An educational strategy for treating chronic, noncancer pain with opioids: a pilot test.

UNLABELLED: Chronic pain is common and can be devastating to the patient and challenging to the health care provider. Despite the importance of the topic, pain management curricula are incomplete in health professionals' training. We developed a longitudinal curriculum to teach therapy for chronic noncancer pain over four units and pilot-tested the teaching of one unit (opioids) to internal medicine residents. The educational strategies we used included didactic sessions, write-up of a management plan following a model, case discussions, and role-play group activities. We pilot-tested one unit (opioid therapy) in March 2008. We performed learner evaluations, using a pretest and posttest, a write-up plan following a model, and a learner knowledge questionnaire. Results showed significant improvement in knowledge. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain. PERSPECTIVE: This article demonstrates that multiple teaching modalities-including didactic lectures, case discussions, write-up of a management plan following a model, and role-play group activities-are effective methods of teaching internal medicine residents how to use opioids to manage chronic noncancer pain.

A repurposed tool: the Programme Evaluation SOAP Note.

CONTEXT: Doctors have used the subjective-objective-assessment-plan (SOAP) note format to organise data about patient problems and create plans to address each of them. We retooled this into the 'Programme Evaluation SOAP Note', which serves to broaden the clinician faculty member's perspective on programme evaluation to include the curriculum and the system, as well as students. METHODS: The SOAP Note was chosen as the method for data recording because of its familiarity to clinician-educators and its strengths as a representation of a clinical problem-solving process with elements analogous to educational programme evaluation. We pilot-tested the Programme Evaluation SOAP Note to organise faculty members' interpretations of integrated student performances during the Year 3 patient care skills objective structured clinical examination (OSCE). RESULTS: Eight community clerkship directors and lead clerkship faculty members participated as observers in the 2007 gateway examination and completed the Programme Evaluation SOAP Note. Problems with the curriculum and system far outnumbered problems identified with students. CONCLUSIONS: Using the Programme Evaluation SOAP Note, clerkship leaders developed expanded lists of 'differential diagnoses' that could explain possible learner performance inadequacies in terms of system, curriculum and learner problems. This has informed programme improvement efforts currently underway. We plan to continue using the Programme Evaluation SOAP Note for ongoing programme improvement.

Implementation of curriculum by family medicine fellows: what factors help and what factors hinder?

BACKGROUND AND OBJECTIVES: The need for change in medical curricula is increasing, due partially to tougher curriculum and evaluation standards. Participants in our academic medicine fellowship learn to develop curricula, but not all are successful at fully implementing them. This study looked for facilitators of and barriers to curriculum implementation by individual fellows. A literature review uncovered studies identifying institutional variables relating to successful curriculum innovation but little that identified variables pertaining to the individual curriculum developer. METHODS: We interviewed alumni of the curriculum development track of the Primary Care Faculty Development Fellowship at Michigan State University, asking what promoted or hindered their curriculum implementation. We analyzed interview notes to identify themes according to a theoretical framework. RESULTS: Common facilitators were (1) having a strong advocate, (2) perception of need for the curriculum by both fellow and institution, and (3) having a curriculum plan. Common barriers were (1) no time slot for curriculum, (2) fellow had left job, and (3) curriculum was too large or complex. CONCLUSION: Successful curriculum developers have powerful advocates of well-designed curriculum plans that address recognized institutional needs.

Facilitators' influence on student PBL small group session online information resource use: a survey.

BACKGROUND: In problem-based learning curricular research has focused on the characteristics of good facilitators and how they influence student performance and satisfaction. Far less frequently addressed has been the question of how PBL facilitators influence the small group session activity of students. We investigated the impact that facilitators' encouragement of use or non-use of the Internet would have on the students' use of online information resources. METHODS: Survey of student and facilitator perceptions of facilitator behavior and student use of online information resources. RESULTS: Students who used online information resources rated their facilitators' behavior as more encouraging, while students in groups who didn't use online information resources during problem-based learning small group sessions rated their facilitators' behavior as less encouraging. This result was statistically significant. CONCLUSIONS: Our study supports the role of the facilitator as an influence on medical students in small groups, particularly with respect to facilitator verbal behavior encouraging or discouraging student use of information technology in the problem-based learning small group session.