Which skills are associated with residents’ sense of preparedness to manage chronic pain?

Aaron D. Fox, MD, MS; Hillary V. Kunins, MD, MPH, MS; Joanna L. Starrels, MD, MS

doi:10.5055/jom.2012.0132

Authors

Aaron D. Fox, MD, MS
Hillary V. Kunins, MD, MPH, MS
Joanna L. Starrels, MD, MS

DOI:

https://doi.org/10.5055/jom.2012.0132

Keywords:

medical education, chronic pain, opioid medications, physician self-assessment

Abstract

Objective: To identify gaps in residents’ confidence and knowledge in managing chronic nonmalignant pain (CNMP) and to explore whether specific skills or pain knowledge was associated with global preparedness to manage CNMP.

Design: Cross-sectional web-based survey.

Setting and participants: Internal medicine residents in Bronx, NY.

Main outcome measures: The authors assessed the following: 1) confidence in skills within the following four content areas: physical examination, diagnosis, treatment, and safer opioid prescribing; 2) pain-related knowledge on a 16-item scale; and 3) global preparedness to manage CNMP (agreement with, “I feel prepared to manage CNMP”). Gaps in confidence were skills in which fewer than 50 percent reported confidence. Gaps in knowledge were items in which fewer than 50 percent answered correctly. Using logistic regression, the authors examined whether skills or knowledge was associated with global preparedness.

Results: Of 145 residents, 92 (63 percent) responded. Gaps in confidence included diagnosing fibromyalgia, performing corticosteroid injections, and using pain medication agreements. Gaps in knowledge included pharmacotherapy for neuropathic pain and interpreting urine drug test results. Twenty-four residents (26 percent) felt globally prepared to manage CNMP. Confidence using pain medication agreements (adjusted odds ratio [AOR], 5.99; 95% confidence interval [CI], 2.02-17.75), prescribing long-acting opioids (AOR, 5.85; 95% CI, 2.00-17.18), and performing corticosteroid injection of the knee (AOR, 5.76; 95% CI, 1.16-28.60]) were strongly associated with global preparedness.

Conclusions: Few internal medicine residents felt prepared to manage CNMP. Our findings suggest that educational interventions to improve residents’ preparedness to manage CNMP should target complex pain syndromes (eg, fibromyalgia and neuropathic pain), safer opioid prescribing practices, and alternatives to opioid analgesics.

Author Biographies

Aaron D. Fox, MD, MS

Albert Einstein College of Medicine, Bronx, New York; Montefiore Medical Center, Bronx, New York

Hillary V. Kunins, MD, MPH, MS

Albert Einstein College of Medicine, Bronx, New York; Montefiore Medical Center, Bronx, New York

Joanna L. Starrels, MD, MS

Albert Einstein College of Medicine, Bronx, New York; Montefiore Medical Center, Bronx, New York

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