Effective teaching modifies medical student attitudes toward pain symptoms

Recent studies have raised the question of whether last year medical students and first year residents show an adequate attitude toward their patient’s pain as reflected by prescribed pain medication. Underuse of analgetics could be demonstrated in several studies even after a correct diagnosis of pain was made and has led to the term “oligoanalgesia.” Our study was aimed at evaluating the potential of improving student attitudes toward pain by changing the curriculum during the last year of medical education.

The study was designed as a prospective, randomized controlled, blinded cohort study. A recent change by law (2002) in the official curriculum (“Approbationsordnung”) made it possible to compare two groups of last year medical students who were trained in different curricula during a 1-year transitional period. One group received special training on various aspects of pain and analgesic therapy (new curriculum), while the other group followed the conventional curriculum (old curriculum) without further special training. Both students and examiners were blinded toward the study target. Measurement parameters were a clinical experiment with standardized patients (OSCE) and a key features test.

The study shows a considerable improvement of attitude toward pain in those students undergoing the new curriculum. This group demonstrated better OSCE results and significant improvement in key features tasks, and also outperformed the old curriculum group in the choice of analgesia.

Our results confirm the importance of humanistic attitudes in future doctors in addition to the traditional implementation of knowledge and skills. Changes in the medical curriculum can positively influence these attitudes.