First ever Europe-wide study reveals that even when undergraduate medical students take a compulsory course on pain, they still only receive on average 12 hours' training.
There is an alarming lack of dedicated teaching on pain in undergraduate medical schools in Europe, according to the APPEAL (Advancing the Provision of Pain Education And Learning) study, the first Europe-wide study on pain education provision. Even when compulsory courses on pain are in place, they represent on average only 12 hours within an entire six-year degree programme - or just 0.2 per cent of the teaching medical students receive during their undergraduate studies.  The APPEAL study was presented at the annual congress of the European Pain Federation, EFIC(R) in Florence.
Currently under-diagnosed and under-treated, chronic pain carries a very high burden for individuals, health systems and economies, accounting for between 3 and 10 per cent of a country's Gross Domestic Product (GDP)., The findings of the APPEAL study suggest that the inadequacies in pain teaching leave future doctors unprepared to treat and manage pain.
"A lack of knowledge about pain among physicians has long been recognised as a key barrier to effective pain treatment and management," said Professor Hans G. Kress, President of EFIC(R). "This study shows us that at best, we are educating our medical students for only 0.2 per cent of their studies on how to deal with one of the most frequent problems they will encounter in medical practice."
Pain teaching not a priority
The APPEAL study, guided by a multi-disciplinary Taskforce of experts under the leadership of EFIC(R), and funded by Mundipharma International Limited, highlights that pain teaching is not a priority in undergraduate medical curricula. The study involved 242 undergraduate medical schools in 15 European countries and found that 82 per cent of these schools have no dedicated courses on pain that are compulsory for all students.
"With the exception of France and a handful of schools in other countries, which have made headway in the provision of pain teaching, there is a striking lack of dedicated teaching on pain across Europe," said Dr Emma Briggs, Lecturer, King's College London, and Chair, British Pain Society Pain Education Special Interest Group. "This raises the question as to whether the provision of pain education in undergraduate medical studies is fit for purpose to address the current and growing unmet public health need."
Pain teaching inconsistent
The APPEAL study found that almost two-thirds of all undergraduate medical schools (62 per cent) offer pain teaching only within other subjects - and that these subjects vary across schools. In addition, 27 per cent of medical schools that offer compulsory courses on pain, do not even document pain topics on the curriculum, making it difficult to assess where and how pain teaching is included in other subjects.
Teaching methods also vary across schools. Although the majority of schools (95 per cent) use classroom-based teaching, other teaching methods vary - only 48 per cent of schools use practical-based teaching and even fewer (26 per cent) use placement-based teaching.
Based on the findings of the study, the APPEAL expert Taskforce calls on medical schools, pain specialists, medical students and relevant policymakers to ensure that pain education for undergraduate medical students across Europe is fit for purpose to address the current unmet public health need to adequately manage and treat pain. More specifically, the expert Taskforce recommends:
- The establishment of a European framework for pain education, developed jointly by pain specialists and educators and drawing on the EFIC(R) Core Curriculum in Pain Management, to ensure consistency in pain teaching within the undergraduate medical curriculum and between medical schools in Europe
- The introduction of compulsory pain teaching for all undergraduate medical students in Europe, to enable them to acquire a defined minimum level of competency in pain and up-to-date pain management
- Improved documentation of pain teaching within the undergraduate medical curriculum, with clearly stated teaching content and defined student competencies in pain.
About the APPEAL study
The APPEAL study is the first ever Europe-wide review of pain education for undergraduates in Europe. Conducted by independent research company Adelphi Research in 15 European countries, the APPEAL study involved the review of publicly available curricula from 242 undergraduate medical schools. The APPEAL study goes beyond existing research by providing a more comprehensive analysis and understanding of pain learning. The research was conducted from April to September 2013 and is part of a Europe-wide initiative aimed at raising the profile and importance of pain education.