Pain Medicine Education in Emergency Medicine Residency Programs

Abstract

Background Pain is a common complaint in the emergency department (ED), yet there is a lack of robust pain curricula in emergency medicine (EM) residency programs. In this study, we investigated pain education in EM residencies and various factors related to educational development. Methodology This was a prospective study collecting online survey results sent to Program Directors, Associate Program Directors, and Assistant Program Directors of EM residencies in the United States. Descriptive analyses with nonparametric tests were performed to investigate relationships between these factors, including educational hours, level of educational collaboration with pain medicine specialists, and multimodal therapy utilization. Results The overall individual response rate was 39.8% (252 out of 634 potential respondents), representing 164 out of 220 identified EM residencies with 110 (50%) Program Directors responding. Traditional classroom lectures were the most common modality for the delivery of pain medicine content. EM textbooks were the most common resource utilized for curriculum development. An average of 5.7 hours per year was devoted to pain education. Up to 46.8% of respondents reported poor or absent educational collaboration with pain medicine specialists. Greater collaboration levels were associated with greater hours devoted to pain education (p = 0.01), perceived resident interest in acute and chronic pain management education (p < 0.001), and resident utilization of regional anesthesia (p = <0.01). Faculty and resident interest in acute and chronic pain management education were similar to each other and high on the Likert scale, with higher scores correlating to greater hours devoted to pain education (p = 0.02 and 0.01, respectively). Faculty expertise in pain medicine was rated the most important factor in improving pain education in their programs. Conclusions Pain education is a necessity for residents to adequately treat pain in the ED, but remains challenging and undervalued. Faculty expertise was identified as a factor limiting pain education among EM residents. Collaboration with pain medicine specialists and recruitment of EM faculty with expertise in pain medicine are ways to improve pain education of EM residents.

Keywords: emergency medicine training; emergency pain management; graduate medical education; pain medicine; teaching in emergency medicine.

Figure 1. Teaching modalities utilized to deliver pain management content.

Survey question: What teaching modalities do you use to deliver pain management content? Content examples include addressing chronic pain, opioid prescribing risks, pharmacology, regional anesthesia, etc. (please select all that apply). Note: The above figure was generated thanks to the Qualtrics platform.

Figure 2. Methods used to evaluate resident competency in pain management knowledge and skills.

Survey question: What methods do you use to specifically evaluate your residents’ pain management knowledge and skills? (please select all that apply). Note: The above figure was generated thanks to the Qualtrics platform.

Figure 3. Level of educational collaboration with pain specialists.

Survey question: What is the level of educational collaboration (didactics, procedure workshops, consults, etc.) with pain medicine specialists at your program? Note: The above figure was generated thanks to the Qualtrics platform.

Figure 4. General thoughts about pain education in emergency medicine residency programs, part 1.

ED = emergency department, CMS = Center for Medicare and Medicaid Services

Figure 5. General thoughts about pain education in emergency medicine residency programs, part 2.

ED = emergency department

Figure 6. Survey for program directors and associate/assistant program directors, page 1.

Figure 7. Survey for program directors and associate/assistant program directors, page 2.

Figure 8. Survey for program directors and associate/assistant program directors, page 3.