Integrated
Progressive
Collaborative
The PIC Pain Project
Developing a Threaded Curriculum
Quiz

The number one symptom which prompts
patients to seek medical attention is:

The prevalence of chronic pain among
adults is:

When is this topic covered in the Queen’s
undergraduate medical curriculum and who
is responsible?
A problem for our students…
1.
What do I need
to know?
2.
When do I need
to know it?
3.
What are the
learning
opportunities?
4.
How will I be
assessed?
…and our teachers…
1.
What do they
already know?
2.
What will they
learn later?
3.
What am I
responsible for
today?
…and the School of Medicine.
1.
Can we
demonstrate
that students
have achieved
the necessary
competencies?
Our Team
Joshua Shadd
 Cathy Cahill
 Lindsay Davidson
 Neil Hobbs
 Cori Schroder
 Elaine van Melle
 Sheila Pinchin

(Medicine)
(Pharm/Tox)
(Surgery)
(Family Medicine)
(Oncology)
(OHSC)
(OHSC)
How do you teach a thread?
An effective curricular thread is…
 Visible
 Progressive
 Integrated
 Collaborative
 Measurable
PIC Pain Curriculum Project
Goals:

to seek consensus about what
medical students should learn about
pain assessment and management

coordinate learning opportunities
which deal with these objectives
Our Philosophy
Smarter, not more.
 Start at home.
 Coordination, not coercion.
 Both bottom up and top down.

Action Research
Implement
Change
Question
Reflection
Data Gathering
Data Gathering
Interpretation &
Evaluation
Our Questions

What should medical students
know/believe/do regarding
assessment and management of
pain?

When should they know/believe/do it?
Action Research in Action
Identify
Topics
Identify
Target
Audience
Survey: What
should students
know & when?
Implement
Change
Gather
Feedback
Pain
Teachers
Survey Analysis
Steering Committee
Recommendations
Curriculum
Committee
Identify Topics

45 topics identified from: Queen’s OCR,
MCC objectives, published curricula &
curricular guidelines

Six clusters:
1.
2.
3.
4.
5.
6.
Foundations
Assessment
Pharmacology
Pharmacologic Treatment
Non-Pharmacologic Treatment
Clinical Application
Cluster 1: Foundations
TOPIC
Queen’s
MCC EFPPEC IASP
Anatomy & physiology of pain
X
Psychosocial & cultural aspects of
pain
X
Taxonomy of pain syndromes
Pharmacology of pain transmission &
modulation
X
X
X
X
X
X
X
X
X
X
X
X
Impact of placebo on pain
experience
Epidemiology and impact of pain
Genetics of pain
U of T
X
X
X
X
Identify Target Audience

local pain teachers/experts
(MD & non-MD)

family medicine residents
The Survey
Anatomy & physiology of pain
Additional topics?
Detailed Results: Residents (N=18)
TOPIC
Essential
Before
Clerkship
Essential
During
Clerkship
Essential
During
Medical School
Not
Essential
Not
Sure
Cluster 1: Foundations
Anatomy & physiology of pain
56
44
100
0
0
Psychosocial & cultural aspects of
pain
28
61
89
11
0
Taxonomy of pain syndromes
22
61
83
17
0
Pharmacology of pain transmission
& modulation
44
44
89
11
0
Impact of placebo on pain
experience
22
72
94
6
0
Epidemiology and impact of pain
33
56
89
11
0
Genetics of pain
21
5
26
53
21
All numbers expressed as percentages.
Summary 1: Essential Pain
Topics in Medical School
TOPIC
% Essential Faculty
% Essential Residents
Cluster 1: Foundations

Anatomy & physiology of pain
100
100

Psychosocial & cultural aspects of
pain
100
89

Taxonomy of pain syndromes
90
83

Pharmacology of pain transmission &
modulation
100
89

Impact of placebo on pain experience
65
94

Epidemiology and impact of pain
90
89

Genetics of pain
20
26
All numbers expressed as percentages.
Topics by Timing - Faculty
Topics for
Pre-Clerkship
Essential,
Timing unclear
Topics for Clerkship
Cluster 1: Foundations




Anatomy & physiology
of pain
Taxonomy of pain
syndromes
Pharmacology of pain
transmission &
modulation
Epidemiology and
impact of pain

Impact of placebo on
pain experience

Psychosocial & cultural
aspects of pain
Key Survey Findings

30 topics considered essential in
medical school by a strong majority
(>66%) of both faculty and resident
respondents

No topic was considered ‘not
essential in medical school’ by a
majority of faculty
Key Survey Findings

Residents are eager to learn about
pain

Residents prefer to learn in a clinical
context

All essential topics taught by at least
one faculty respondent
Our Recommendations
Identify
Topics
Identify
Target
Audience
Survey: What
should students
know & when?
 Content
 Process
Pain
Teachers
Survey Analysis
Steering Committee
Recommendations
Curriculum
Committee
Topics by Timing
– Committee Recommendations
Bridge Topics*
Topics for
Pre-Clerkship
Topics for Clerkship
Cluster 1: Foundations




Anatomy & physiology
of pain
Psychosocial & cultural
aspects of pain
Taxonomy of pain
syndromes
Pharmacology of pain
transmission &
modulation
*Introduce in Preclerkship, teach in Clerkship
What, Why
Who, When, Where, How
Topics by Timing
– Committee Recommendations
Topics for
Pre-Clerkship
Bridge Topics
Topics for Clerkship
Cluster 2: Assessment
Pain history & physical
exam
Pain measurement in
humans
Multidimensional pain
assessment
Interprofessional
assessment
Pain assessment in the
cognitively impaired
Pain assessment in
children
Cluster 3: Pharmacology of Analgesics
Antipyretic analgesics
Opioids
Anticonvulsants
Antidepressants
Other adjuvants
Local anesthetics
Topics by Timing
– Committee Recommendations
Topics for
Pre-Clerkship
Bridge Topics
Topics for Clerkship
Cluster 4: Pharmacologic Treatment
Using opioid & non-opioid
analgesics (prescribing,
management of a/e’s, etc.)
Using adjuvant
analgesics
Analgesics & renal failure
Analgesics & children
Analgesics & the elderly
Opioids & addiction
Cluster 5: Non-Pharmacologic Treatment
Physical medicine and
rehabilitation
Psychiatric treatment
Psychological treatments
Radiation therapy and
chemotherapy for cancer
pain
Topics by Timing
– Committee Recommendations
Bridge Topics
Topics for
Pre-Clerkship
Topics for Clerkship
Cluster 6: Clinical Applications

General management
approach based on
pain category



Develop basic pain
management strategy
for pain arising from
prototypical pain
syndromes
Contribute to recording
a holistic management
plan
Assist in monitoring the
efficacy of treatment
Committee Recommendations
- Topics Not Included












Impact of placebo on pain experience
Epidemiology and impact of pain
Genetics of pain
Embryonic development of pain systems
Research: design, reporting, and interpreting clinical studies
about treatments for pain
Imaging studies in pain assessment
Nerve function studies in pain assessment
Interventional pain management
Complementary therapies
Work rehabilitation
Surgical pain management
Stimulation-produced analgesia
Content Recommendations:
Summary

Recommendations similar, but not
identical, to survey results

30 topics: Preclerkship, Bridge &
Clerkship
Process Recommendations
What is required to ensure ‘delivery’ of
essential topics in a progressive,
integrated & collaborative fashion?
1.
Centralized curricular oversight
2.
Support for collaborative teaching
3.
Clerkship curriculum
Challenges on the Horizon

Topics  Objectives

Clerkship

Closing the loop

Sustainability
What do you think…

Are there other ‘threads’ in the
medical curriculum?

Might a similar process be helpful for
these threads?
Our gratitude…

Office of Health Science Education

Sheila has been absolutely invaluable!