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Acad Med. 2017 Nov 14. doi: 10.1097/ACM.0000000000002053. [Epub ahead of print]

Medical Trainees' Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education.

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1
K. Rice is a postdoctoral fellow, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. J.E. Ryu is a medical student, Faculty of Medicine, University of Toronto, Toronto, Canada. C. Whitehead is director and scientist, Wilson Centre, University Health Network; associate professor, Department of Family and Community Medicine, University of Toronto; vice president for education, Women's College Hospital; and BMO Financial Group Chair, Health Professions Research, University Health Network, Toronto, Canada. J. Katz is professor, and Canada Research Chair in Health Psychology, Department of Psychology, York University, Toronto, Canada. F. Webster is associate professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; scientist, Wilson Centre, University Health Network; and academic fellow, Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada.

Abstract

PURPOSE:

Evidence suggests that physicians' opinions about chronic pain patients become progressively negative over the course of medical training, leading to a decline in empathy for these patients. Few qualitative studies have focused on this issue and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula.

METHOD:

This study adopted a descriptive qualitative interview-based approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating chronic pain patients, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, training in treating patients with chronic pain specifically, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015.

RESULTS:

Most interviewees described the management of chronic pain patients as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure these patients left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value.

CONCLUSIONS:

Because chronic pain is subjective and incurable, listening and communication skills become crucial for patient care. Based on study data, the authors contend that chronic pain patients present an often missed opportunity to teach empathy-related skills through practice.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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