Improving Pain Practices Through Core Competencies


  • Judy Watt-Watson RN, MSc, PhD,

    Professor Emerita, Senior Fellow
    1. The Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
    2. Massey College, University of Toronto, Toronto, Ontario, Canada
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  • Philip J. Siddall MBBS, PhD

    Senior Staff Specialist, Associate Professor
    1. Pain Medicine, HammondCare, Greenwich, New South Wales, Australia
    2. University of Sydney, Greenwich Hospital, Greenwich, New South Wales, Australia
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  • Disclosures: Judy Watt-Watson serves on the executive committee for the Interprofessional Pain Management Competency Program and in this role received an honorarium in the amount of $1,000 for her time developing the Pain Management Core Competencies for Prelicensure Learners over a time period of approximately 12 months.

Recent evidence reveals the continuing lack of pain content in health science curricula [1-3] despite the need worldwide to improve pain management practices. Comprehensive pain assessment and management is multidimensional and requires collaboration that reflects competencies in pain knowledge and skill attained by all health professionals. The Institute of Medicine has pointed to the need for health professionals to have greater pain knowledge and skills to participate in the cultural change needed to more successfully help people with pain [4]. As well, the World Health Organization has suggested that collaborative practice results in more effective health service and delivery and more positive patient outcomes [5]. However, collaboration will not occur if health professionals do not understand each others' roles and expertise and if they do not have a common language, for example, to discuss patient assessment and management issues. Although evidence for interprofessional education supports positive health outcomes, few health science programs offer the opportunity to learn common content together. Moreover, core competencies supporting basic knowledge and skills for all health professionals at the entry-to-practice level have not been found.

The International Association for the Study of Pain (IASP) has recognized the problem and published its first core curriculum over 20 years ago. Subsequent revisions also have provided the basis for uniprofessional outlines to facilitate discipline knowledge development [6]. Most recently, the IASP approved an Interprofessional Pain Curriculum Outline that was developed by a subgroup of their Education Initiatives Working Group [6] based on the IASP CORE Curriculum. This curriculum resource provides a common basis for different professions to learn the same language as well as a basic understanding of pain mechanisms and major biopsychosocial concepts important to all. This outline is to be used with health science students who are in their first professional program (pre-licensure/undergraduate/entry-practice level) to facilitate shared opportunities for students from more than one profession to learn together (e.g., dentistry, medicine, nursing, occupational therapy, pharmacy, physical therapy, psychology, and/or social work). The outline provides a basic overview of suggested topics for interprofessional learning that can be developed further and be implemented in a variety of ways considering the professions involved, patient populations being studied, and regional needs. Interprofessional pain education can be successful when it reflects real world practices and is integrated early in the educational experience [7].

We have excellent curriculum resources but statistics for unrelieved pain continue to be problematic. This dilemma raises two questions about why this is happening. The first is how to ensure that students receive adequate pain education. The second related one is how to guarantee that students can integrate what they are being taught into practice and graduate being competent in appropriate pain assessment and management practices. As Fishman et al. [8] state, the emphasis in educational processes has shifted from focusing on factual knowledge acquired by learners to what they are able to apply in varying and complex situations. Competency-based education moves the focus to the desired outcomes of the educational process rather than content [9]. Increasingly, we are recognizing that ensuring quality care outcomes requires an evaluation of competencies and not just the accumulation and dissemination of best evidence.

Pain competencies are measurable outcomes of learning that could be used by regulatory and accreditation bodies to influence health science faculty curricula and help ensure competent beginning practitioners. To help bridge the gap between the needed ability to manage pain in society and the skills and knowledge of the interprofessional health care team, an interprofessional group of North American pain experts participated in a consensus project funded by the Mayday Foundation. This process has resulted in a set of competencies that are parallel to and complement the existing IASP work, including the uniprofessional and interprofessional pain curriculum outlines. These core competencies are inclusive and can be used in a variety of ways both within and across diverse professions. They will play an important role in evaluating outcomes related to pain education and guiding curriculum development.

In conclusion, the lack of competencies related to pain has implications for advancing the skillful and ethical practice for all health professionals. The current project of providing pain competencies will improve the capacity for health care professionals to alleviate suffering, foster autonomy, and use resources justly. Influencing professional bodies to increase the number of required entry-to-practice pain competencies may ultimately have the greatest impact on education and pain management outcomes [10].