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Elective Pain Course for Fourth Year Medical Students

Objectives

At the completion of this course the student will have acquired the following competencies, knowledge, and attitudes:

  1. Competencies
    • Conduct a thorough pain assessment, including
      • Interview
      • Physical exam
      • Diagnosis
      • Ruling out other disease process
    • Establish goals of treatment together with patient (i.e., reduce pain, increase physical activity, improve sleep, improve mood, return to work, resume family/social role, etc.)
    • Develop an interdisciplinary treatment plan (e.g., medications, invasive interventions, psychology, nurse counseling, physical therapy, etc.)
    • Write a summary report of patient case and a treatment plan
    • Evaluate preliminary outcome of treatment
    • Present a clinical case of a patient with chronic pain
  2. Knowledge
    • Learn about the different types of pain
    • Interdisciplinary approach to pain prevention and treatment
    • Types and doses of typical medications used for different types of pain and related problems (mood, sleep)
    • Side-effects of medications used
  3. Attitudes
    • Acknowledge the reality of the patient’s experience of pain
    • Listen respectfully and supportively, while maintaining control of interview
    • Consult and collaborate with other team members
    • Be prepared for divergent points of view on cases and treatments
    • Participate fully in team discussions

Training Experiences

  1. Observation: students will sit and observe with
    • Physicians of different disciplines (family medicine, anesthesia , rheumatology, physiatry)
    • Nurses (in outpatient pain unit and on wards)
    • Physiotherapists
    • Chiropractor
    • Psychologists
  2. Clinical Practice
    • Assessment interviews
    • Follow-up visits
    • Weekly follow-up visits with one patient
    • Telephone calls with patients, as needed
    • Treatment recommendations (in conjunction with supervisor)
    • Letters/reports concerning patients
  3. Meetings: Clinical & multidisciplinary
    • Case discussions
    • Clinical and academic rounds
    • Psychology meetings
    • Present a case together with background literature
  4. Projects
    • Literature review on a specific topic
    • Daily journal: types of cases seen, patient’s “stories”, day’s learning, personal reflections

Readings

  • Pain Terms (handout)
  • Medications (handout)
  • Selected articles chosen beforehand by Pain Team
  • Project related

Time Line

Week 1: Observe interviews; ask patients some questions

Week 2: Conduct parts of interviews and follow-up visits with supervisor present most of the time; see selected follow-up patient alone

Week 3: Conduct full interviews with supervisor present some of the time; see selected follow-up patient alone

Week 4: Conduct full assessment interview alone with supervisor seeing patient briefly in beginning and at end of visit; see selected follow-up patient for last time

Note: It is understood that all clinical decisions will be made together with supervisor

Feedback and Evaluation

Review rotation experience with supervisor

  • Mutual feedback
  • Discussion of evaluation