Assessing Resident Knowledge of Acute Pain Management in Hospitalized Children: A Pilot Study

Abstract

This pilot study was undertaken to evaluate the hypotheses that there are differences in pediatric pain management (PPM) knowledge across resident specialties, that questions in the form of multiple-choice items could detect such differences, and that resident knowledge of analgesic-related adverse drug events (ADEs) would be greater than knowledge of PPM. Questions were based on two general categories of knowledge within acute pain management in hospitalized children: pediatric pain assessment and treatment, and identification of analgesic-related ADEs. As part of the pilot nature of this study, a convenience sample of 60 residents completed a 10-item PPM knowledge assessment prior to a PPM lecture. Twenty-six were pediatric residents (43%), 19 were orthopedic residents (32%), and 15 were anesthesiology residents (25%). All items had content validity. When controlling for resident year, performance by resident specialty was significantly different between anesthesia and orthopedics (P=0.006) and between anesthesia and pediatrics (P<0.001). Resident knowledge of analgesic-related ADEs was not greater than knowledge of PPM. The most difficult topics were opioid equianalgesia, assessment of the cognitively impaired child, and maximal acetaminophen doses. Repeated administration of the PPM knowledge assessment at multiple institutions will allow further evaluation of our initial findings, and with directed educational interventions, provide opportunity for measurement of improvement.

Balancing Knowledge Among Resident Specialties: Lecture-Based Training and the OUCH Card to Treat Children's Pain

“…18 To further evaluate this perceived educational need, we recently developed and preliminarily validated a resident PPM knowledge assessment in a multiple-choice test format. 8 In using this instrument, we showed that there were clear PPM knowledge deficiencies among the resident specialties; specifically, pediatric and orthopedic residents performed significantly poorer on this knowledge assessment when compared to a group of anesthesiology residents. 8 Despite identifying the PPM issue in the literature, there are only a few known educational interventions that demonstrate ways to improve clinicians' knowledge of acute-pain assessment.…”

“…8 In using this instrument, we showed that there were clear PPM knowledge deficiencies among the resident specialties; specifically, pediatric and orthopedic residents performed significantly poorer on this knowledge assessment when compared to a group of anesthesiology residents. 8 Despite identifying the PPM issue in the literature, there are only a few known educational interventions that demonstrate ways to improve clinicians' knowledge of acute-pain assessment. Existing studies have focused on the teaching of behavioral techniques 19,20 or pharmacologic management of children in pain.…”

“…8,27 Six domains related to pediatric pain assessment and treatment, and 4 related to recognition and treatment of ADEs. We wrote 2 multiplechoice questions for each of the 10 knowledge domains, resulting in a total of 20 items, and then constructed 2 parallel test forms (Form A and Form B).…”

“…4,5 Lapses in the treatment of children's pain have been attributed, in part, to the following: systematic and logistical barriers within institutions providing pediatric care, 6 knowledge-based barriers including insufficient knowledge of pain assessment and treatment in children, 7 and inadequate pediatric pain management (PPM) educational requirements for residency programs. 8 These inadequacies have also been shown to be widespread across a variety of pediatric settings such as cardiac surgery,…”

“…[22][23][24][25] The present study addresses the issue of pediatric residents' comparably low PPM knowledge. 8 It tests the extent to which providing pediatric residents with lecturebased PPM training (to increase their knowledge), as well as a targeted PPM memory aid at the point of decision during their clinical activities (to decrease their reliance on memory or limited experience), has a positive and long-term effect. Specifically, through training and a memory aid, it is predicted that they will perform no differently than their generally more knowledgeable and more experienced anesthesiology resident colleagues.…”