Use of a comprehensive survey as a first step in addressing clinical competence of physicians-in-training in the management of pain

2005 ◽  
Vol 1 (2) ◽  
pp. 98 ◽  
Author(s):  
Mark Chaitowitz, MBBCh ◽  
William Tester, MD ◽  
Glenn Eiger, MD
Keyword(s):  
Internal Medicine ◽  
Pain Management ◽  
Residency Program ◽  
Clinical Competence ◽  
Initial Step ◽  
Educational Interventions ◽  
Pain Scale ◽  
Contributing Factors ◽  
Management Interventions ◽  
Comprehensive Survey

Deficiencies in practice, knowledge, and competence among physicians are important contributing factors to the unsatisfactory level of analgesic care in hospitalized patients. By way of a comprehensive survey, we characterized these deficiencies within an internal medicine residency program as an initial step in designing remedial educational strategies. To do so, an anonymous 43-item survey was administered to residents in an internal medicine program. A total of 61 residents (69 percent) responded.The results indicated that patient-controlled analgesia (PCA), a standardized pain scale, and an opioid equivalence table were underused. Competence in opioid conversion was suboptimal, but completion of an oncology rotation and familiarity with the opioid equivalence table predicted greater competence in this area (p = 0.007 and p = 0.001, respectively).Self-perceptions of adequacy of training and painmanagement competence were predictors of knowledge (p = 0.026 and p = 0.038, respectively). Attitudes regarding opioid analgesia were generally satisfactory (i.e., low “opiophobia” score), although the risk of addiction was still overestimated.The characterization of deficiencies in pain management in a residency program is an essential step in the design and implementation of educational interventions. Administration of a comprehensive survey is a simple and effective method of gathering this data and has the additional benefit of promoting awareness of pain management issues. Our experience served to establish, among other findings, the didactic value of experience on an oncology floor; this result substantiates the value of practical experience in the gaining of clinical competence in pain management. Interventions that capitalize on the findings of the survey and the interest in pain management generated by its administration are currently ongoing at our institution.

scholarly journals Transitioning to competency-based medical education: impact of educational interventions on resident understanding

2019 ◽  
Vol 10 (4) ◽  
pp. e96-e98
Author(s):  
Vijay J. Daniels ◽  
Jesse Stach ◽  
Gurtej Sandu
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Residency Program ◽  
Educational Interventions ◽  
Internal Medicine Residency ◽  
Internal Medicine Residency Program ◽  
Competency Based Medical Education ◽  
Successful Launch ◽  
Competency Based

In this paper, we describe our efforts to improve resident understanding of Competency-Based Medical Education (CBME) in an Internal Medicine residency program that launched CBME earlier than most of the country's programs. We also share the resources we have developed to address this issue with the intent of helping other programs have a successful launch.

scholarly journals Final Year Nursing Students’ Knowledge and Attitudes regarding Children’s Pain

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Abigail Kusi Amponsah ◽  
Joana Kyei-Dompim ◽  
Evans Frimpong Kyei ◽  
Evans Oduro ◽  
Richard Adongo Afaya ◽  
...  
Keyword(s):  
Pain Management ◽  
Nursing Students ◽  
Financial Burden ◽  
Well Being ◽  
Educational Interventions ◽  
Pediatric Pain ◽  
Knowledge And Attitudes ◽  
Management Interventions ◽  
Pain Knowledge ◽  
Children's Pain

Pain is one of the commonest reasons why children visit the hospital. Inadequately treated pain in children can negatively affect their physical, psychological, and social well-being; it also places financial burden on families of affected children and healthcare systems in general. Considering the eventual suffering of vulnerable children and their families if nursing students are insufficiently educated and ill-prepared, the current study aimed at assessing final year nursing student’s knowledge and attitudes pertaining to pediatric pain. A descriptive cross-sectional study was conducted among 100 final year undergraduate nursing students at a private university college in Ghana. In addition to their ages and gender, the students responded to the 42 individual items on the Pediatric Nurses’ Knowledge and Attitudes Survey regarding pain (PNKAS) instrument. Descriptive statistical analysis was aided by the Statistical Package for Social Sciences version 25 software. The mean age of the final year nursing students was 29 years (range of 21 to 47 years); a majority of them were females (78%). Participants had an average (SD) correct answer score of 44.0% (10.6%). Good pediatric pain knowledge and attitudes were observed in items that were related to the individualized and multidimensional nature of the pain experience and its treatment, benefits of pre-emptive analgesia, pharmacodynamics, and pain assessment. Poor pediatric pain knowledge and attitudes occurred in items that focused on pain perceptions, opioid drug administration, useful pain medications, pain physiology, and nonpharmacological pain management interventions. Final year nursing students have insufficient knowledge and attitudes toward children’s pain management. Areas of good and poor pediatric pain knowledge and attitudes should be considered when designing and implementing educational interventions on this subject. Curricular revisions should be made on existing nursing curriculum to lay more emphasis on children’s pain management and use educational interventions that support knowledge translation for improved care.

scholarly journals Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians

2021 ◽  
Author(s):  
Pankti P. Acharya ◽  
Brianna Fram ◽  
Jenna R. Adalbert ◽  
Ashima Oza ◽  
Prashanth Palvannan ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Pain Management ◽  
Educational Intervention ◽  
General Surgery ◽  
Educational Interventions ◽  
Physician Education ◽  
Opioid Epidemic ◽  
Prescribing Habits ◽  
Resident Physicians

Abstract Background The opioid epidemic is a multifactorial issue, which includes pain mismanagement. A recent study has shown that residents have received little training for opioid related patient care. Therefore, resident physician education is essential in addressing this issue. We aimed to analyze the effects of an educational intervention on the knowledge and potential prescribing habits of emergency medicine, general surgery, and internal medicine residents. Methods Resident physicians were provided with educational materials and were given pre- and posttests to complete. Descriptive statistics were used to analyze pre- and posttest responses. Chi-squared analysis was used to identify changes between the pre and posttests. A p < 0.05 value was considered statistically significant. Results Following the educational intervention, we observed improvement in correct prescribing habits for acute migraine management among emergency medicine residents (from 14.8–38.5%). Among general surgery residents, there was significant improvement in adherence to narcotic amounts determined by recent studies for sleeve gastrectomy (p = 0.01) and laparoscopic cholecystectomy (p = 0.002). Additionally, we observed a decrease in the number of residents who would use opioids as a first line treatment for migraines, arthritic joint pain, and nephrolithiasis. Conclusions Resident physicians have an essential role in combating the opioid epidemic. There was significant improvement in various aspects of opioid related pain management among emergency medicine, internal medicine, and general surgery residents following the educational interventions. We recommend that medical school and residency programs consider including opioid related pain management in their curricula.

scholarly journals A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frederick Mun ◽  
Alyssa R. Scott ◽  
David Cui ◽  
Erik B. Lehman ◽  
Seong Ho Jeong ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Extracurricular Activities ◽  
Residency Program ◽  
Medical Schools ◽  
Program Directors ◽  
Program Director ◽  
Personal Knowledge ◽  
Clinical Knowledge ◽  
Alpha Omega ◽  
Residency Program Directors

Abstract Background United States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process. Methods A 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association’s Fellowship and Residency Electronic Interactive Database. Results We received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit. Conclusion Orthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.

scholarly journals Implementing ERAS: how we achieved success within an anesthesia department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dan B. Ellis ◽  
Aalok Agarwala ◽  
Elena Cavallo ◽  
Pam Linov ◽  
Michael K. Hidrue ◽  
...  
Keyword(s):  
General Hospital ◽  
Residency Program ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Massachusetts General Hospital ◽  
Educational Interventions ◽  
Nurse Anesthetists ◽  
Intervention Period ◽  
Post Intervention ◽  
Anesthesia Group

Abstract Background The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions. Methods We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway. RESULTS: Increased adherence to the four elements of the anesthesia bundle (p < 0.001) was achieved during the intervention period. Compliance with the pathway was sustained in the post-intervention period despite no additional actions. Conclusions Implementing the anesthesia bundle of an ERAS pathway in a large anesthesia group with diverse providers successfully occurred using implementation science-based approach of intense interventions, and these results were maintained after the intervention ceased.

scholarly journals Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

2010 ◽  
Vol 2 (2) ◽  
pp. 278-282 ◽  
Author(s):  
Colleen Y. Colbert ◽  
Curtis Mirkes ◽  
Paul E. Ogden ◽  
Mary Elizabeth Herring ◽  
Christian Cable ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical School ◽  
Advance Directives ◽  
Advance Directive ◽  
Residency Program ◽  
Health Science ◽  
Science Center ◽  
Sufficient Knowledge ◽  
Significant Difference ◽  
School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

scholarly journals Equine Discomfort Ethogram

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 580
Author(s):  
Catherine Torcivia ◽  
Sue McDonnell
Keyword(s):  
Pain Management ◽  
Line Drawing ◽  
Clinical Work ◽  
Pain Scale ◽  
University Of Pennsylvania ◽  
Systematic Evaluation ◽  
Clear Understanding ◽  
Physical Discomfort ◽  
Professional Health ◽  
The University

In recent years, there has been a growing interest in and need for a comprehensive ethogram of discomfort behavior of horses, particularly for use in recognizing physical discomfort in domestically managed horses. A clear understanding of the physical discomfort behavior of horses among caretakers, trainers, and professional health care personnel is important to animal welfare and caretaker safety. This is particularly relevant to pain management for hospitalized equine patients. Various pain scale rubrics have been published, typically incorporating only a few classically cited pain behaviors that, in many cases, are specific to a particular body system, anatomic location, or disease condition. A consistent challenge in using these rubrics in practice, and especially in research, is difficulty interpreting behaviors listed in various rubrics. The objective of this equine discomfort ethogram is to describe a relatively comprehensive catalog of behaviors associated with discomfort of various degrees and sources, with the goal of improving understanding and clarity of communication regarding equine discomfort and pain. An inventory of discomfort-related behaviors observed in horses has been compiled over 35 years of equine behavior research and clinical consulting to medical and surgical services at the University of Pennsylvania School of Veterinary Medicine’s equine hospital. This research and clinical work included systematic evaluation of thousands of hours of video-recordings, including many hundreds of normal, healthy horses, as well as hospitalized patients with various complaints and/or known medical, neurologic, or orthopedic conditions. Each of 73 ethogram entries is named, defined, and accompanied by a line drawing illustration. Links to online video recorded examples are provided, illustrating each behavior in one or more hospitalized equine patients. This ethogram, unambiguously describing equine discomfort behaviors, should advance welfare of horses by improving recognition of physical discomfort, whether for pain management of hospitalized horses or in routine husbandry.

scholarly journals Nursing-Related Barriers to Children’s Pain Management at Selected Hospitals in Ghana: A Descriptive Qualitative Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Abigail Kusi Amponsah ◽  
Evans Frimpong Kyei ◽  
John Bright Agyemang ◽  
Hanson Boakye ◽  
Joana Kyei-Dompim ◽  
...  
Keyword(s):  
Pain Management ◽  
Qualitative Study ◽  
Developed Countries ◽  
Assessment Tools ◽  
Pediatric Care ◽  
Material Resources ◽  
Management Interventions ◽  
Communication Difficulties ◽  
Children's Pain ◽  
Descriptive Qualitative

Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children’s pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children’s pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children’s pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n = 24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses’ inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children’s pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children’s pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management.

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