Introducing medical students to paediatric pain management Ira Todd Cohen & Lauryn Bennett Context and setting Over the last 3 decades, the misunderstanding and undertreatment of paediatric pain has been repeatedly documented in the litera- ture. Trainees, doctors and nurses continue to demonstrate inadequate comprehension of existing evaluative instruments and appropriate treatment regiments. Although great strides have been made in the science and pharmacology of pain management, the dissemination and application of these advances is lagging. At a university medical centre a survey of medical students, who were completing their first year of clinical training, demonstrated a similarly low level of awareness and knowledge. Why the idea was necessary Optimal pain manage- ment in patients of all ages requires a thorough understanding of assessment techniques and man- agement strategies. Because medical school curricula cover a multitude of informational, cognitive and behavioural goals, little time or emphasis is placed on pain management in general and paediatric pain management specifically. The International Associ- ation for the Study of Pain, the American Medical Association, the European Federation of IASP Chap- ters and the Royal Australasian College of Physicians all recognise the need for the early introduction of pain concepts in medical training. They cite the advantages of an interdisciplinary approach that brings together the different domains of clinical medicine. Attempts to introduce pain-related know- ledge and skills later on, during specialty or sub- specialty training, have been unsuccessful. What was done A 9-minute problem-based learning (PBL) discussion incorporating mock pain assess- ment and analgesic treatment exercises was added to the paediatric rotation’s educational programme at a university medical centre children’s hospital. The activity was structured to encompass the following areas in paediatric pain management: development, assessment and pharmacology. Students were intro- duced to and encouraged to use different paediatric pain assessment tools including the Objective Pain Scales, the Face)Legs)Activity)Cry)Consolable (FLACC) Scale, Wong)Baker Faces and a vertical visual analogue scale. Approaches to treatment modalities such as oral analgesics, intravenous opi- oids, patient-controlled analgesia (PCA), and the World Health Organization’s Analgesic Ladder were examined during this facilitated interactive exercise. The advantages, limitations and side-effects of each method were compared and contrasted. Supple- mental reading and follow-up activities were provided and encouraged. Evaluation of results and impact Internal Review Board approval was obtained. Over 1 year, a total of 127 students participated in the paediatric pain PBL session during their rotations in paediatrics. Students completed pre- and post-tests, which examined developmental aspects of pain physiology, psychol- ogy, assessment and pharmacology. The pre-test consisted of single-answer multiple-choice questions (MCQs) to assess recognition and comprehension. The post-test consisted of multiple-answer MCQs (k-type) to assess application and synthesis. Scores in the areas of pain assessment and opioid pharmacol- ogy increased significantly between the 2 tests. The pass rate on a year-end paediatric pain knowledge survey improved from 46Æ7% to 76Æ2% (Yates correc- ted chi-square, p ¼ 0Æ001). Correspondence: Ira Todd Cohen MD, Associate Professor, Anaesthesiology and Paediatrics, Children’s National Medical Centre, 111 Michigan Avenue NW, Washington, District of Columbia 20010, USA. Tel: 00 1 202 884 5621; E-mail: icohen@cnmc.org doi: 10.1111/j.1365-2929.2006.02462.x Plastic surgery and the undergraduate medical school curriculum AR Parikh, A Clarke, PEM Butler Context and setting It has been acknowledged that the image of plastic surgery as portrayed by the media is of concern to all plastic surgeons. Television shows such as Nip ⁄ Tuck have outraged plastic surgeons and have strengthened further the stereotype that plastic surgeons do little but perform cosmetic surgery. This stereotype is widespread among the general public. Unfortunately, medical students are also unable to understand fully the diversity of the speciality and may share similar beliefs. Why the idea was necessary The undergraduate curriculum is currently very crowded. Most under- graduate deaneries treat plastic surgery as a speciality offering either very complex reconstructive proce- dures or cosmetic procedures. Subsequently, plastic surgery has been excluded almost universally from the undergraduate curriculum. This loss of teaching can only exacerbate the situation and damage the credibility of the speciality. Studies have shown that medical students do not feel sufficiently prepared for clinical practice. The transition from medical student to clinician often causes problems. Most students perceive a difficulty in applying theoretical knowledge to clinical practice. really good stuff 476 Ó Blackwell Publishing Ltd 2006. MEDICAL EDUCATION 2006; 40: 459–489