Assessment of pain management skills in emergency medicine residents: the role of a pain education program

Abstract

A prospective study of Emergency Medicine (EM) residents was conducted over two consecutive 1-month periods at a rural tertiary-care teaching hospital with a residency in EM to evaluate the effect of a 4-h pain management education program on the assessment and management of acute pain in the emergency department (ED). All patients presenting to the ED with an acute, painful condition were eligible to participate in the survey. Patients were excluded if they had taken any pain medication within 4 h of presenting to the ED, or had any condition requiring immediate resuscitation, suspected cardiac pain, or pain from a potential surgical abdomen. Baseline and 30-min pain scores were evaluated using a 100-mm, unnumbered visual analog scale (VAS). A 4-h pain management educational program (EP) aimed toward the EM residents was conducted. Comparisons were made with respect to the overall treatment of pain as evaluated by the change in VAS score between baseline and 30 min as well as the global assessment of treatment. A total of 126 surveys were completed, 54 before (Group 1) and 72 after (Group 2) the EP. The mean ΔVAS score for patients in Group 2 was significantly better than the ΔVAS score for patients in Group 1. Only 65% of the patients studied before the EP had significant reduction in their pain scores after 30 min in the ED; after institution of the EP, 92% had a significant reduction in their pain scores at 30 min. Similarly, a significant improvement was seen in the patients’ global evaluation of treatment after the educational program was instituted. It appears that the use of a 4-h educational program on pain assessment and management directed toward EM residents in their training can improve their skills at recognizing and treating painful conditions.