be very common in the community. Less is known about the epidemiology of more significant or severe chronic pain. The impact of chronic pain in the community, in terms of general health, employment and interference with daily activity, has not been quantified. The aim of this study was to describe the prevalence and distribution in the community of chronic pain defined as 'significant' and 'severe', and to explore the impact of chronic pain on health and activity. A questionnaire survey was carried out of a sample drawn from the general population in the Grampian region of SCOTLAND: Questionnaires were sent to a random sample of 4611 individuals aged 25 years and over, stratified for age and gender, selected from the practice lists of 29 general practices (total practice population 136,383). The study instrument included a case definition questionnaire, from which were identified individuals with 'any chronic pain' (pain of at least 3 months duration). The instrument also included a level of expressed need questionnaire and the chronic pain grade questionnaire, from which were derived definitions for 'significant chronic pain' (based on the reported need for treatment and professional advice) and 'severe chronic pain' (based on reported intensity and pain-related disability). The SF-36 general health questionnaire and demographic questions were also included. Of the sample, 14.1% reported 'significant chronic pain', and this was more prevalent among women and older age groups. A total of 6.3% reported 'severe chronic pain', and this was more common in older age groups. On multiple logistic regression modelling, female gender, housing tenure, employment category and educational attainment were found to be independently associated with both 'significant' and 'severe' chronic pain. The presence of 'any', 'significant' and 'severe' chronic pain had progressively more marked adverse associations with employment, interference with daily activities and all measured dimensions of general health. Comparison of the epidemiology of 'significant chronic pain' and 'severe chronic pain' with 'any chronic pain' allows an understanding of the more clinically important end of the chronic pain spectrum. These results support the suggestion that chronic pain is multidimensional, both in its aetiology and in its effects, particularly at this end of the spectrum. This must be addressed in management and in further research.
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            Depression and anxiety associated with three pain conditions: results from a nationally representative sample.

            Investigations of the relationship between pain conditions and psychopathology have largely focused on depression and have been limited by the use of non-representative samples (e.g. clinical samples). The present study utilized data from the Midlife Development in the United States Survey (MIDUS) to investigate associations between three pain conditions and three common psychiatric disorders in a large sample (N = 3,032) representative of adults aged 25-74 in the United States population. MIDUS participants provided reports regarding medical conditions experienced over the past year including arthritis, migraine, and back pain. Participants also completed several diagnostic-specific measures from the Composite International Diagnostic Interview-Short Form [Int. J. Methods Psychiatr. Res. 7 (1998) 171], which was based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association 1987]. The diagnoses included were depression, panic attacks, and generalized anxiety disorder. Logistic regression analyses revealed significant positive associations between each pain condition and the psychiatric disorders (Odds Ratios ranged from 1.48 to 3.86). The majority of these associations remained statistically significant after adjusting for demographic variables, the other pain conditions, and other medical conditions. Given the emphasis on depression in the pain literature, it was noteworthy that the associations between the pain conditions and the anxiety disorders were generally larger than those between the pain conditions and depression. These findings add to a growing body of evidence indicating that anxiety disorders warrant further attention in relation to pain. The clinical and research implications of these findings are discussed.
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              The prevalence of chronic pain in Canada.

              While chronic pain appears to be relatively common, published population prevalence estimates have been highly variable, partly due to differences in the definition of chronic pain and in survey methodologies. To estimate the prevalence of chronic pain in Canada using clear case definitions and a validated survey instrument. A telephone survey was administered to a representative sample of adults from across Canada using the same screening questionnaire that had been used in a recent large, multicountry study conducted in Europe. The prevalence of chronic pain prevalence for adults older than 18 years of age was 18.9%. This was comparable with the overall mean reported using identical survey questions and criteria for chronic pain used in the European study. Chronic pain prevalence was greater in older adults, and females had a higher prevalence at older ages compared with males. Approximately one-half of those with chronic pain reported suffering for more than 10 years. Approximately one-third of those reporting chronic pain rated the intensity in the very severe range. The lower back was the most common site of chronic pain, and arthritis was the most frequently named cause. A consensus is developing that there is a high prevalence of chronic pain within adult populations living in industrialized nations. Recent studies have formulated survey questions carefully and have used large samples. Unfortunately, a substantial proportion of Canadian adults continue to live with chronic pain that is longstanding and severe.
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                Author and article information

                Journal
                Pain Res Manag
                Pain Res Manag
                PGI
                Pain Research & Management : The Journal of the Canadian Pain Society
                Pulsus Group Inc
                1203-6765
                1918-1523
                Sep-Oct 2014
                : 19
                : 5
                : 230-234
                Affiliations
                [1 ]Department of Psychology, York University;
                [2 ]The Wasser Pain Management Centre, Mount Sinai Hospital;
                [3 ]Palliative Care Consult Team, Sunnybrook Health Sciences Centre;
                [4 ]Temmy Latner Centre for Palliative Care;
                [5 ]Division of Orthopaedic Surgery, Mount Sinai Hospital;
                [6 ]The Wilson Centre, The Banting Institute, Toronto, Ontario
                Author notes
                Correspondence: Dr Denise Paneduro, Graduate Office, Behavioural Science Building, Room 297, 4700 Keele Street, Toronto, Ontario M3J 1P3. Telephone 647-965-8040, fax 416-586-5067, e-mail dpanedur@ 123456yorku.ca
                Article
                prm-19-230
                4197749
                24851239
                16f70cff-a5a0-454e-bdd4-4c7c85fcc9ef
                © 2014, Pulsus Group Inc. All rights reserved

                This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) ( http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact support@ 123456pulsus.com

                History
                Categories
                Original Article

                chronic pain,knowledge about pain,pain,pain education,palliative care

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