Schiel Zoberi Kimberly, Everard Kelly M, Antoun Jumana
Department of Family and Community Medicine, Saint Louis University.
Fam Med. 2016 May;48(5):353-8.
Chronic pain is a common and important disease state in North America, but many medical students and practicing physicians feel poorly prepared to treat this condition.
Data were collected via the 2014 CERA Family Medicine Clerkship Director survey, which was electronically sent to 121 US and 16 Canadian clerkship directors. The authors sought to determine the quantity of chronic pain management instruction included in clerkship curricula and any characteristics of clerkship directors that correlated with the teaching of various pain topics. Survey items included the total amount of time spent teaching about chronic pain, various subtopics addressed, and personal characteristics of clerkship directors (years as clerkship director, number of years since graduation, amount of pain-related CME taken yearly, confidence in caring for patients with chronic pain, and belief in efficacy of various treatments).
The response rate was 91%. Half of respondents indicated that they do not teach about chronic pain during the clerkship at all. The mean number of minutes spent teaching about chronic pain during the family medicine clerkship was 48 minutes (SD=65.). The majority of clerkship directors felt confident about their ability to treat chronic pain, and there was a positive correlation between confidence and time teaching about chronic pain during the family medicine clerkship. Confidence in treating chronic pain patients also correlated with the likelihood of covering several specific pain subtopics, including pain assessment, documentation skills, non-pharmacologic treatment, treatment with opioids, and treatment with non-opioids.
Chronic pain management is currently taught in only about half of family medicine clerkships. Confidence in caring for chronic pain patients is the only characteristic of clerkship directors that predicts whether the subject of chronic pain will be taught within the family medicine clerkship.
慢性疼痛在北美是一种常见且重要的疾病状态，但许多医学生和执业医师觉得在治疗这种疾病方面准备不足。
数据通过2014年CERA家庭医学实习主任调查收集，该调查以电子方式发送给121名美国和16名加拿大实习主任。作者试图确定实习课程中慢性疼痛管理教学的数量以及与各种疼痛主题教学相关的实习主任的任何特征。调查项目包括用于慢性疼痛教学的总时间、涉及的各种子主题以及实习主任的个人特征（担任实习主任的年限、毕业年限、每年接受的疼痛相关继续医学教育量、照顾慢性疼痛患者的信心以及对各种治疗效果的信念）。
回复率为91%。一半的受访者表示他们在实习期间根本不讲授慢性疼痛。家庭医学实习期间用于慢性疼痛教学的平均分钟数为48分钟（标准差=65）。大多数实习主任对他们治疗慢性疼痛的能力有信心，并且在家庭医学实习期间，信心与慢性疼痛教学时间之间存在正相关。治疗慢性疼痛患者的信心也与涵盖几个特定疼痛子主题的可能性相关，包括疼痛评估、记录技能、非药物治疗、阿片类药物治疗和非阿片类药物治疗。
目前只有大约一半的家庭医学实习课程教授慢性疼痛管理。照顾慢性疼痛患者的信心是实习主任的唯一特征，可预测家庭医学实习课程是否会教授慢性疼痛主题。
