A 70-year old woman named Edna is helping to change the poor state of pain education in the United States.
She has chronic low back pain from spinal stenosis and osteoarthritis. Physical therapy and acetaminophen haven’t helped Edna, who is also depressed and lonely.
If you were Edna’s doctor, what treatment would you recommend?
Would you refer her to a spine surgeon for an epidural? Prescribe an opioid painkiller? Or send Edna to a psychologist?
Those are some of the real choices a doctor would have to make, although Edna isn’t a real patient.
Edna is a “cyber patient” – part of an online education class developed at the University of Pittsburgh to give medical students experience in evaluating and caring for chronic pain patients. The online training program, reported in the Journal of the American Geriatrics Society, is the first curriculum resource created through the efforts of the National Institutes of Health Pain Consortium’s Centers of Excellence in Pain Education.
“To our knowledge, this is the first study that has demonstrated the potential of an online interactive module to improve medical student clinical skills related to evaluating a patient with chronic pain,” said the study’s lead author Debra K. Weiner, MD. “While our module focused specifically on an older adult with chronic low back pain, we see this type of educational intervention as a powerful and efficient curriculum tool for a variety of patient scenarios.”
There’s a pressing need for such training. Fewer than 4,000 pain specialists are currently practicing in the U.S. and surveys have found that most primary care physicians feel inadequately prepared to counsel patients on pain.
A recent studyof 117 U.S. and Canadian medical schools found that less than 4 percent had a required course in pain education. Only one in six offered a pain education class as an elective. A large number of U.S. medical schools do not have any pain courses and many of those that do have less than five hours of classes.
The study warned that unless steps are taken to improve the training of physicians who treat pain “the crisis in pain care and resultant deaths from opioid abuse will only spiral upwards.”
A team of experts in education, information technology, pain management, and geriatrics at the University of Pittsburgh developed the online training program, focusing on common errors in clinical exams.
The program shows brief video clips of Edna interacting with her physician:
The training module also contains multiple choice tests and interactive questions. You can take the test yourself by clicking here.
Twenty-seven medical students were exposed to the Edna training module and 28 were not. The students in the group exposed to the module did significantly better on their objective structured clinical examinations, an exam in which students rotate through multiple stations, demonstrating their clinical skills and knowledge while interviewing real or simulated patients.
Ninety-three percent of the students in the exposed group passed the exam, compared to just 60 percent of the non-exposed group.
“Management of chronic lower back pain is one of the most common and difficult problems that patients and health care providers face,” said Josephine P. Briggs, MD, a member of the NIH Pain Consortium Executive Committee. “The educational materials that have been developed through this partnership will be a great asset in helping the next generation of physicians build clinical skills to support their chronic pain patients.”
The NIH Pain Consortium is creating and testing additional online pain education modules using Edna and several other “patients.” They’ll be made available to other teaching institutions beginning in the fall of 2014.