Background Management of chronic nonmalignant pain (CNMP) is a clinical challenge for residents and practicing physicians. Surveys of both groups have revealed attitudinal barriers and knowledge deficits to pain management. These include negative views about patients with CNMP, inadequate knowledge of pseudoaddiction and addiction, and fear of regulatory scrutiny. The purpose of this study is to determine medical student preclinical attitudes toward patients with CNMP.
Methods A survey was administered to third-year students prior to their first clinical rotation in July 2006. Students were asked to define chronic pain and describe characteristics of patients with chronic pain. They were also asked to complete the following sentence: Working with patients with chronic pain will be… Finally, students responded to eight attitudinal statements about CNMP and three questions about clinical exposure to and personal or family experience with CNMP.
Results The response rate was 48% (N = 93/193). Mean student age was 26 years, 56% were female, and 38.4% planned a primary care residency. Most students had no clinical exposure to or personal or family experiences with CNMP (61%). CNMP was defined by four themes: (1) long duration, (2) decreased quality of life, (3) patient discomfort, and (4) treatment challenges. Eleven percent included an emotional or psychological term in their definition. Students characterized CNMP patients as (1) depressed, (2) frustrated, (3) tired, and (4) irritable, and 25% described a decrease or loss in patient function. Students anticipate that working with CNMP patients will be “rewarding,” “educational,” “interesting,” and “worthwhile.” A majority disagreed with the statements Narcotics should be reserved for terminally ill patients (79%) and Any patient given narcotics is at significant risk of addiction (67%). Most students plan to treat patients with CNMP after residency (71%), and nearly all believe that medical school and residency will train them to manage patients with CNMP (80%).
Conclusions Overall, students accurately defined CNMP and their written responses showed empathy and optimism. Students have a willingness to use narcotics for patients without terminal illness and an understanding that not all patients are at risk of addiction. A majority of students plan to treat patients with CNMP and believe that they will be trained effectively. These results open the door for curriculum interventions that preserve positive attitudes toward the treatment of patients with CNMP as well as thwart misconceptions. A targeted competency-based curriculum intervention in medical education is warranted.
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