Plastic surgery and the undergraduate medical school curriculum

Context and setting Over the last 3 decades, the misunderstanding and undertreatment of paediatric pain has been repeatedly documented in the literature. Trainees, doctors and nurses continue to demonstrate inadequate comprehension of existing evaluative instruments and appropriate treatment regiments. Although great strides have been made in the science and pharmacology of pain management, the dissemination and application of these advances is lagging. At a university medical centre a survey of medical students, who were completing their first year of clinical training, demonstrated a similarly low level of awareness and knowledge. Why the idea was necessary Optimal pain management in patients of all ages requires a thorough understanding of assessment techniques and management strategies. Because medical school curricula cover a multitude of informational, cognitive and behavioural goals, little time or emphasis is placed on pain management in general and paediatric pain management specifically. The International Association for the Study of Pain, the American Medical Association, the European Federation of IASP Chapters and the Royal Australasian College of Physicians all recognise the need for the early introduction of pain concepts in medical training. They cite the advantages of an interdisciplinary approach that brings together the different domains of clinical medicine. Attempts to introduce pain-related knowledge and skills later on, during specialty or subspecialty training, have been unsuccessful. What was done A 9-minute problem-based learning (PBL) discussion incorporating mock pain assessment and analgesic treatment exercises was added to the paediatric rotation’s educational programme at a university medical centre children’s hospital. The activity was structured to encompass the following areas in paediatric pain management: development, assessment and pharmacology. Students were introduced to and encouraged to use different paediatric pain assessment tools including the Objective Pain Scales, the Face)Legs)Activity)Cry)Consolable (FLACC) Scale, Wong)Baker Faces and a vertical visual analogue scale. Approaches to treatment modalities such as oral analgesics, intravenous opioids, patient-controlled analgesia (PCA), and the World Health Organization’s Analgesic Ladder were examined during this facilitated interactive exercise. The advantages, limitations and side-effects of each method were compared and contrasted. Supplemental reading and follow-up activities were provided and encouraged. Evaluation of results and impact Internal Review Board approval was obtained. Over 1 year, a total of 127 students participated in the paediatric pain PBL session during their rotations in paediatrics. Students completed preand post-tests, which examined developmental aspects of pain physiology, psychology, assessment and pharmacology. The pre-test consisted of single-answer multiple-choice questions (MCQs) to assess recognition and comprehension. The post-test consisted of multiple-answer MCQs (k-type) to assess application and synthesis. Scores in the areas of pain assessment and opioid pharmacology increased significantly between the 2 tests. The pass rate on a year-end paediatric pain knowledge survey improved from 46Æ7% to 76Æ2% (Yates corrected chi-square, p 1⁄4 0Æ001).