Educating medical professionals in managing chronic pain patients through a “supervised student inter-professional pain clinic” at Mercy Pain Center

Dr. Stephen Hull of the Mercy pain Clinic and Dr. Ling Cao of UNE's College of Osteopathic Medicine discuss chronic pain

Dr. Stephen Hull of the Mercy Pain Clinic and Dr. Ling Cao of UNE’s College of Osteopathic Medicine discuss chronic pain

Chronic pain is a serious health problem that affects about 100 million adults in the United States, with an estimated annual cost ranging from $560 to $635 billion. Yet current medical education regarding pain management is extremely lacking, which in part leads to insufficient pain care. The recently published National Pain Strategy recognized “Professional Education and Training” as one of the six major objectives and action plans that should be focused on in the “effort to reduce the burden of pain in the United States”. This is aligned with the mission of healthcare education at the University of New England (UNE).

UNE is Maine’s largest private university and a home to the College of Osteopathic Medicine, Maine’s only medical school, the College of Pharmacy, the College of Dental Medicine, and the College of Health Professions (which includes programs such as physician assistant, physical therapy, occupational therapy, nursing, and social work). UNE is striving to provide all professional students integrated learning experiences, as demonstrated by the establishment of the Inter-Professional Education (IPE) Collaborative. UNE also houses a significant numbers of pain researchers, highlighted by the NIH/NIGMS-funded Center of Biomedical Research Excellence (COBRE) for the Study of Pain and Sensory Function (since 2012). UNE COBRE faculty believe that to improve the training on chronic pain management, there needs to be more of an emphasis of learning in a clinical setting. Particularly, emerging evidence has recognized the value of inter-professional team-based practice models in managing complex conditions, such as chronic pain. Thus, in a recently conducted UNE Scholarship of Teaching and Learning (SoTL) mini-grant awarded project, Dr. Ling Cao, Associate Professor at UNE’s College of Osteopathic Medicine, took advantage of UNE’s unique mix of health profession educational programs, commitment in pain education/research, and UNE’s partnership with the Mercy Pain Center (Portland, Maine) and piloted and evaluated an education program “supervised student inter-professional pain clinic”, in the spring of 2016.

During this pilot run (February – May 2016), with the enormous help from faculty within each health profession, two inter-professional student teams were assembled that included students from the following 5 professions: osteopathic medicine, nursing, occupational therapy, pharmacy, and social work across from three colleges at UNE, College of Osteopathic Medicine, College of Pharmacy and Westbrook College of Health Professions. Throughout the training program, each team worked with one chronic pain patient under the supervision of Dr. Stephen Hull, Director of the Mercy Pain Center, Portland, ME. Click here to watch a short video by Dr. Hull outlining his experience working with chronic patients in an interprofessional format.

Each team of interprofessional students conducted the initial evaluation, generated treatment plans, and conducted follow-up examinations for its patient. Team members participated in a total of three 2-hour long group meetings, prior to meeting with their patient, after initial appointment with their patient, and after the follow-up appointment with their patient. At each of these team meetings, the team-selected student leader chaired the meeting and Dr. Hull along with faculty advisors from each participating health profession provided valuable input during the team discussion. At the end of students’ clinic participation, both teams debriefed their experience during their final team meetings and presented their experience to the UNE community on May 6, 2016.

At the final debriefing meeting with all participating students, Dr. Hull and available faculty advisors from each profession, and all participating students spoke highly about the training program and emphasized the values of “real” patient contact, built-in follow-up examination with the patient, and meaningful team interactions. They also expressed the wish to see more patients in the future to get a better sense about the demographics of chronic pain patients. Preliminary results from student surveys a trend of improvement in 1) students’ knowledge in the neurophysiology of pain (measured by the “revised neurophysiology pain questionnaire”), 2) interprofessional education perceptions scale (IEPS) that measures participants’ “professional competence & autonomy”, “perceived need for cooperation” and “actual cooperation”, and 3) the modified team skill scale (TSS) that assesses students’ team skills. The results from patient surveys showed that both participating patients enjoyed their experience with respective student teams, believed they had learned a great deal about chronic pain during this experience, and loved the opportunity of contributing to medical education. Both participating faculty advisors and Dr. Hull expressed their willingness to contribute to this training program again in the near future.

 

Dr. Cao would like to sincerely thank the funding support from the SoTL award and believes that the pilot study provided valuable information on the feasibility and effectiveness of this approach. As a result, Dr. Cao and her team would like to expand this program by adding more inter-professional teams and conducting more comprehensive outcome analyses. The team would like to improve the diversity of this program by establishing similar training programs with multiple pain clinics and pain specialists in the region. The ultimate goal is to incorporate this innovative educational program to the current curricula within the various health educational programs as well as in UNE’s IPE program.

 

UNE students present their experiences working together at the Mercy Pain Clinic

UNE students present on their experiences working together at the Mercy Pain Clinic. L-R: Anna-Marie Brown (OT), Kelly Dell’Aquila (SW), Kelcey Ladner (SW), Jenny (Chen Chun) Chiang (COM), Ethan M. Duane (COM), Richard Zheng (COM), Katie Rogers (COP), Nichole Bell (OT), Samantha Beckwith (Nursing), Sophia Chan (COM), Ling Cao (COM faculty) On screen left to right: Peter-John Trapp (COP), Jacklyn Waterfield (OT), Jennifer Madore (SW)

 

FMI: Please contact Dr. Ling Cao, lcao@une.edu, 207 602-2213

 

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