A poor understanding of pain medicine by doctors and nurses significantly hinders optimal pain management. Limited evidence suggests that undergraduate pain education in medical schools is often inadequate, but this has not been comprehensively assessed in Italy. The Advancing the Provision of Pain Education and Learning (APPEAL) study, guided by an expert taskforce of pain and education specialists under the leadership of the European Pain Federation (EFIC®), is a Europe-wide review of pain education in all undergraduate medical schools in 15 countries. These findings have informed recommendations by the APPEAL Taskforce on improving undergraduate pain education. Here, we compare data on pain education between Italian medical schools and those in other European countries.
A cross-sectional review of undergraduate pain education in 2012–2013 (assessing its organisation, quantity and methods) was performed for all undergraduate medical schools in Belgium, Bulgaria, Denmark, France, Germany, Ireland, Italy, Netherlands, Poland, Portugal, Romania, Spain, Sweden, Switzerland and the UK. Information was sourced from curricula and websites (including school and government websites, student forums and university guides). Supplementary information was obtained via follow-up phone calls or emails.
Curriculum information was gained from 97% (n=242/249) of all medical schools in the 15 countries, including all 40 Italian schools. Curricula of all Italian medical schools (100%; 40/40) showed evidence of pain education. Among other countries this percentage varied between 60% in Bulgaria and 100% in seven other countries. In 78% (31/40) of Italian schools pain featured only within compulsory, non-pain-specific modules. This was similar to the level in Spain (75%) and the Netherlands (78%) and exceeded only by Ireland, Denmark and Poland (83–100%). Only 15% (n=6/40) of Italian schools had dedicated pain modules; this incidence varied across Europe, being highest in France (87%) and lowest (0%) in Belgium, Denmark, Ireland and Poland. Information on hours dedicated to pain teaching was available from only two Italian schools, giving a median 4.0 hours (range 2.0–6.0 hours) for compulsory non-pain-specific modules versus a European-wide median of 9.0 hours (1.0–60.0 hours). Italian schools used a mean of two methods for pain education (similar to the European-wide average), most commonly classroom-based methods (100%; 20/20 with available information), practical sessions (50%; 10/20) and case-based learning (25%; 5/20). Pain teaching was assessed in Italian schools principally by examinations (95%; 18/20 with available information), with only three schools (16%) using assignments and one (5%) using placements.
Undergraduate pain education in medicine is limited and inconsistent across Europe. Although all Italian medical schools provide some form of pain education, few offer dedicated pain modules and hence training occurs mostly within non-pain-specific courses. The focus on classroom teaching and testing by examinations might emphasise the recall of theoretical knowledge over the development of clinical competence. The APPEAL Taskforce has made three recommendations to improve pain teaching: establish a European-wide framework for pain education, introduce compulsory pain teaching for undergraduates, and improve the documentation of pain teaching.
