Original Articles Pain Management Practices by Internal Medicine Residents—A Comparison Before and After Educational and Institutional Interventions Emma Scott, MD, Uma Borate, MD, Stephen Heitner, MD, Mark Chaitowitz, MD, William Tester, MD, FACP, and Glenn Eiger, MD, FACP We aimed to improve internal medicine residents’ deficiencies in pain management and evaluate the effectiveness of our intervention, which included an interactive conference series, e-mail vignettes, and didactic sessions. An anonymous survey was adminis- tered at the beginning and at the end of an academic year, before and after the intervention, respectively. We analyzed 65 preintervention and 63 postinterven- tion surveys. Self-perception of competency in pain management increased from 40% to 60% (P ¼ .02). Perception of adequacy of training increased from 38.5% to 55.6% (P ¼ .05). Opioid conversion skills improved by 25% (P ¼ .02). Overall, knowledge did not change significantly, except in the subgroup of residents who had completed the oncology rotation from 0.60 to 0.72 (P ¼ .003). ‘‘Opiophobia’’ improved by 20% (P ¼ .05). Documentation of pain improved (rank cor- relation ¼ 21; P ¼ .02). We concluded that educational and institutional interventions administered over an academic year improved pain management skills and doc- umentation and reduced ‘‘opiophobia’’ among residents. Keywords: pain management; resident education; hospital standards; opioid conversion; opiophobia Introduction Pain management has been identified as an area in need of improvement in the clinical care setting for many years. 1 Despite the availability of a multitude of opioid and nonopioid analgesics and administration techniques, there is still an unacceptably high level of unrelieved pain in both the ambulatory and inpatient settings. 2-4 Multiple barriers exist that prevent effec- tive management of pain, the responsible parties including health care professionals, medical educa- tors, regulatory agencies, and patients. 5,6 Moreover, analgesic care delivered by residents during their graduate medical training is subject to inconsistencies in training that vary from program to program. 7 Deficiencies of knowledge and pain management skills among doctors of all levels have been reported. Physician factors include a fear of opioid side effects, including respiratory depression, decreased level of consciousness, and a fear of addiction. Why do these deficiencies in knowledge and skills exist? Literature on undergraduate medical training suggests that the focus on palliative care, end-of-life issues, and pain management has been neglected in the past. 8 A mod- ular course or rotation devoted exclusively to pallia- tive care was the exception rather than the norm as recently as 2000. 9 A movement to include pain man- agement and end-of-life issues in medical schools in the United States is currently underway. The Liaison Committee on Medical Education released a man- date in May 2003 stating that all medical students From the Albert Einstein Medical Center (ES, UB, SH, WT, LB, GE); and Thomas Jefferson University Hospital (MC), Philadel- phia, Pennsylvania. Address correspondence to: Emma Scott, Kline 3, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19147; phone: (215) 456-3488; e-mail: emma.c.scott@gmail.com. 431 American Journal of Hospice & Palliative Medicine 1 Volume 25 Number 6 December/January 2009 431-439 # 2009 Sage Publications 10.1177/1049909108320884 http://ajhpm.sagepub.com hosted at http://online.sagepub.com