SEA UK Project Grant
Development and validation of an instrument to assess the quality of the pain education environment for anaesthetic trainees
Dr Helen Laycock
Pain is common. A large number of patients in hospital experience pain during their admission. The causes are multifactorial and probably include inexperience in pain management and shortfalls in relevant knowledge amongst junior doctors. This may reflect limited exposure to the principles and practice of pain management during undergraduate programmes. This limited exposure within the undergraduate curriculum is only partially addressed once they become doctors, with evidence suggesting scope for improvement in early postgraduate training.
Anaesthetists are experts in pain management, treating pain frequently as part of their daily work, during and after operations or by advising other doctors on complex and difficult pain problems. Therefore doctors who start anaesthetic training demonstrate a knowledge gap between their initial understanding of treating pain and the knowledge required as a trained anaesthetist, 'the specialist'. This warrants standardised training for anaesthetic trainee doctors in pain management across the UK. In reality training is varied, depending on the hospital a doctor works in, and can range from timetabled dedicated classroom teaching, to a less focused 'off the cuff' discussion during an operation.
Pain education for anaesthetic trainees needs to improve. However the first step is not about creating an engaging teaching session that inspires learning. The first step involves understanding and delivering that teaching in a quality learning environment. The learning environment is the location in which the learning occurs. However it includes more than just the physical environment surrounding the teacher and learner. It involves multiple factors including the supervision and support a learner receives and the opportunity to make decisions. Together these influence the information someone gains from teaching and their ability to incorporate it into clinical care. Learning about pain can occur in numerous settings (in lectures, in theatre, on wards). The quality of each of these settings as a learning environment requires assessment to ensure doctors are learning in the most effective setting. Quality is normally assessed using questionnaires designed specifically to answer this question. Questionnaires have been designed to assess the quality of the learning environment for a number of different clinical settings (wards, operating theatres) and for a number of different types of doctors (anaesthetists, surgeons, newly qualified doctors). Unfortunately those currently available may not be useful in assessing the learning environment specific to pain education.
This study aims to develop an assessment tool specific to assessing the quality of the learning environment for pain education. Well-established methods for development and validation of such a tool will be utilised including reviewing the current evidence, specialist and trainee evaluation and finally statistical analysis to ensure its reliability. This tool will provide anaesthetists with the ability to identify effective locations based on quality, for learning to occur. This understanding will help target formal standardised pain management education across the UK, ensuring all anaesthetists leave training with excellent knowledge in pain management.
