Background & Aims
Chronic pain affects one in five people in Australia and is one of the most common reasons for seeking health care as well as a leading cause of disability (1). Effective management involves biopsychosocial input from a range of specialties (2). The International Association for the Study of Pain (IASP) has created core undergraduate healthcare curriculum guidelines for teaching chronic pain (3). However, currently, no medical schools in Australia follow these guidelines (4,5). This study aimed to assess the pain understanding and confidence of pre-registration healthcare students in Australia, by using the Pain Understanding and Confidence Questionnaire (PUnCQ) (6) and compared the differences across disciplines and years of study. Furthermore, it aimed to determine students’ perspectives on the adequacy of their pain education.
A linked study used an online survey to gather patients’ beliefs about their doctors’ pain management knowledge.
Methods
An online survey was distributed to healthcare course leads across Australia to share with students in medicine, nursing, physiotherapy, occupational therapy, pharmacy and psychology. The PUnCQ was devised by the National Interprofessional Preregistration Pain Education (NIPPED) group in Scotland. This aims to assess students’ pain management knowledge using 12 questions related to a clinical scenario of a patient who has developed widespread chronic primary or nociplastic pain. The answers to the questions were graded as correct, wrong or wrong with a biomedical bias. Subjects were also asked about their confidence on various chronic pain domains, connected to the IASP undergraduate curriculum using a Likert scale. Further questions explored students’ views on the adequacy of their pain education. Data was analysed using non-parametric tests and free-text responses underwent thematic analysis.
Results
There were a total of 437 responses across the healthcare disciplines. The median percentage correct answers to the clinical vignette was 58%, with psychology students performing significantly worse than the other disciplines. Median confidence levels were 7 out of 10. It was hypothesised that students would be more likely to pick biomedical answers over the correct biopsychosocial answer and this was seen in 3 of the 6 questions with biomedical options.
Some questions had significantly lower correct answers; question 3, “Making an objective measure
of her pain by seeing how much damage there is on MRI”, had 38% correct answers with 56% picking a biomedical option; Question 4, “Encouraging her to do more exercise”, had only 30% correct with 66% picking biomedical options;”she needs to watch out in case she worsens her condition”, “exercise only causes flare ups” or “she could cause herself more harm”. Question 11, “Doing further investigations”, had the lowest correct response rate, with only 10% choosing “Not very helpful as it could increase worry”. 82% chose a biomedical options. More than 90% of students expressed a desire for more chronic pain teaching through e-learning, clinical experience, case-based learning, and multi-disciplinary team teaching
Conclusions
Australian students performed better in the PUnCQ than Scottish students undertaking the same questionnaire (7). Despite this many students still did not feel prepared to manage chronic pain. Incorporating the IASP curriculum recommendations could help improve students’ pain understanding and confidence.
This study highlights the requirement for improved pain education in Australian pre-registration healthcare courses. Universities need to align their curricula with international guidelines and incorporate biopsychosocial management, to better prepare healthcare students for chronic pain management(8,9,10).
References
1.Royal Australasian College of Physicians. National Pain Strategy National Pain Strategy Pain Management for all Australians National Pain Strategy [Internet]. 2010. Available from: www.painaustralia.org.au
2. Mankelow J, Ryan C, Taylor P, Atkinson G, Martin D. A Systematic Review and Meta-Analysis of the Effects of Biopsychosocial Pain Education upon Health Care Professional Pain Attitudes, Knowledge, Behavior and Patient Outcomes. Vol. 23, Journal of Pain. Elsevier B.V.; 2022. p. 1–24.
3. https://www.iasp-pain.org/education/curricula/
4.Elspeth E. Shipton, Frank Bate, Raymond Garrick, Carole Steketee, Edward A. Shipton, Eric J. Visser. Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain [Internet]. 2018; Available from: https://doi.org/10.6084/
5.Shipton EE, Bate F, Garrick R, Steketee C, Visser EJ. Pain medicine content, teaching and assessment in medical school curricula in Australia and New Zealand. BMC Med Educ. 2018 May 11;18(1).
6. https://www.highlandpaininfo.com/_files/ugd/047154_b08d3905b4aa445ba2035d1278feb291.pdf and https://www.highlandpaininfo.com/_files/ugd/047154_59755d3c7747441893297af64acdb8fb.pdf
7. Carroll SP, Augeard N, Tennant J, Seenan C. How do the attitudes, confidence, knowledge and understanding differ in pre-registration healthcare students towards treating people with chronic pain: an observational, cross-sectional study. Eur J Physiother. 2021;23(5):311–8. 13.Government 8. 8. Shipton E, Steketee C, Visser E. The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum. Frontiers in Pain Research. 2022;3. Department of Health A. NATIONAL STRATEGIC ACTION PLAN FOR PAIN MANAGEMENT [Internet]. 9. Hunter J, Watt-Watson J, McGillion M, Raman-Wilms L, Cockburn L, Lax L, et al. An Interfaculty Pain Curriculum: Lessons learned from six years experience. Pain. 2008 Nov 15;140(1):74–86. 2021. Available from: https://www.dpmc.gov.au/
10. Shipton EE, Steketee C, Bate F, Visser EJ. Exploring assessment of medical students’ competencies in pain medicine—A review. Vol. 4, Pain Reports. Lippincott Williams and Wilkins; 2019.