Basic Pain Medicine Training Guidance
for Schools of Anaesthesia in Scotland.
ST1/2 Basic Training
Supporting Advisory Documentation
This document has been updated to help traineesachieve core competencies in pain management at a basic level, as specified in theRCoA 2010 curriculum.
In two years, to achieve an end of unit sign-off for your pain block, you must:
Keep a Logbook of pain cases, clinics and regional blocks
Successfully sign-off (at a minimum):
• 8 consultant supervised acute pain rounds,
• 1 CBD, 1 A-CEX &1 pain-related DOPS
• 2 chronic pain clinics
• Initial pain assessment & management competencies
By the end of ST2, it is desirable:
To have attended 4 Chronic Pain Clinics
To have completed the Learnpro modules Chronic Pain Modules 1-5
To have undertaken an audit in pain management.
Training opportunities must be actively sourced.
Completion of this module is your responsibility.
Aims and objectives for basic training in pain medicine are outlined in "Curriculum
for Anaesthetics 2010," on the Royal College of Anesthetists website
( Annex B – Basic level training, B70-71, B-97 and B-100.
Briefly, these are as follows:
To be competent in the assessment and effective management of acutepost-operative and acute non post-operative pain
To acquire knowledge necessary to provide a basic understanding of themanagement of chronic pain in adults
Gain competence in the assessment of acute surgical and non-surgicalpain.
To have an understanding of chronic pain in adults
Basic Pain Medicine Training Guidance
for Schools of Anaesthesia in Scotland.
KNOWLEDGE (competencies PM_BK_01 to 09)
Recalls the anatomy and physiology of pain medicine to include nociceptive, visceral
and neuropathic pain
Describes drugs used to manage pain and their pharmacology [including but not
limited to opioids, NSAIDs, Coxibs, local anaesthetics and drugs used to manage
neuropathic pain]
Explains the principles of neural blockade for acute pain management Describes the
methods of assessment of pain
Explains the relationship between acute and chronic pain
Describes a basic understanding of chronic pain in adults
Explains the importance of the biopsychosocial aspects of pain
Describes the organisation and objectives of an acute pain service
Explains the limitations of pain medicine
SKILLS (competencies PM_BS_01 to 08)
Demonstrates the ability to assess manage and monitor acute surgical and non
surgical pain and side effects of medication (CEX)
Demonstrates appropriate and safe drug prescribing (CEX/DOPS)
Demonstrates the safe use of equipment used to manage pain including equipment
used for PCA, epidurals and inhalational techniques (CEX/DOPS)
Demonstrates the safe and effective use of local anaesthetic peripheral and regional
neural blockade techniques (DOPS)
Demonstrates the ability to manage severe unrelieved acute pain and distress in a
timely, safe and effective manner (CEX, MSF)
Demonstrates the importance of regular on-going monitoring of pain
management/follow up (CEX, CBD, MSF)
Demonstrates recognition of acute neuropathic pain (CBD)
Demonstrates the ability to communicate effectively with patients, relatives and carers
including advantages, disadvantages and side effects of pain management (CEX,
CBD)
ATTITUDES & BEHAVIOUR
Communication with patients, relatives, staff.
Rapid response to unrelieved pain.
Management with awareness of potential complications and side effects.
Awareness of limitations in pain management.
Making efforts to follow up patients on the wards.
Recognition of need for team approach and partnerships in a pain team.
WORKPLACE TRAINING OBJECTIVES
To prescribe appropriately for patients in pain awaiting surgery.
To prescribe pain management for patients after common surgical procedures.
To institute appropriate action to relieve pain quickly in recovery.
To become familiar and technically proficient with a variety of therapeutic methods
listed above
Basic Pain Medicine Training Guidance
for Schools of Anaesthesia in Scotland
OBJECTIVES WILL BE ACHIEVED USING THE FOLLOWING:
Ward and theatre based teaching, targeted references and web-based learning.
Logbook of pain rounds (Consultant or Clinical Nurse Specialist) & regional
local anaesthetic techniques performed as outlined above.
Competencies in using PCA (mandatory at 0-3months) and epidural pumps inyour hospital
2 written structured acute pain cases to be discussed as part of your
assessment. These cases should reflect the continuum of pain medicine
involving acute pain, chronic pain, and palliative care issues as relevant.
1 A-CEX
1 CBD
1 pain related DOPS, e.g. set-up PCA, epidural top-up
MSF
Pain Related Audit desirable
ASSESSMENT
Log Book review including review of recommended targets for pain rounds.
Review of pain case based discussions & WBPAs.
PCA and epidural pump use, competency tests completed and signed.
Specific review of the recommended method for assessment and managementof acute severe pain in a postoperative patient
Your local Lead Clinician for Acute pain or Educational Supervisor will be availablefor advice and sign-offs. Should you need further advice or guidance contact yourRegional Advisor in Pain Medicine.
WEB BASED RESOURCES:
1. West of ScotlandSchool of Anaesthesia.
2. Australian Evidence Based Guidelines for Acute Pain Management (3rd edition)
3.
BOOKS:
Acute Pain Management: A practical guide, P McIntyre B Ready.
Basic Pain Medicine Training Guidance
for Schools of Anaesthesia in Scotland.
INITIAL ASSESSMENT OF COMPETENCE
PUMP TRAINING/COMPETENCY RECORD
Unit of Training:Pain Medicine (ST1/2Basic Level)
Trainee:
NTN: RCoA-number:
Educational-lead:
This assessment must be carried out within the first 3 months of ST1 training and
prior to starting on-call duties.
It is envisaged that the Acute Pain Nurse would carry out the necessary pump training
on the PCA & Epidural equipment used in your hospital.
Once completed a copy should be kept by the trainee.
Another copy should be kept by the local educational supervisor/lead clinician.
PumpTypeDateHospital Signature
(Trainee)
Signature
(Trainer)
PCA (Specify):
Epidural (Specify):
Other (Specify):
The above named person has satisfactorily demonstrated understanding of and use of
the above named pumps at date of signing only. They must judge themselves
competent whenever dealing with these pumps.
Basic Pain Medicine Training Guidance
for Schools of Anaesthesia in Scotland.
Initial Assessment and Management of Acute Pain
Unit of Training:Pain Medicine (ST1/2 Basic Level)
Trainee:
NTN: RCoA-number:
Educational-lead:
You should be confident in these areas within the first few months of training. You
are encouraged to discuss the following sign-offs with consultants during theatre lists
or pain rounds. Time spent in the recovery room learning about pain assessment &
safe titration of opioid analgesia may be an alternative option.
Patient Assessment Date
Achieved
Trainer’s
Signature
Appropriate assessment and documentation of pain
Appropriate assessment of source of pain(s)
Exclusion of surgical problems in acute severe pain
Consideration of acute neuropathic pain
Assessment of Analgesia Date
Achieved
Trainer’s
Signature
Review analgesia given intraoperatively
Confirm patient’s analgesic requirements preoperatively
Check for allergies and contraindications
Confirm postoperative analgesia given
Management Date
Achieved
Trainer’s
Signature
Titrate an appropriate analgesic to effect
Demonstrate awareness of side effects
Reassess pain at intervals during therapy
Adjust prescription for ongoing analgesia
Communication Date
Achieved
Trainer’s
Signature
Communicate empathetically and reassure patient
Communicate with relevant staff on acute pain team
Accurate documentation in patient’s notes
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