title: Computer-based simulation as a teaching tool for residents treating patients with cancer-related pain crises.
abstract: BACKGROUND
  Residents often fail to escalate narcotics to ensure pain relief in patients with cancer because of fear of overdose. A computer simulation of patients in pain may provide a way to improve management without fear of harm. We developed a pain care simulation to train residents. STUDY DESIGN/MEASURES: Thirty-one residents trained on 2 to 3 consecutive simulated patients. Simulated cases were assigned variable tolerances to narcotics and starting pain scores. The goals of training were as follows: (1) rapid induction of pain relief, (2) measurement of pain response at appropriate times, and (3) early institution and escalation in care long-acting pain medication to ensure stable pain control for 48 hours. Seven reviewers judged graphical summaries of care and assessed if pain improved, worsened, or stayed the same.
  
  
  RESULTS
  Thirty-one residents participated: 25 completed 3 simulations; 6 completed only 2. Sixty-eight percent improved from case 1 to 2; 90% improved by 3. The average pain score declined from 2.5 in case 1 to 1.9 in case 3 (P = .04). Rescue medication use declined from 37% for the first case to 23% by the third (P = .18). Reviewers' intraclass correlation for improved pain care was 0.821 (95% CI, 0.721-0.895).
  
  
  CONCLUSIONS
  Residents improved using a pain treatment simulator. A graphical representation of pain scores more than 48 hours of care that provides a useful way to assess pain control. Lessons learned may translate into improved patient care.
authors.affiliation: Patient Safety Committee, Department of Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Harting
authors.forename: Scott
authors.initials: S
authors.lastname: Hasler
authors.forename: Richard
authors.initials: R
authors.lastname: Abrams
authors.forename: Richard
authors.initials: R
authors.lastname: Odwazny
authors.forename: Robert
authors.initials: R
authors.lastname: McNutt
mesh_terms: D003198:Computer Simulation; D006801:Humans; D007396:Internship and Residency; D009294:Narcotics / Q000627:therapeutic use; D009369:Neoplasms / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy*; D015397:Program Evaluation; D013663:Teaching
chemical_list: D009294:Narcotics