Learning from Our Learners: Implications for Pain Management Education in Medical Schools

The high prevalence of pain seen by clinicians in ambulatory settings [1,2] combined with the insufficient number of pain specialists in the community necessitate that most patients with pain are managed in primary care. However, most primary care physicians (PCPs) have had little formal education or training in pain management [3]. The limited pain instruction that PCPs receive is usually fragmented and learned “on the job” rather than as part of a comprehensive course that spans their medical school (undergraduate) and residency (graduate) years. As a result, PCPs may lack the requisite knowledge and skills to effectively diagnose and treat patients with pain. Furthermore, work by our group [4] and Dobscha et al. [5] show that PCPs view treating chronic pain as “frustrating” and “difficult” largely because of their perceived inability to offer optimal treatments for chronic pain. There is a significant gap in medical school education related to pain management. According to a 2001 Association of American Medical Colleges survey, only 3% of medical schools required a course on pain management [6]. In the last decade, health care systems (Veterans Health Affairs) and professional societies such as the American Academy of Pain Medicine [6] and the International Association for the Study of Pain [7] have developed comprehensive curricula to help fill this educational gap. Furthermore, academic centers alone and in collaboration with pharmaceutical partners have created innovative pain curricula targeting students and trainees. A few notable examples include those developed at Virginia Commonwealth University [8], Johns Hopkins University [9,10], and Beth Israel Medical Center [11]. Despite these efforts, pain management education is still struggling to establish a foothold in an already crowded medical school curriculum [12].