Developing a Comprehensive Pain Management Curriculum in Physician Assistant Education

Developing a Comprehensive Pain Management Curriculum in Physician Assistant Education

Background:

The opioid crisis has been a hot topic for several years now, and much emphasis has been placed on reducing the use of opioids in the treatment of acute and chronic pain. However, since the release of the 2016 CDC guidelines for treating pain, the pendulum has swung, and many patients are not getting the treatment they need because providers fear the consequences of prescribing opiates.¹ Based on a survey done in 2016, of the 209 PA programs surveyed, 86% of programs responded that they do include pain management as part of the curriculum. However, over 50% indicated that only 1-3 hours were spent on this topic, and the methods of instruction were inconsistent.^2,3 To address this issue, a more comprehensive and standardized pain management curriculum must be developed and delivered in physician assistant (PA) programs nationwide.^4,5

Purpose/Objectives:

The Comprehensive Pain Management Curriculum (CPMC) project aims to develop a curriculum that will teach PA students a multi-dimensional approach to pain and develop methods of instruction that enable them to put their knowledge and skills into practice. It involves various educational activities and assessments spanning the didactic and clinical years. The educational activities include instruction on safe and effective pain management principles, clinical application, and patient education. The purpose of this project is to better educate PA students so that upon graduation, they are able to provide patients in pain with the care they need, which will, in turn, improve patient outcomes.

Method:

The lectures, activities, and assessments were developed by the author and the University of the Pacific PA Program Director. The curriculum changes were implemented in the Summer of 2022, during the students’ first year of PA school. They were introduced to the principles of pain management at the end of the didactic year. The lecture focused on the approach to patients with chronic and acute pain. This included a review of the pathophysiology of pain, types of pain, CDC opioid prescribing guidelines, and non-pharmacological and pharmacological treatments for pain. We also reviewed the appropriate screening and monitoring of patients prescribed opiate medications. One month before their clinical rotations, we added a domain Objective Structured Clinical Examination (OSCE), which required the students to provide patient education regarding opiate medication. The education they provided should include expectations of treatment, risks and benefits of the medications, and plans for monitoring progress.

Results:

The CPMC project is still being implemented. However, based on preceptor and student feedback, we have been meeting all the objectives outlined. They include identifying gaps in the PA curriculum involving the management of acute and chronic pain patients and developing learning activities and methods of instruction to close the gaps in the didactic and clinical years. The next phase is underway and occurs during the clinical year after students have gained more exposure and experience treating patients with acute or chronic pain. This will include webinars and an interprofessional event with pharmacy students to practice dosing and patient education.

Conclusions: Pain continues to be one of the most common reasons adults seek medical care in the United States.6 PA students must be better prepared to treat acute and chronic pain patients when they enter clinical practice. The updated CDC guidelines were released in November 2022, and data reviewed as part of this update showed that inadequate clinician education, training, and guidance contributed to the misapplication of the 2016 guidelines.6 Unfortunately, many PA programs are not addressing this topic adequately. The focus in PA education is turning more toward treating opioid use disorder rather than preventing it. The goal should be to teach our students safe and effective ways to manage pain and reinforce this with learning activities focusing on clinical application. The CPMC aims to lay the foundation of knowledge during the didactic year and then focus on the clinical application during the clinical year. To assess this, the final phase will include a team-based learning activity in which students develop a treatment plan based on various clinical scenarios. The completed curriculum, through various methods of instruction, will teach PA students a multi-dimensional approach to pain and enable them to put their knowledge and skills into practice upon graduation.

References: 1. Comerci, G., Jr., J. Katzman, and D. Duhigg, Controlling the Swing of the Opioid Pendulum. N Engl J Med, 2018. 378(8): p. 691-693.

2. Yealy, J.K., M. Martinasek, and T. Doran, The Current State of Physician Assistant Pain Curriculum: A National Survey. J Physician Assist Educ, 2019.
30(1): p. 20-26.

3. Yorkgitis, B.K., B. Garbas, and D. Cole, Opioid Prescribing Education for Physician Assistant Students: A Physician Assistant Educator Survey. J
Physician Assist Educ, 2019. 30(1): p. 27-33.
4. International Association for the Study of Pain. IASP Curriculum Outline for Pain in Medicine. https://www.iasp-pain.org/education/curricula/iasp-
curriculum-outline-on-pain-for-medicine/?ItemNumber=729. Accessed Marcy 4, 2022.

5. PAEA Yealy, J. Incorporating Pain Management Content into PA Curriculum. https://paeaonline.org/resources/public-resources/paea-
news/incorporating-pain-management-content-into-pa-curriculum. Published July 8, 2020. Accessed March 1, 2022.

6. Dowell, D., et al., CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep, 2022 71(3): 1-95.