Education for APPs Healthcare Clinicians

There is well-documented evidence of the need for increased pain management education for physicians (Shipton, et al., 2018; Tran, et al., 2018). The Institute of Medicine (Institute of Medicine, 2011) and the National Pain Strategy (Von, et al., 2016) have called for better training for all healthcare clinicians.

As the number of Advance Practice Providers (APPs) who move into specialty pain practices increases, and even for those in primary care, the question should be asked, “What is known about the state of APPs’ needs regarding pain education?”

• According to the American Association of Nurse Practitioners (AANP), “The last AANP Member Educational Needs Assessment distributed in February/March 2020, received over 6,000 responses and found that about 1 in 5 (19%) of clinically practicing NPs indicated pain management was an area they would like additional continuing education in. Pain management ranked in the top 10 (specifically, 8th) areas members requested additional resources on.” (C. Tracy, personal communication, July 14, 2020).
• Data from the 2016 Physician Assistant Education Association’s Support to Advance Research grant, of the 209 programs surveyed, 14% reported that pain management is excluded from the curriculum, and 3% reported that it is a stand-alone module (Yealy, et al., 2019).

There is a lack of information known about the education in pain management provided in primary APPs training, and how prepared these clinicians are to provide basic pain management after graduation.

A pilot study was undertaken by this author (Mallick-Searle, et al., 2021) as a first attempt to assess the current state of pain education for advanced practice registered nurses (APRNs) and physician assistants (PAs) as reported by novice and experienced clinicians, and to present the opportunity to enhance pain management education for future clinicians.

A Call to Action (Pain Education) – Survey Results

• 69% of respondents had been practicing for 5+ years. Of the respondents, the majority report < 5 hours of pain management education in their primary training. This is even less than the 11 hours reportedly received in medical school in the U.S. (Shipton, et al., 2018).
• Most of the respondents report on the job training as their primary mode of education, followed by self-directed ongoing continuing education activities.
• 46% report they spend at least 50% of their time managing pain. Of those, 15% work in a pain management or palliative care specialty. The remainder work in other specialties, with the majority working in family/internal medicine.
• An interesting finding was that of those that reported primary care/internal medicine/surgery as their practice specialty, collectively they reported less time spent on pain management than their peers in other specialties.
• Finally, in preparation to care for patients with basic chronic or acute pain management needs, 66% felt “neutral or unprepared” to do so, in their first year in clinical practice.

This is a first attempt to look at the educational need for pain management at a national level, from the perspective of perceived readiness to practice, from individual APRNs and PAs, looking at both the novice and more advanced clinicians.

These initial findings call for a transformation within APRN & PA education and training regarding pain management. For those who focus their careers on pain management as a specialty, a system for certification would help to facilitate a metric of quality control, and further delineation of competency in practice.

References

• Institute of Medicine. 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press.
• Mallick-Searle T, Jackson H, O’Brien S. Educating Providers of Advanced Practice in Pain Management: A Needs Assessment. Poster presented at the 2021 American Academy of Nurse Practitioners National Conference; June 15-June 20. Poster 53.
• Shipton EE, Bate F, Garrick R, Steketee C, Shipton EA, Visser EJ. Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain Ther. 2018;7(2):139-161.
• Shipton EE, Steketee C, Bate F, Visser EJ. Exploring assessment of medical students’ competencies in pain medicine-A review. Pain Rep. 2018;4(1):e704.

• Tran UE, Kircher J, Jaggi P, Lai H, Hillier T, Ali S. Medical students’ perspectives of their clinical comfort and curriculum for acute pain management. J Pain Res. 2018;11:1479-1488.
• Von Korff M, Scher AI, Helmick C, et al. United States National Pain Strategy for Population Research: Concepts, Definitions, and Pilot Data. J Pain. 2016;17(10):1068-1080.
• Yealy JK, Martinasek M, Doran T. The Current State of Physician Assistant Pain Curriculum: A National Survey. J Physician Assist Educ. 2019;30(1):20-26.

Theresa Mallik-Searle is an Adult Nurse Practitioner with over 28 years of experience at Stanford Health Care in Palo Alto, Ca. Her clinical practice within the Division of Pain Medicine focuses on evaluating and treating individuals suffering from acute and chronic pain conditions in hospital and outpatient settings. Her sub-specialty is diagnosis and management of chronic headaches. She lectures extensively on surrounding pain management both locally and regionally. She has also authored and co-authored numerous articles, abstracts, and book chapters on pain assessment and management topics.

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