Mahmoud Ammar, Aman Mansoor M, Trumbo Jennifer L, Paracha Umera, Langell Ashley, Petersen Erika
Department of Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA.
Department of Pain Medicine, Advocate Aurora Health, Oshkosh, WI, USA.
J Pain Res. 2023 Dec 27;16:4367-4377. doi: 10.2147/JPR.S428851. eCollection 2023.
Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) exposure and clinical adoption remains low despite multiple well-designed trials that demonstrate safety, efficacy, reliability, and cost-saving benefits. This study aims to understand the possible contributing factors starting with Pain Medicine fellowship training.
An internet-based, anonymous pilot survey was distributed to pain medicine fellows enrolled in an Accreditation Council for Graduate Medical Education (ACGME) accredited pain medicine training program during the 2021-2022 academic year. Fellowship programs were identified using published online ACGME accreditation data. The survey was distributed via email to fellowship program directors and coordinators and was made available through pain medicine societies.
Seventy-one of four hundred and twenty-three pain medicine fellows (17% response rate) completed the survey. Nine percent of respondents evidence-informed opinion coincided with the most recent Polyanalgesic Consensus Conference (PACC) guidelines recommendations for IDDS treatment indications. Fifty-one percent of respondents felt there was an unmet need for IDDS training. About one-third of respondents felt that lack of curriculum, faculty, and cases were barriers to IDDS use, respectively. Thirty-one percent of fellows reported sufficient training for IDDS in their fellowship programs. The majority (70%) of respondents somewhat or strongly support direct training by IDDS manufacturers.
A wide variability exists surrounding IDDS training during ACGME accredited pain medicine fellowship. Insufficient case exposure and lack of a standardized curriculum may play a role in future therapy adoption. The results from this study call for a more standardized training approach with an emphasis on adequate clinical exposure, utilization of peer reviewed educational curriculum and supplemental material to aid pain medicine fellows' education.
尽管有多项精心设计的试验证明鞘内药物输送系统（IDDS）在靶向药物递送（TDD）方面具有安全性、有效性、可靠性和成本节约效益，但通过IDDS进行的靶向药物递送的临床应用率仍然很低。本研究旨在从疼痛医学专科培训入手，了解可能的影响因素。
在2021-2022学年，向参加研究生医学教育认证委员会（ACGME）认可的疼痛医学培训项目的疼痛医学专科住院医师开展了一项基于互联网的匿名试点调查。通过在线发布的ACGME认证数据确定专科培训项目。该调查通过电子邮件分发给专科培训项目主任和协调员，并通过疼痛医学学会提供。
423名疼痛医学专科住院医师中有71名（回复率17%）完成了调查。9%的受访者的循证意见与最新的多模式镇痛共识会议（PACC）关于IDDS治疗适应症的指南建议一致。51%的受访者认为IDDS培训存在未满足的需求。分别约有三分之一的受访者认为缺乏课程、教员和病例是使用IDDS的障碍。31%的专科住院医师报告在其专科培训项目中接受了足够的IDDS培训。大多数（70%）受访者有点或强烈支持IDDS制造商进行直接培训。
在ACGME认可的疼痛医学专科培训期间，IDDS培训存在很大差异。病例接触不足和缺乏标准化课程可能会影响未来治疗方法的采用。本研究结果呼吁采用更标准化的培训方法，重点是提供足够的临床接触机会，利用经过同行评审的教育课程和补充材料来辅助疼痛医学专科住院医师的教育。
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