Academy of Distinguished Medical Educators - Pritzker School of ...

3. Survey of Problem Based Learning for Medical Student
Pain Curricula
Dalia Elmofty, MD; Magdalena Anitescu, MD, PhD; Ashley Agerson, MD
Statement of Problem, Question, or Issue Addressed: Chronic pain is one of the most prevalent conditions
encountered in clinical practice. Chronic pain can burden patients in multiple domains: socioeconomic,
psychological and quality of life. In 2010, the Department of Health and Human Services enlisted the Institute
of Medicine to examine pain as a public health problem. The committee reported that chronic pain affects
at least 116 million adults in the US; more than those affected by heart disease, cancer and diabetes (1). In
1988, The International Association for the Study of Pain (IASP) published a pain curriculum for medical
schools and estimated that it would require a minimum of 74h (2). For a majority of medical schools, pain
education encompass about 10 hr maximum during a 4 year time period. Pain education must be an integral
part of medical student education at all levels in order to improve chronic pain management. It is essential for
medical students to have adequate exposure in order to develop knowledgeable and skilled future healthcare
professionals. While progress is taking place, many gaps still exist.
Objectives of Program/Intervention: To promote pain education in PBLD format, allowing students to develop
authority, competency, skills and attitudes that enhance the learning process.
Description of Program/Intervention: At the University of Chicago, third year medical students complete a two
week rotation as part of their surgical clerkship in Anesthesia and Critical Care. During these two weeks, they
spend 5 hours in the Acute Pain Service (APS) and 8 hours in the Pain Clinic. The neurophysiology, etiology,
ethical issues and management of acute and chronic pain are reviewed. More recently, in spring of 2011, we
introduced a Problem Based Learning Discussion (PBLD) on the management of Chronic Low Back Pain
to promote pain education. Low back pain is one of the most common complaints in our society. We chose
PBL type discussion as it allows students to develop authority, competency, skills and attitudes that enhance
the learning process. Each PBL session consisted of approximately 5-6 medical students and was 60 minutes
in length. A case discussion was emailed to the students at least 24 hr before the scheduled session to allow
adequate preparation time. As well, the Pain PBLD was performed during the second week of their rotation to
ensure that all students had completed their APS and Pain Clinic rotation. An online survey of a series of seven
questions using a Likert-type scale was then conducted regarding their experience during the Pain PBLD.
Results/Findings to Date: We achieved a 100% response rate. Of the 18 medical students that attended the
Pain PBLD, all responded to the survey. The majority of students were favorable towards this mode of learning.
All but 1 student responding to the survey strongly agreed that their educational background knowledge was
increased with this modality of learning.
Key Lessons Learned/Conclusions: Implementing a pain assessment and management program for medical
students can provide a solid foundation upon which students can continue to build as their career develops. A
European survey conducted in 2007 highlighted the anxiety of final year medical students in managing chronic
pain (3). Our survey showed that the most favorable response was “The case scenario enriched my background
knowledge for the rotation.” The students felt very comfortable in stating their opinions within the group. This
emphasizes that the fundamental knowledge to improve chronic pain management can be introduced in PBLD
format rather than the standard lecture format. PBL allows students to work as a team and engage in group
discussion.
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