Sloan P A, Montgomery C, Musick D
Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, USA.
J Pain Symptom Manage. 1998 Jun;15(6):359-64. doi: 10.1016/s0885-3924(98)00018-9.
Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean +/- SEM) that morphine should be given on a regular schedule for cancer pain (3.41 +/- 0.08), that cancer pain management frequently requires co-analgesics (3.36 +/- 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.
医生培训不足导致癌症疼痛治疗不充分。为解决这些问题，肯塔基大学为医学专业最后一年的学生开设了一门为期四周的课程，教授临床药理学原理和疼痛管理。本研究的目的是评估医学专业最后一年的学生在使用吗啡治疗癌症疼痛方面的知识缺陷，并评估一门关于癌症疼痛管理的短期课程的效果。八十六名医学专业最后一年的学生完成了一份包含22个条目的问卷，以评估他们对使用吗啡治疗癌症疼痛的知识和态度。学生们用四点量表（一，强烈反对；四，强烈同意）表明他们对每个陈述的认同程度。所有学生随后完成了一门关于疼痛管理的必修短期课程。课程内容包括一小时关于慢性非恶性疼痛的讲座、一小时关于急性疼痛管理的讲座以及一小时关于癌症疼痛管理的讲座。此外，学生们还完成了关于疼痛管理几个方面的小组问题式学习模块。课程结束后，所有学生再次完成了相同的22个条目的调查。预测试工具的阿尔法信度分数为0.55，后测试的信度为0.86。课程结束时，学生们最强烈认同（均值±标准误）的是，对于癌症疼痛应按常规给药吗啡（3.41±0.08），癌症疼痛管理常常需要联合使用辅助镇痛药（3.36±0.06），以及疼痛得到良好缓解的患者比持续疼痛的患者功能更好（3.39±0.08）。对预测试和后测试在特定条目上的均值比较表明，在以下内容领域学生收获最多：吗啡是一种良好的口服镇痛药；癌症疼痛加剧时应通过增加吗啡剂量来治疗；呼吸抑制不是癌症疼痛患者需要担心的问题；以及吗啡可以在很宽的剂量范围内使用。吗啡的常规使用被公认为癌症疼痛的首选治疗药物。学生们在后测试调查的22个条目中有10个条目的知识得分有所提高。在6个知识和态度条目上有显著的学习进步。在后测试中，只有一个条目（吗啡的副作用恶心）的知识得分下降。相当一部分（40%）医学专业高年级学生在使用吗啡治疗癌症疼痛方面存在知识缺陷。相当一部分（25%）学生对成瘾风险、呼吸抑制和耐受性存在误解。
