title: Medical students retain pain assessment and management skills long after an experiential curriculum: a controlled study.
abstract: We implemented a pain assessment and management (PAM) curriculum for second year medical students and evaluated long-term skills retention compared to the prior year's class which did not receive the curriculum. The curriculum included pain pathophysiology, assessment and treatment instruction plus feedback on PAM practice with standardized patients. Both cohorts underwent a required end-of-third-year clinical skills examination. Intervention and control group performance on three pain cases (acute, chronic and terminal) was compared. The PAM curriculum was implemented 1.5years before the intervention cohort participated in the clinical skills exam. More intervention students (134/159, 84.3% response rate) obtained basic (87.2% vs. 76.0%, p=.028) and comprehensive (75.2% vs. 60.9%, p=.051) descriptions of acute pain than control students (n=129/174, 74.1% response rate). Intervention students demonstrated superior skills for terminal pain, including: more often asking about impact on functioning (40.7% vs. 25.8%, p=.027), advising change of medication (97.3% vs. 38.7%, p<.001), and providing additional medication counseling (55.0% vs. 27.0%, p<.001). Virtually all students obtained basic descriptions of chronic (intervention vs. control, 98.1% vs. 96.1%, p=.367) and terminal (92.9% vs. 91.7%, p=.736) pain. Surprisingly, more control than intervention students obtained a comprehensive description of chronic pain (94.6% vs. 77.8%, p<.001) and asked about current pain medication in the terminal case (75.6% vs. 55.0%, p=.004). Exposure to the curriculum resulted in durable increases in students' ability to perform PAM skills in patients with acute and terminal pain.
authors.affiliation: New York University School of Medicine, Division of General Internal Medicine, Section of Primary Care, New York, NY, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Stevens
authors.forename: Danielle
authors.initials: D
authors.lastname: King
authors.forename: Ryan
authors.initials: R
authors.lastname: Laponis
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hanley
authors.forename: Sondra
authors.initials: S
authors.lastname: Zabar
authors.forename: Adina L
authors.initials: AL
authors.lastname: Kalet
authors.forename: Colleen
authors.initials: C
authors.lastname: Gillespie
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence; D015331:Cohort Studies; D004501:Education, Medical; D004521:Educational Measurement / Q000379:methods; D006801:Humans; D017145:Models, Educational; D010146:Pain / Q000175:diagnosis; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology*; D013997:Time Factors