American Society of Regional Anesthesia and Pain Medicine August 2017 - 29

Resident and Medical Student Pain Education Special Interest Group:
Teach Everyone
Inevitably, at some point during our careers, we physicians have all
heard the often-impractical adage "See one. Do one. Teach one."
During the advent of medical education, when apprenticeship was
the predominant form of learning, this first step made sense.
Over the years, this style of teaching was replaced by the lecture
hall and "see one" in the teaching paradigm turned to "hearing"
one or more plainly didactic learning. As this proverb suggests, to
treat patients and teach future generations, we must first be taught
about the topic.
When it comes to pain management, however, oftentimes in
medical school, this teaching is brief, inadequate, or worse yet,
dangerously outdated or completely absent from the curricula.
This lack of education and training in pain management that
physicians receive during their early formative years raises grave
concerns, especially given the widespread prevalence of pain. It
is estimated that 1.5 billion people worldwide suffer from chronic
pain.1 In Europe, chronic pain is one of the most common reasons
that patients see their primary care physician.2 In the United
States, total costs for treating chronic pain have surpassed those
estimated for heart disease, cancer, and diabetes.3 In addition, it
has been reported that pain is not adequately treated in 65% of
nursing home residents.4 Thus as the population ages, the impact
associated with chronic pain may grow even bigger. Given the high
degree of suffering and costs to society, health care providers must
be equipped to treat pain appropriately. And yet, medical trainees,
the physicians of the future, receive limited education in the field.

Kellie M. Jaremko, MD, PhD
Anesthesiology Resident
Massachusetts General Hospital
Boston, MA
Chair of ASRA Resident and Medical
Student Pain Education Special
Interest Group

Lynn R. Kohan, MD
Assistant Professor
Director of Pain Medicine Fellowship
University of Virginia
Founding and Newsletter Liaison for
ASRA Resident and Medical Student
Pain Education Special Interest Group
Charlottesville, VA

Section Editor: Magdalena Anitescu, MD

in the participating European medical schools. This was coupled
with inconsistent training across countries. Even with an optimistic
assumption of improvement across these metrics in the past 6
years, subpar pain education is a global problem that is evident in
American medical training.
Unsurprisingly, for newly
graduated interns, a sense
of dread supersedes clinical
knowledge when paged
in the middle of the night
to prescribe an analgesic
regimen to a patient in
pain. In a brief voluntary
survey of our institutions'
pain specialists, over
60% reported minimal
or next-to-no confidence in their pain treatment readiness level
when entering internship. Fortunately, anesthesiology is among
the few specialties whose faculty coach house staff on pain
treatment options in different clinical scenarios during residency.
Pain education across other residency programs does not routinely
include dedicated and thorough analgesia treatment guidelines.
Therefore, in the clinical setting, managing patients' pain as a
trainee can become reflexive, based on peers' experience at an
institution. Treatment may be delegated, mismanaged, avoided, or
ignored at the patient's expense.

"When it comes to pain management,
oftentimes in medical school, this
teaching is brief, inadequate, or worse
yet, dangerously outdated or completely
absent from the curricula."

In 2009, at the First National
Pain Medicine Summit, the
panel came to the conclusion
that medical training in
pain management was of
low quality and did not lead
to competency.4 This poor
training was evident in every
specialty, even in oncology
where pain management
should have been an integral part of cancer care.4 Furthermore,
Menzi et al investigated the presence, content, and time dedicated
to pain medicine education in a total of 117 United States and
Canadian medical schools. Although neither country uniformly
incorporated pain into their curricula at the time of the study
(2011), American schools paled in comparison to their northern
counterparts with merely 11 hours of pain teaching on average.
In addition, less than 4% of medical schools had a mandatory
dedicated course on pain education.5 The European Advancing
the Provision of Pain Education and Learning (APPEAL) study6
found a similar situation across the ocean where pain education
consisted mainly of intermittent and sporadic pain topics amidst
general required coursework, with less frequent specific courses

While many institutions do have an inpatient pain service to help
design multimodal analgesic regimen in difficult-to-treat patients, it

American Society of Regional Anesthesia and Pain Medicine
2017

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