Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA.
J Pain. 2013 May;14(5):431-7. doi: 10.1016/j.jpain.2013.01.005. Epub 2013 Mar 22.
Contemporary medical education is inadequate to prepare medical students to competently assess and design care plans for patients with acute and chronic pain. The time devoted to pain education in most medical school curricula is brief and not integrated into case-based clinical experiences, and it is frequently nonexistent during clinical clerkships. Medical student pain curricula have been proposed for over 30 years and are commonly agreed upon, though rarely implemented. As a consequence of poor undergraduate pain education, postgraduate trainees and practicing physicians struggle with both competency and practice satisfaction; their patients are similarly dissatisfied. At the University of Washington School of Medicine, a committee of multidisciplinary pain experts has, between 2009 and 2011, successfully introduced a 4-year integrated pain curriculum that increases required pain education teaching time from 6 to 25 hours, and clinical elective pain courses from 177 to 318 hours. It is expected that increased didactic and case-based multidisciplinary clinical training will increase knowledge and competency in biopsychosocial measurement-based pain narrative and risk assessment, improve understanding of persistent pain as a chronic complex condition, and expand the role of patient-centered interprofessional treatment for medical students, residents, and fellows, leading to better prepared practicing physicians.
Strategies for improving multidisciplinary pain education at the University of Washington School of Medicine are described and the preliminary results demonstrated.
当代医学教育在使医学生能够胜任评估和设计急慢性疼痛患者的护理计划方面做得不够。大多数医学院课程中用于疼痛教育的时间很短,且没有与基于案例的临床经验相结合,在临床实习期间通常也不存在。医学生疼痛课程已经提出了 30 多年,虽然很少实施,但已得到广泛认同。由于本科疼痛教育不佳,研究生培训生和执业医师在能力和实践满意度方面都存在困难;他们的患者也同样不满意。在华盛顿大学医学院,一个多学科疼痛专家委员会在 2009 年至 2011 年期间成功引入了一个为期 4 年的综合疼痛课程,将疼痛教育的必修教学时间从 6 小时增加到 25 小时,临床选修疼痛课程从 177 小时增加到 318 小时。预计增加理论和基于案例的多学科临床培训将提高医学生、住院医师和研究员对生物心理社会测量为基础的疼痛叙述和风险评估的知识和能力,加深对持续性疼痛作为一种慢性复杂疾病的理解,并扩大以患者为中心的多专业治疗的作用,从而为执业医师做好更充分的准备。
本文描述了华盛顿大学医学院改善多学科疼痛教育的策略,并展示了初步结果。