Training them early EPM Lite Bridging the gap in Undergraduate Pain Training Helen Makins Consultant in Pain Medicine, Gloucestershire Hospitals NHS Foundation Trust Sailesh Mishra Consultant in Pain Medicine and Anaesthesia, Newcastle University Hospitals

EPM Lite What is it and why is it needed? Background to the course and Faculty of Pain Medicine involvement UK Pilot National uptake (Newcastle example) Making it work What next?

Do you recall receiving specific, formal undergraduate training in the multidisciplinary management of pain? Yes/No

Do you feel that your personal undergraduate training in Pain Management was adequate? Yes/No

Do you feel that UK undergraduates in all healthcare professions currently receive adequate training in the multidisciplinary management of pain? Yes/no

How it all started Australian and New Zealand College of Anaesthetists Roger Goucke Wayne Morriss First Course in Papua New Guinea in 2010 SE Asia, Mongolia, Pacific Islands, Uganda, Rwanda 2013 UK EPM working group – Africa Development of EPM Lite – Linda Huggins

What is EPM Lite? Essential Pain Medicine Lite Half day course For medical students Appropriate for all medical professionals Bridges a gap between theory and practise Standardised, multidisciplinary approach Acronym UK med students at present but completely adaptable for all professionals – at undergrad and postgrad level Physiology/pathophysiology/pharmacology well taught Translating the facts into managing a patient not formally or universally taught

What EPM Lite covers What is pain and why treat it? Classification of Pain Pain physiology and pathology Treatment Management

Management “ABC” approach Recognise Assess Treat

Faculty of Pain Medicine Royal College of Anaesthetists 2008 Chief Medical Officers Report highlighted need for improved Pain Education <1% of training time at undergraduate level spent on pain* Project for medical schools in the UK To reflect the biopsychosocial nature of pain and the multidisciplinary approach to management Standardised approach * Briggs et al; Survey of Undergraduate Pain Curricula for Undergraduate Healthcare Professionals in the UK https://www.britishpainsociety.org/static/uploads/resources/files/members_sig_edu_short_report_survey.pdf 2008 – plight of patients with pain highlighted by Sir Liam Donaldson First recommendation was improved education in Pain management for all undergraduate healthcare professionals Physios and vets have more training time at Uni than Doctors or nurses Standardised teaching means all professionals managing and understanding in a similar way resulting in improved communication and care

Course Materials Student manual Instructor manual Slide set Evaluation form Certificate of attendance All materials provided – only familiarisation needed

All resources available on RCOA website

Bristol Pilot 2014 Enthusiastic Year 4 curriculum lead 4 teaching sessions throughout the year Anaesthetic module 60 students each session Year 4 curriculum lead for Bristol Uni happened to be an Anaesthetist – always useful to have a friend or contact

Session Structure Total length 3 hours MCQ at beginning and end Time Duration (mins) Lecture / Discussion Instructor/s 14.00-14.15 15 Welcome, Introduction & Pre-test Helen 14.15-14.35 20 What is pain and why should we treat it? (a) All – small groups 14.35-14.45 Classification of pain Mike 14.45-15.00 Pain physiology and pathology - revision Sarah 15.00 -15.20 Tea   15.20 -15.35 Pain Treatment Overview 15.35-15.45 10 RAT approach to pain management Ann 15.45 -16.35 50 RAT approach to pain management (b) 16.35 -17.00 25 Post-test, answers & feedback (c) Total length 3 hours MCQ at beginning and end 2 small group sessions totalling 1h 10mins 20 minute tea break Otherwise lecture based

What the students said Content was generally useful Level was mostly right although some felt too simple Liked the small group discussions Opportunity to learn from experienced physicians was very enjoyable Understanding improved

Tutor Reflection Lectures too long but content needed to remain to cater for all knowledge levels Small group sizes were good – max 15 students Pre-course information hadn’t been read MCQ questions were pitched incorrectly

2015 Revisions Curriculum all changed Anaesthetics all taught in the Academies Fought for our spot Central Study days in year 3 Had to teach the whole year (240 students) together

New timetable Small group session time increased to 1hour 30 mins Incorporated an additional small group session on the use of opiates in pain management – using case studies and with points to cover for tutors Re-vamped MCQs No food or drink!

The Venue More like a wedding venue than a teaching environment Bearing in mind the wish to increase the small group element, it was a challenge to achieve this with 240 students in one room Email contact list of all those who might be interested in helping – nurses and Doctors – Consultants, Anaesthetic Trainees, Pain Specialist Nurses (prescribers) Ended up with 17 tutors and groups of max 14 students

Feedback Generally extremely positive Lecture length good Experienced tutors valued Small groups allow flexibility MCQs too long MCQs pre and post for evaluation and assessment reasons – technology failed! Long and boring to go through the same test 3 times. Flexibility of small groups good to cater for all levels of knowledge, making session challenging for all

Sailesh’s part here

Uptake so far Aberdeen Bristol Birmingham Edinburgh Leeds Newcastle Nottingham Oxford Plymouth St Andrews Plenty of gaps!

Next…….. Tutors needed for all existing programmes Local leads needed for Medical Schools in other regions Find an opportunity Adapt to local need We will support Existing programmes need help to run – especially if teaching multiple times per year. Those areas not yet covered, we would be happy to assist anyone who is enthusiastic to get started Fitting it into the curriculum may be the hardest part Use contacts/networks to approach the University for direct inclusion in curriculum Teach during the Anaesthetic module – centrally or through academies/individual hospitals

Other Healthcare Professionals Use the resources Adapt accordingly Improve management of pain in your Institute or Department We will support

Please get in touch Faculty of Pain Medicine website Jchand@rcoa.ac.uk Helen.makins@glos.nhs.uk Mike.oconnor@btinternet.com