Pain Curriculum Design Models and Implementation Approaches

Numerous pain societies and organizations have declared “pain management is a human right” [8]. However, decades of research have documented inadequate acute pain management, and the Global Burden of Disease Study points to persistent pain as an increasing cause of morbidity and disability worldwide [13]. These data will not change without making pain education a priority and pain care competency a requirement for all of our health professional graduates. Although integrating pain content into already full curricula can be challenging, the use of existing resources can facilitate the process. 

Depending on curriculum requirements, all four domains of the IASP Curricula need to be considered: 

• multidimensional nature of pain
• pain assessment and measures
• management of pain 
• application to clinical conditions

Moreover, the importance of interprofessional education is increasingly being recognized so clinicians learn to work together to provide more effective pain care [4,7,14]. 

Curriculum design involves: 

• clearly defined goals and rationale for student learning about pain
• the people to involve for success and sustainability
• the content, learning approaches, and evaluation methods that are feasible considering resources [9,14]. 

Implementation involves strategies that consider:

• the level and experience of the student
• sequential learning targets
• iterative evaluation methods to ensure the required knowledge and skill outcomes

Adapting already developed curricula, models, and strategies can help save time and effort. 

RESOURCES

1. Professional and interprofessional curricula at the prelicensure level (undergraduate, entry-to-practice)

• The IASP website offers both professional and interprofessional curricula that can be implemented in a variety of ways considering the professions involved, patients being studied, and regional needs.

• Pain competencies related to the IASP Curricula are foundational to ensure that all heath professional graduates are able to provide effective and safe pain management [5,6,7].

• A four-day pain course for first-year students at Johns Hopkins School of Medicine includes reflective activities such as a “pain portfolio” of students’ responses to pain images in works of art, personal pain experiences, and the role of empathy in medicine [11,12].

• Blueprint of pain content and teaching methods with interprofessional collaboration from the University of Washington’s six health-science schools with recommendations for adding pain content [3]. 

• “Pain Interprofessional Curriculum Model,” based on IASP domains, guides curriculum design and implementation through clarifying four key questions: (1) Why pain content is important in your context; (2) who to involve for success; (3) what content, scheduling, and resources are realistic; and (4) How to implement, whether professional or interprofessional, mandatory or elective, integrated hours or a course [14].
• Integrating pain content in 19 UK universities across seven disciplines: both challenges and successful approaches [1].
  • An Essential Pain Management-UK has been introduced into 12 medical schools. 

• Online learning and mentoring-at-a-distance telemedicine programs have produced improvements in observed clinical skills in students, as well as in prescribing choices, knowledge, and confidence in primary care practitioners, but evidence for the effectiveness of these modalities is currently limited to high-resource settings [15, 16, 17].
• Education interventions in clinical settings for health-care professionals 
• Deteriorating patient simulation as an effective “low tech” alternative for clinicians’ education on postoperative pain assessment, with improvements in performance and knowledge comparable with more costly standardized patient-based simulation [10].
• Pain education workshops for nurses working in pediatric and neonatal units improved pain knowledge scores in a pretest and post-test design [3].
• Postgraduate and professional continuing education
• IASP Pain Schools and Camps
• IASP chapters and federation websites

REFERENCES

1. Carr E, Briggs E, Allcock N, Black P. Understanding factors that facilitate the inclusion of pain education in undergraduate education: Perspectives from a UK survey. Bri J Pain 2016;10(2):100-107.
2. Dongara AR, Nimbalkar SM, Phatak AG, et al. An Educational Intervention to Improve Nurses’ Understanding of Pain in Children in Western India. Pain management nursing 2017; 18: 24-32. 2016/12/15. DOI: 10.1016/j.pmn.2016.10.003.
3. Doorenbos A, Gordon D, Tauben D, et al. A Blueprint of Pain Curriculum Across prelicensure Health Sciences Programs: One NIH Pain Consortium Centre of Excellence in Pain Education (CoEPE) Experience. J Pain 2013;14(12): 1533-1538.
4. Dow A, Thibault G. Interprofessional education – a foundation for a new approach to health care. N Engl J Med 2017;377(9):803-805.
5. Fishman S, Young H, Arwood E, Chou R, Herr K, Murinson (Hgans) B, Watt-Watson J, Carr D, Gordon D, Stevens B, Bakerjian D, Ballantyne J, Courtenay M, Djukic M, Koebner I, Mongoven J, Paice J, Prasad R, Singh N, Sluka K, Marie B, Strassels S. Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit.  Pain Med 2013;14:971-981.
6. Herr K, St Marie B, Gordon D, Paice J, Watt-Watson J, Stevens B, Bakerjian D, Young H. An Interprofessional consensus of core competencies for prelicensure education in pain management: Curriculum application for nursing. J Nurs Educ 2015; 54(6):317-328. 
7. Hoeger Bement M, St Marie B, Nordstrom T, Christensen N, Mongoven J,  Koebner I, Fishman S, Sluka K. An Interprofessional consensus of core competencies for prelicensure education in pain management: curriculum application for physical therapy. Physical Therapy 2014;94(4): 451-464.
8. International Association for the Study of Pain. Declaration of Montreal. Montreal, Canada. https://www.bing.com/search?q.www.iasp-pain.org/DeclarationofMontreal/ (accessed August 5, 2017).
9. 9.Lattuca, L. & Stark, J. (2009) Shaping the college curriculum: Academic plans in context. San Francisco: Jossey-Bass.
10. McGillion M, Dubrowski A, Stremler R, Watt-Watson J, Campbell F, McCartney C, Victor JC, Snell L, Wiseman J, Nelson S, Stinson J, Costello J, Robb A, Hunter J, Dao T, Promislow S, Shobbrook C, Regehr C, Leegaard M, Schreiber M, Silver I. The post-operative pain assessment skills pilot trial. Pain Research and Management 2011; 16: 401-406. 
11. Murinson (Hogans) B, Nenortas E, Mayer RS, Mezei L, Kozachik S, Nesbit S, Haythornthwaite J, Campbell J. A new program in pain medicine for medical students: Integrating core curriculum knowledge with emotional and reflective development. Pain Med 2011:12;186-195.
12. Murinson (Hogans) B. Pain and the humanities: exploring the meaning of pain in medicine through drama, literature, fine arts and philosophy. MedEdPORTAL Publications. 2010;6:8129. http://doi.org/10.15766/mep_2374-8265.8129
13. Rice A, Smith B, Blyth F. Pain and the global burden of disease. Pain 2016;157(4):791–6.
14. Watt-Watson J, Lax L, Davies R, Langlois S, Oskarsson J, Raman-Wilms L.(2017).The Pain Interprofessional Curriculum Design Model. Pain Med 2017; 18: 1040-1048 doi: 10.1093/pm/pnw337 
15. Weiner DK, Morone NE, Spallek H, Karp JF, Schneider M, Washburn C, Dziabiak MP, Hennon JG, Elnicki DM. E-learning module on chronic low back pain in older adults: evidence of effect on medical student objective structured clinical examination performance. J Am Geriatr Soc. 2014 Jun;62(6):1161-7.
16. Frank JW, Carey EP, Fagan KM, Aron DC, Todd-Stenberg J, Moore BA, Kerns RD, Au DH, Ho PM, Kirsh SR.Evaluation of a telementoring intervention for pain management in the Veterans Health Administration. Pain Med. 2015 Jun;16(6):1090-100.

17. Ball S, Wilson B, Ober S, Mchaourab A. SCAN-ECHO for Pain Management: Implementing a Regional Telementoring Training for Primary Care Providers. Pain Med. 2017 May 19. doi: 10.1093/pm/pnx122. [Epub ahead of print]

AUTHORS

Judy Watt-Watson, RN, MSc, PhD
Professor Emeritus
Lawrence S. Bloomberg Faculty of Nursing
Senior Fellow, Massey College
University of Toronto
Toronto, Ontario, Canada

Beth B. Hogans, M.S. (Biomath), M.D., Ph.D.
Associate Professor
Director of Pain Education
Department of Neurology
Johns Hopkins School of Medicine
Baltimore, Md., USA

Eloise C J Carr, BSc (Hons), RN, PGCEA, RNT, MSc, PhD
Professor, Faculty of Nursing
University of Calgary
Calgary, Alberta, Canada 

Deb Gordon, RN, DNP, FAAN
Anesthesiology & Pain Medicine
Co-Director Harborview Integrated Pain Care Program
University of Washington
Seattle, Wash., USA

REVIEWERS

John Hughes, MBBS, FRCA, FFPMRCA
Pain Management Unit
The James Cook University Hospital
Middlesbrough, UK

Hellen N. Kariuki, B.D.S., MSc, PhD
Senior Lecturer
Department of Medical Physiology
University of Nairobi
Nairobi, Kenya