Journal of Pain & Palliative Care Pharmacotherapy. 2014;28:402–403. ISSN: 1536-0288 print / 1536-0539 online DOI: 10.3109/15360288.2014.972004
EUROPEAN PERSPECTIVES ON PAIN AND PALLIATIVE CARE
Pain Education Policies and Initiatives in Europe Kirstin Fragemann and Christoph Wiese AB STRACT Curriculum development processes and guidelines in Europe are discussed. Both medical and nursing education are addressed and the goals of interprofessional education are described. The need to involve other professional liaison groups is described. Integration of research findings into education and multidisciplinary educational strategies are encouraged. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. KEYWORDS education, medicine, nursing, policies, interprofessional
Effective pain management is complex, requiring the knowledge and initiative of the multidisciplinary team as well as the implementation of appropriate management structures. Reviews on pain knowledge amongst healthcare professionals reveal issues regarding poor education and insufficient qualifications.1,2 Pain education needs to involve healthcare professionals at all levels of qualification in order to improve skills and outcome.3–5
courage the integration of pain education into medical school curricula. Approximately 20 years ago, the International Association for the Study of Pain (IASP) published the first edition of a core curriculum for professional pain education.5 Several years later, IASP provided specific core curricula for professionals, such as physiotherapists, to ensure access to pain education for all.5,6 Recent surveys on the status of contemporary pain education at undergraduate level suggest that current efforts may not be enough to eliminate insufficient pain control.7–9 Despite advances in curriculum development, a survey of UK universities published in 2011 revealed an average of only 12 hours of undergraduate training allocated to pain medicine.7,8 A survey of 242 undergraduate medical schools in Europe has also revealed a limited average number of hours allocated to pain-related subjects.8,9 There are different approaches toward postgraduate courses at the national level. Country-specific differences in the European Union may mean that there is variation and many countries do not formally control the content and duration of pain education programs. As an example, in Germany there are many different pain education programs for nurses. Whilst these courses demonstrate a general consensus on learning objectives, we have found a huge range in course titles and length, from 8–192 hours.10
LACK OF CURRICULA HOURS AND CONSISTENCY Most existing curricula guidelines have been created by national and international pain societies, to en-
Kirstin Fragemann is a graduate professional educator specializing in nursing science and Christoph Wiese, MD, PhD, is Medical Director of the Pain Management Center, Department of Anaesthesia, University Hospital Regensburg, Regensburg, Germany. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. Address correspondence to: Dr. Christoph Wiese, University of Utah, Salt Lake City, Utah, United States. E-mail: [email protected]
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European Perspectives On Pain & Palliative Care
A national committee of the German Nurse Association is attempting to unite the professional interests of German pain nurses. The status in German universities is probably analogous to that of other European countries. According to the German Pain Society, approximately half of the existing 36 medical schools in Germany are teaching pain management.11,12 However, the recent introduction of amendments to the medical licensure laws has led to the introduction of pain medicine as a specific topic in the medical curriculum, and this must be implemented by all faculties by 2016.13
INTERPROFESSIONAL EDUCATION The major goal of interprofessional education is to enhance patient-centered care in a collaborative manner, in order to improve patient safety. Greater cooperation is urgently required to ensure that graduates entering clinical practice are trained for interprofessional collaboration and patient-centered care.4,5 As one of the first providers of an interprofessional pain curriculum for pre-licensed healthcare students, which was implemented and evaluated yearly from 2002 to 2008, the University of Toronto yielded encouraging data for future learning and development.4,5 Following delivery of a 20-hour curriculum over a period of 1 week, statistically significant changes were demonstrated in students’ pain knowledge and beliefs (t = 181.28, p < 0.001).5 High ratings were given by most students for the content, relevancy and organization of the information provided.4 IASP has since published a core curriculum on interprofessional pain education in 2012.14 In 2014, The British Pain Society is to constitute national recommendations for universities on interprofessional pain education.8 In Germany, little effort has been made regarding interprofessional pain management in further education. One national program to enhance the efficacy of pain management is the Regensburg model, which aims to develop an integrated interprofessional pain curriculum.15 Program evaluation suggests acceptance of interprofessional learning approaches and encourages activities in the field of ongoing education.16 Aside from educational deficiencies in the medical field itself, we also need to look at other professional liaison groups, such as pharmaceutical sales representatives (PSRs). A descriptive question-based study from Germany revealed that most PSRs do not meet their self-proposed ideal high standards of being equal partners to the specialist physicians they visit.17
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CONCLUSION Integrating research evidence into practice requires an educational strategy aimed at the multidisciplinary team as a whole. There is more chance of success if pain management representatives are defined within the team, enabling clearly defined tasks and responsibilities. Creating interprofessional algorithms for pain assessment and treatment may help to co-ordinate care and transfer concepts into practice. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
REFERENCES [1] Bhamb B, Brown D, et al. Curr Med Res Opin. 2006;22(9): 1859–65. [2] Johnson M, Collett B, et al. J Pain Res. 2013;6:393–401. [3] Carr E, Watt-Watson J. Br J Pain. 2012;6(2):59–65. [4] Hunter J, Watt-Watson J, et al. Pain. 2008;140(1):74–86. [5] Watt-Watson J, Hunter J, et al. Pain 2004;110(1–2):140–8. [6] IASP. IASP Curricula, 2012. Available from: www.iasppain.org/Education/CurriculaList. aspx?navItemNumber = 647 (accessed 11 February 2014). [7] Briggs EV, Carr EC, et al. Eur J Pain. 2011;15(8):789–795. [8] Briggs E. Nurs. Times 2014;110(4):13. [9] Mundipharma International. A Blueprint for Pain Education— Advancing the Provision of Pain Education and Learning (APPEAL), 2013. [10] Fragemann K, Wiese CHR. Weiterbildung in der Schmerztherapie—Stand mono-und interprofessioneller Konzepte im deutschsprachigen Raum. P17.6. Poster presentation. German Pain Congress 2011, Congress Center, Rosengarten, Germany, 5–8 October 2011. [11] Deutsche Schmerzgesellschaft e.V. Medizinische Fakult¨aten in denen das Deutsche Schmerzgesellschaft e.V. Curriculum implementiert ist, 2012. Available from: www.dgss.org/ aus-weiterfortbildung/curriculare-lehre/ (accessed 19 February 2014). ¨ [12] Arztekammer N. Medizinische Fakult¨aten und Fachschaften ¨ in Deutschland, Osterreich und der Schweiz, 2014. Available from: www.aekno.de/page.asp?pageID = 5297 (accessed 24 February 2014). [13] Dusch M, Benrath J, et al. Schmerz. 2013;27(4):387–94. [14] IASP. Interprofessional Pain Curriculum Outline, 2012. Available from: www.iasp-pain.org/ Education/CurriculumDetail. aspx?ItemNumber = 2057 (accessed 12 February 2014). [15] Fragemann K, Meyer N, et al. Schmerz. 2012;26(4):369– 82. [16] Fragemann K, Lindenberg N, et al. Interprofessionelle Lehre - ein Zukunftsmodell? Einstellungen und Kenntnisse zur ¨ Schmerzmedizin und zum berufsgruppenubergreifenden Lernen im Rahmen eines interprofessionellen Weiterbildungscurriculum. P09b.2. Poster presentation. German Pain Congress 2013, Congress Center, Hamburg, Germany 23–26 October 2013. [17] Lassen CL, Fragemann K, et al. Eur. J Clin. Pharm. 2012;68(2): 161–70.
Copyright of Journal of Pain & Palliative Care Pharmacotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
EUROPEAN PERSPECTIVES ON PAIN AND PALLIATIVE CARE
Pain Education Policies and Initiatives in Europe Kirstin Fragemann and Christoph Wiese AB STRACT Curriculum development processes and guidelines in Europe are discussed. Both medical and nursing education are addressed and the goals of interprofessional education are described. The need to involve other professional liaison groups is described. Integration of research findings into education and multidisciplinary educational strategies are encouraged. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. KEYWORDS education, medicine, nursing, policies, interprofessional
Effective pain management is complex, requiring the knowledge and initiative of the multidisciplinary team as well as the implementation of appropriate management structures. Reviews on pain knowledge amongst healthcare professionals reveal issues regarding poor education and insufficient qualifications.1,2 Pain education needs to involve healthcare professionals at all levels of qualification in order to improve skills and outcome.3–5
courage the integration of pain education into medical school curricula. Approximately 20 years ago, the International Association for the Study of Pain (IASP) published the first edition of a core curriculum for professional pain education.5 Several years later, IASP provided specific core curricula for professionals, such as physiotherapists, to ensure access to pain education for all.5,6 Recent surveys on the status of contemporary pain education at undergraduate level suggest that current efforts may not be enough to eliminate insufficient pain control.7–9 Despite advances in curriculum development, a survey of UK universities published in 2011 revealed an average of only 12 hours of undergraduate training allocated to pain medicine.7,8 A survey of 242 undergraduate medical schools in Europe has also revealed a limited average number of hours allocated to pain-related subjects.8,9 There are different approaches toward postgraduate courses at the national level. Country-specific differences in the European Union may mean that there is variation and many countries do not formally control the content and duration of pain education programs. As an example, in Germany there are many different pain education programs for nurses. Whilst these courses demonstrate a general consensus on learning objectives, we have found a huge range in course titles and length, from 8–192 hours.10
LACK OF CURRICULA HOURS AND CONSISTENCY Most existing curricula guidelines have been created by national and international pain societies, to en-
Kirstin Fragemann is a graduate professional educator specializing in nursing science and Christoph Wiese, MD, PhD, is Medical Director of the Pain Management Center, Department of Anaesthesia, University Hospital Regensburg, Regensburg, Germany. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. Address correspondence to: Dr. Christoph Wiese, University of Utah, Salt Lake City, Utah, United States. E-mail: [email protected]
402
European Perspectives On Pain & Palliative Care
A national committee of the German Nurse Association is attempting to unite the professional interests of German pain nurses. The status in German universities is probably analogous to that of other European countries. According to the German Pain Society, approximately half of the existing 36 medical schools in Germany are teaching pain management.11,12 However, the recent introduction of amendments to the medical licensure laws has led to the introduction of pain medicine as a specific topic in the medical curriculum, and this must be implemented by all faculties by 2016.13
INTERPROFESSIONAL EDUCATION The major goal of interprofessional education is to enhance patient-centered care in a collaborative manner, in order to improve patient safety. Greater cooperation is urgently required to ensure that graduates entering clinical practice are trained for interprofessional collaboration and patient-centered care.4,5 As one of the first providers of an interprofessional pain curriculum for pre-licensed healthcare students, which was implemented and evaluated yearly from 2002 to 2008, the University of Toronto yielded encouraging data for future learning and development.4,5 Following delivery of a 20-hour curriculum over a period of 1 week, statistically significant changes were demonstrated in students’ pain knowledge and beliefs (t = 181.28, p < 0.001).5 High ratings were given by most students for the content, relevancy and organization of the information provided.4 IASP has since published a core curriculum on interprofessional pain education in 2012.14 In 2014, The British Pain Society is to constitute national recommendations for universities on interprofessional pain education.8 In Germany, little effort has been made regarding interprofessional pain management in further education. One national program to enhance the efficacy of pain management is the Regensburg model, which aims to develop an integrated interprofessional pain curriculum.15 Program evaluation suggests acceptance of interprofessional learning approaches and encourages activities in the field of ongoing education.16 Aside from educational deficiencies in the medical field itself, we also need to look at other professional liaison groups, such as pharmaceutical sales representatives (PSRs). A descriptive question-based study from Germany revealed that most PSRs do not meet their self-proposed ideal high standards of being equal partners to the specialist physicians they visit.17
C
2014 Informa Healthcare USA, Inc.
403
CONCLUSION Integrating research evidence into practice requires an educational strategy aimed at the multidisciplinary team as a whole. There is more chance of success if pain management representatives are defined within the team, enabling clearly defined tasks and responsibilities. Creating interprofessional algorithms for pain assessment and treatment may help to co-ordinate care and transfer concepts into practice. Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
REFERENCES [1] Bhamb B, Brown D, et al. Curr Med Res Opin. 2006;22(9): 1859–65. [2] Johnson M, Collett B, et al. J Pain Res. 2013;6:393–401. [3] Carr E, Watt-Watson J. Br J Pain. 2012;6(2):59–65. [4] Hunter J, Watt-Watson J, et al. Pain. 2008;140(1):74–86. [5] Watt-Watson J, Hunter J, et al. Pain 2004;110(1–2):140–8. [6] IASP. IASP Curricula, 2012. Available from: www.iasppain.org/Education/CurriculaList. aspx?navItemNumber = 647 (accessed 11 February 2014). [7] Briggs EV, Carr EC, et al. Eur J Pain. 2011;15(8):789–795. [8] Briggs E. Nurs. Times 2014;110(4):13. [9] Mundipharma International. A Blueprint for Pain Education— Advancing the Provision of Pain Education and Learning (APPEAL), 2013. [10] Fragemann K, Wiese CHR. Weiterbildung in der Schmerztherapie—Stand mono-und interprofessioneller Konzepte im deutschsprachigen Raum. P17.6. Poster presentation. German Pain Congress 2011, Congress Center, Rosengarten, Germany, 5–8 October 2011. [11] Deutsche Schmerzgesellschaft e.V. Medizinische Fakult¨aten in denen das Deutsche Schmerzgesellschaft e.V. Curriculum implementiert ist, 2012. Available from: www.dgss.org/ aus-weiterfortbildung/curriculare-lehre/ (accessed 19 February 2014). ¨ [12] Arztekammer N. Medizinische Fakult¨aten und Fachschaften ¨ in Deutschland, Osterreich und der Schweiz, 2014. Available from: www.aekno.de/page.asp?pageID = 5297 (accessed 24 February 2014). [13] Dusch M, Benrath J, et al. Schmerz. 2013;27(4):387–94. [14] IASP. Interprofessional Pain Curriculum Outline, 2012. Available from: www.iasp-pain.org/ Education/CurriculumDetail. aspx?ItemNumber = 2057 (accessed 12 February 2014). [15] Fragemann K, Meyer N, et al. Schmerz. 2012;26(4):369– 82. [16] Fragemann K, Lindenberg N, et al. Interprofessionelle Lehre - ein Zukunftsmodell? Einstellungen und Kenntnisse zur ¨ Schmerzmedizin und zum berufsgruppenubergreifenden Lernen im Rahmen eines interprofessionellen Weiterbildungscurriculum. P09b.2. Poster presentation. German Pain Congress 2013, Congress Center, Hamburg, Germany 23–26 October 2013. [17] Lassen CL, Fragemann K, et al. Eur. J Clin. Pharm. 2012;68(2): 161–70.
Copyright of Journal of Pain & Palliative Care Pharmacotherapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
