Abstract:Recent surveys suggest that most physicians have inadequate knowledge to assess and manage cancer pain; however, the important domain of clinical performance has not yet been clearly evaluated. The Objective Structured Clinical Examination (OSCE) has become a widely- used and accepted method to evaluate the clinical abilities of medical students. The purpose of this study was to develop and test a Cancer Pain OSCE for medical students evaluating their clinical competence in the area of cancer pain management. … Show more
“…Nineteen studies used existing instruments or modified existing instruments for assessment of medical students' knowledge, attitudes, or skills. The Pain Knowledge and Beliefs Questionnaire, 63,125 the Cancer Pain Objective Structured Clinical Examination, 108,109 the Back Pain Beliefs, 18,69,112 Health Care Providers' Pain and Impairment Relationship Scale, 18,84,96 the Cancer Pain Questionnaire, 50,68,129 and Paediatric Pain Knowledge Questionnaire 9,24 were each used in 2 studies. Most of these existing instruments were developed before 2005 (n = 17 89%).…”
Section: Resultsmentioning
confidence: 99%
“…New instruments were designed in 78% (n = 32) of studies. 6,9,12,24,25,34,46,55,56,60,63,68,71,73,80,85,87,88,90,92,94,95,99,101,109,110,114,118,120,125,127,132…”
Section: Resultsmentioning
confidence: 99%
“…The OSCE was used in 8 studies, 55,56,73,101,108–110,127 primarily to assess clinical skills (88%), but also to assess knowledge (37%) 55,108,109 and attitude to pain (13%). 101 One OSCE focussed primarily on regional anaesthesia techniques, 55 2 studies assessed clinical competence in the area of cancer pain management, 108,109 and 2 studies assessed clinical skills in examining chronic low-back pain. 56,127 The number of OSCE stations ranged from 1 to 10, with a median of 3.…”
Section: Resultsmentioning
confidence: 99%
“…55,56,73,101,108–110,127 The OSCE assessment was used effectively for assessing competencies such as attitude, empathy, and communication as part of a pain assessment in a variety of contexts (acute, low-back, and cancer pain). 55,73,109,110,124,127 The OSCE may currently be the most appropriate summative assessment for educators to use to identify students who may be at risk of poor performance in a clinical workplace environment and is used extensively within clinical medical education. 32,70,79,115 Careful attention needs to be paid to test content, design, and implementation factors such as wide sampling of cases, large numbers of stations and examiners, and good standardisation of patients to improve validity and reliability.…”
“…Nineteen studies used existing instruments or modified existing instruments for assessment of medical students' knowledge, attitudes, or skills. The Pain Knowledge and Beliefs Questionnaire, 63,125 the Cancer Pain Objective Structured Clinical Examination, 108,109 the Back Pain Beliefs, 18,69,112 Health Care Providers' Pain and Impairment Relationship Scale, 18,84,96 the Cancer Pain Questionnaire, 50,68,129 and Paediatric Pain Knowledge Questionnaire 9,24 were each used in 2 studies. Most of these existing instruments were developed before 2005 (n = 17 89%).…”
Section: Resultsmentioning
confidence: 99%
“…New instruments were designed in 78% (n = 32) of studies. 6,9,12,24,25,34,46,55,56,60,63,68,71,73,80,85,87,88,90,92,94,95,99,101,109,110,114,118,120,125,127,132…”
Section: Resultsmentioning
confidence: 99%
“…The OSCE was used in 8 studies, 55,56,73,101,108–110,127 primarily to assess clinical skills (88%), but also to assess knowledge (37%) 55,108,109 and attitude to pain (13%). 101 One OSCE focussed primarily on regional anaesthesia techniques, 55 2 studies assessed clinical competence in the area of cancer pain management, 108,109 and 2 studies assessed clinical skills in examining chronic low-back pain. 56,127 The number of OSCE stations ranged from 1 to 10, with a median of 3.…”
Section: Resultsmentioning
confidence: 99%
“…55,56,73,101,108–110,127 The OSCE assessment was used effectively for assessing competencies such as attitude, empathy, and communication as part of a pain assessment in a variety of contexts (acute, low-back, and cancer pain). 55,73,109,110,124,127 The OSCE may currently be the most appropriate summative assessment for educators to use to identify students who may be at risk of poor performance in a clinical workplace environment and is used extensively within clinical medical education. 32,70,79,115 Careful attention needs to be paid to test content, design, and implementation factors such as wide sampling of cases, large numbers of stations and examiners, and good standardisation of patients to improve validity and reliability.…”
“…3 Further evidence that students, residents, and practicing physicians have a poor understanding of the assessment and management of cancer pain comes from studies at our institution. [6][7][8][9] In one study, the skills of 30 finalyear medical students in assessing and managing the severe pain of a cancer patient were tested using a five-minute patient interaction and a five-minute short-answer questionnaire concerning pain management. While the students did well in assessing pain-relieving factors, deficits in knowledge were found.…”
The Structured Clinical Instruction Module (SCIM) is an educational format developed for the teaching of clinical and interpersonal skills. The purpose of this study was to develop and pilot-test a SCIM to enhance medical students' learning and understanding about cancer pain assessment and management. The Cancer Pain SCIM was presented to 34 third-year medical students. Eight instructors and six standardized patients (five cancer patients) participated in the course. All participants evaluated the course using a five-point Likert scale (1 = strongly disagree; 5 = strongly agree). Students self-assessed their clinical skills before and after the course using a five-point scale (1 = not competent; 5 = very competent). Students agreed [mean (S.D.)] very strongly that the SCIM was a valuable educational experience [4.4 (0.56)] and that it was beneficial to use actual cancer patients in the SCIM [4.5 (0.63)]. Students believed their skills in the assessment and management of cancer pain significantly improved after the course. The SCIM is a valuable and novel instructional format to teach essential skills in the assessment and management of cancer pain to medical students.
Successful management of pain in the cancer patient requires careful assessment of the components of the pain complaint and accurate diagnosis of the cause of pain. Symptomatic management of pain involves pharmacotherapeutic strategies that focus on opioid use. Factors influencing the choice of opioid in patients with cancer pain include the severity of pain, the presence of coexisting disease, response to previous analgesic therapy, pharmacokinetic factors, available formulations, and patient compliance. Long-term opioid prescription always requires individual titration of medication to adequate pain relief, which is determined on an individual patient basis and/or based on manageable adverse effects. Failure to continuously monitor opioid use generally results in overtreatment or undertreatment of pain. The cognitive and psychomotor effects of long-term opioid therapy are not well-defined and merit further study.
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