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      Medical students’ perspectives of their clinical comfort and curriculum for acute pain management

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          Acute pain is a common presenting complaint in health care. Yet, undertreatment of pain remains a prevailing issue that often results in poor short- and long-term patient outcomes. To address this problem, initiatives to improve teaching on pain management need to begin in medical school. In this study, we aimed to describe medical students’ perspectives of their curriculum, comfort levels, and most effective pain teaching modalities.

          Materials and methods

          A cross-sectional, online survey was distributed to medical students at the University of Alberta (Edmonton, Canada) from late May to early July 2015. Data were collected from pre-clerkship (year 1 and 2) and clerkship (year 3 and 4) medical students for demographic characteristics, knowledge, comfort, and attitudes regarding acute pain management.


          A total of 124/670 (19.6%) surveys were returned. Students recalled a median of 2 (interquartile range [IQR]=4), 5 (IQR=3.75), 4 (IQR=8), and 3 (IQR=3.75) hours of formal pain education from first to forth year, respectively. Clerkship students were more comfortable than pre-clerks with treating adult pain (52.1% of pre-clerks “uncomfortable” versus 22.9% of clerks, p<0.001), and overall, the majority of students were uncomfortable with managing pediatric pain (87.6% [64/73] pre-clerks and 75.0% [36/48] clerks were “uncomfortable”). For delivery of pain-related education, the majority of pre-clerks reported lectures as most effective (51.7%), whereas clerks chose bedside instruction (43.7%) and small group sessions (23.9%). Notably, 54.2%, 39.6%, and 56.2% of clerks reported incorrect doses of acetaminophen, ibuprofen, and morphine, respectively, for adults. For children, 54.2%, 54.2%, and 78.7% of clerks reported incorrect doses for these same medications.


          Medical students recall few hours of training in pain management and report discomfort in treating and assessing both adult and (more so) pediatric pain. Strategies are needed to improve education for future physicians regarding pain management.

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          Most cited references 21

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          Causes and consequences of inadequate management of acute pain.

          Intense acute pain afflicts millions of patients each year. Despite the recently increased focus on the importance of pain control, management of acute pain has remained suboptimal.
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            Consequences of inadequate analgesia during painful procedures in children.

            To explore the effect of inadequate analgesia for painful procedures (bone marrow aspiration, lumbar puncture, or both) on the pain of subsequent procedures. A cohort of patients with cancer who had participated in a placebo-controlled, randomized study that documented the efficacy of oral transmucosal fentanyl citrate for painful procedures rated the pain associated with subsequent procedures performed with open-label oral transmucosal fentanyl. Twenty-one children undergoing diagnostic procedures who had been participants in previous study. All children were given oral transmucosal fentanyl, 15 to 20 microgram/kg, prior to the procedure; at its conclusion they were asked to rate the associated pain. In children younger than 8 years (n = 13), mean pain ratings during each subsequent procedure were consistently higher for those who had received placebo (n = 8) in the original study compared with those who had received the active drug (n = 5). A repeated-measures analysis of variance suggests that this difference is statistically significant (P = .04). Older children (n = 8) did not show this pattern. Inadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.
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              Underuse of analgesia in very young pediatric patients with isolated painful injuries.

              We sought to compare the use of analgesic agents in very young children with that in older children with isolated painful injuries. We performed a retrospective chart review of patients seen between 1999 and 2000 in a pediatric emergency department. Patients aged 6 months to 10 years who sustained isolated long bone fractures or second- and third-degree burns were included. Exclusion criteria included head injury, chest or abdominal trauma, and developmental delay or neurologic disorder. Research subjects were separated into 2 study groups: very young (ages 6 to 24 months) and school age (ages 6 to 10 years). One hundred eighty research subjects met the inclusion and exclusion criteria: 96 in the very young group and 84 in the school age group. Research subjects in the very young group received no analgesic agents more often than school age research subjects for all injuries (64.6% versus 47.6%, respectively), all fractures (70.6% versus 48.8%, respectively), displaced fractures (55.0% versus 22.0%, respectively), and all burns (50.0% versus 25.0%, respectively). When analgesic agents were administered, very young patients were less likely to receive narcotics compared with school age patients. Analgesic dosing for both the very young and school age groups was similar and within established guidelines. Children younger than 2 years of age receive disproportionately less analgesia than school age children, despite having obviously painful conditions. Emergency physicians should consider special issues involved in assessing and managing pain in very young children.

                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                03 August 2018
                : 11
                : 1479-1488
                [1 ]Undergraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
                [2 ]Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
                [3 ]Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, sali@ 123456ualberta.ca
                [4 ]Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
                [5 ]Women and Children’s Health Research Institute, Edmonton, Alberta, Canada, sali@ 123456ualberta.ca
                Author notes
                Correspondence: Samina Ali, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405–87 Avenue, Edmonton, Alberta T6G 1C9, Canada, Tel +1 780 248 5575, Fax +1 888 775 8876, Email sali@ 123456ualberta.ca
                © 2018 Tran et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Anesthesiology & Pain management

                survey, analgesia, medical education, curriculum, undergraduate


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