|Welcome to the December 2017 Essential Pain Management Newsletter. We have information on resources, recent workshops, upcoming events.
Following the successful MOU on Trademarking between ANZCA and the WFSA we hope to use this relationship to promote EPM more widely (especially in Africa). A joint approach to publicity, funding, evaluation and delivery of EPM will allow expansion of pain education across the globe.
EPM resources available
The following resources are available on the EPM website to use during and after courses and in the promotion of EPM.
EPM flyer– The flyer has general information about EPM
EPM reference bookmark (updated) – The bookmark outlines the RAT acronym on one side and has the Faces Pain Scale on the other
EPM promotional videos – The following short videos are available for viewing and promoting EPM
- EPM in Argentina – In this video, instructors and participants at an EPM course in Argentina discuss the EPM program and why it works so well (with English subtitles).
- Alu’s Story – This video follows anaesthetic registrar Alu Kali from Papua New Guineaas he participates in the Essential Pain Management (EPM) courses.
- EPM in PNG – In this video EPM instructors and participants in Papua New Guinea discuss how the program works and why there is a need for such a program in PNG and across the world.
EPM App – The EPM app for both iPhone and Android is available for downloading. Search for <essential pain management> in the App Store or Google play.
EPM workshop material
- 1-day workshop manual – the second edition is now available in both English and French
- 1-day course slide set – the second edition is now available in both English and French
- EPM Lite course manual second edition (updated March 2017)
- EPM Lite course slide set second edition (updated March 2017)
The following course material is available on request email@example.com
- 1-day course instructor manual
- EPM Lite course instructor manual
- EPM completion certificates
- EPM Pre and post test sheets
- EPM evaluation spreadsheet
The EPM Facebook page regularly has EPM updates and articles of interest, photos and course reports. Please follow, like and encourage EPM participants to take a look at the Essential Pain Management Facebook page.
EPM around the world
A co-ordinated approach for EPM in the Pacific continues, using Counties Manukau District Health Board Pacific Health Development team, Auckland, NZ, and linking with ANZPM Pacific Palliative Care working group, the APHN Pacific SIG and APLI.
Dr Linda Huggins now has an official University of Auckland appointment to teach EPM through the Faculty of Anaesthesiology – congratulations Linda!
Our colleague Dr Carolina Hylock Loor in Honduras provides this update from this region.The Essential Pain Management course has been in a constant expansion in Latin America since the first course in 2012 at San Pedro Sula, Honduras. It has now spread to 13 countries (from Mexico, to Central and South America), 36 courses have been taught, received by 902 attendees, and trained 121 anesthesiologists as EPM instructors. Many of whom have actively multiplied the courses in their own countries.
In 2008 the WHO stated that 80% of the worlds population is lacking or has poor access to pain relief alternatives for moderate to severe pain. EPM has been helping in the region to narrow this existing global gap. The aim is to improve knowledge and change practice through Recognize, Assess and Treat pain. Using the systematized approach taught in the EPM course allows attendees to speak the same language in essential pain management, and encourages them to tailor their institutional protocols and overcome different local barriers for the benefit of their patients.
A big step forward in the EPM journey in Latin America has been the introduction of the EPM lite course to undergraduates in medical schools as part of the curricula. This is a lot of work but a worthy job to do for the common good.
The United Kingdom
The UK EPM Advisory Group at the Faculty of Pain Medicine together with the World Federation of Society of Anaesthesiologists, St Mary’s Hospital in Lacor, Uganda and Kumi Hospital, Uganda, have been awarded a funding grant from the Tropical Health Education Trust (THET) to run a year-long programme of EPM workshops in Uganda which will incorporate some in depth evaluation of the project.
Dr PP Chen writes, following the pilot EPM Train-the-trainer workshops held in March 2017, another series of EPM lite workshops were successfully held in Hong Kong on 6th – 8th September 2017. A total of 182 participants completed the EPM Lite workshop, of which 36 underwent further Train-the-trainer courses to become EPM Lite instructors. The participants came from different disciplines including doctors, nurses, physiotherapists, occupational therapists and clinical psychologists. We received very positive feedback from the participants about the well-structured curriculum, and succinct teachings on pain management, as well as the focus on a multidisciplinary team approach through group discussions with other health professionals. The Organising Committee is grateful for the guidance and contributions from Dr Roger Goucke, Dr Michael O’Connor, Dr Mary Cardosa, Dr Timothy Brake, and other local faculty.
The future of EPM in Hong Kong looks extremely promising, as a governance structure for this programme has just been established under the Hospital Authority (HA)’s Committee on Pain Management Services. Regular EPM lite workshops targeting multidisciplinary frontline healthcare professionals are expected to be rolled out in all seven HA health service Clusters in 2018. In the meantime, the Hong Kong Pain Society has also agreed to coordinate and run EPM workshops targeting healthcare professionals outside HA.
Jocelyn Que from the University of Santo Tomas and Dolma Santos from the Pain Society of the Philippines have provided this update. Since 2015, the Pain Society of the Philippines has run 28 EPM courses across the Philippines. These courses have trained 1058 health professionals including doctors, nurses and allied health professionals. Senior EPM champions in the Philippines continue to receive positive feedback about the program from both participants and instructors. In relation to change in practice as a result of EPM, the following comments have been noted –
“After EPM was run in our hospital, our Pain service has been receiving increased in number of referrals for pain management.” (in Cebu City and in Davao city)
“Nurses who have attended the workshop have started to include pain assessment whenever vital signs are being monitored and recorded.”
– Both the Pain Society of the Philippines and the University of Santo Tomas continue to run EPM programs in Metro Manila and beyond in the quest to improve pain management in the Philippines. The number of senior medical students who have been taught EPM Lite is now 512 students from UST.
EPM Indonesia 2017
Professor Eddy Rahardjo and Dr Herdiani Sulistyo Putri from the Dr Soetoma Hospital in Surabaya are our very busy EPM champions in Indonesia and have sent this update from their 2017 activities.
This year we held 5 EPM courses in Indonesia.
Palembang, South Sumatra 10 – 12th March 2017 we held 3-days EPM workshops with 5 instructors from Surabaya. We collaborated with The Indonesian Society of Anesthesiology and Intensive Therapy, South Sumatra Branch. There were 23 participants in the first day and 17 participants for the Instructor workshops. On the third day, instructors were divided in to three different groups to learn how to run and teach an EPM course. There were 70 participants on the third day.
Jember, East Java 17 – 19th March 2017 we held 3-days EPM workshops with 4 instructors from Surabaya and 2 instructors from Jember. We collaborated with The Indonesian Society of Anesthesiology and Intensive Therapy, East Java Branch. There were 126 participants in the first day. This was the very first time in Indonesia we had such avery large amount of participants in one day, so we had to use a Hotel Ballroom. On the second day we had 15 participants for the Instructor workshops. On the third day, instructors were divided in to three different groups to learn how to run and teach an EPM course. There were 100 participants on the third day.
Jayapura, Papua 12 – 14th July 2017 we held 3-days EPM workshops with 4 instructors (2 from Perth, Australia; 1 from Makassar and 1 from Surabaya). We collaborated with The Indonesian Society of Anesthesiology and Intensive Therapy, Papua Branch. There were 24 participants in the first day and 12 participants for the Instructor workshops. On the third day, instructors were divided in to three different groups to learn how to run and teach an EPM course. There were 91 participants on the third day. We are grateful for financial support from RACS.
Surabaya, East Java 3rd August 2017, In conjunction with the 5th National Meeting ISAPM (Indonesian Society of Anesthesiology for Pain Management) in Surabaya, we held one day EPM course for GPs. There were 42 participants and 4 instructors (3 from Surabaya and 1 from Jember).
Sidoarjo, East Java 4th November 2017, we run one day EPM workshop in collaboration with Delta Surya Hospital in Sidoarjo. The participants came from different divisions in the hospital such as ward nurses, pharmacists, GP and midwifes. There were 35 participants and 4 instructors from our department in Surabaya.
EPM workshops during the last six months
Summary acknowledging the programs and instructors involved in EPM workshops during the last six months:
*Unreported in previous newsletter
EPM workshops in the planning stage
EPM Evaluation Report
Over the last few years we have been trialling a number of evaluation techniques. These have included collecting data on the number of courses run in each country, number of countries running courses, number of instructor courses run and numbers trained. We have also collected a large amount of pre and post test data. Two years ago we embarked, following a review of our processes, on a more structured evaluation system. Dr Mike O’Connor from Bristol in the UK has been collating data sheets returned to him and has prepared this early evaluation report. If readers of the newsletter wish to use the new evaluation system in your own Teaching (and we encourage you all to do so) please firstname.lastname@example.org or email@example.com
The evaluation spreadsheet
- Is producing useful data about where EPM is needed and where the course needs improvement.
- Generally worked well both globally and in UK medical schools
- Globally (3 day courses outside the UK) elements were missed or adapted, for example, on occasion the MCQ results and Delphi walls were incorporated into the report rather than standing alone in the spreadsheet. It may be that this is a better option. We need to ensure that we do not overburden trainers with duplicating paperwork. It also suggests that a local leader and a member of the visiting faculty should take joint responsibility for evaluation. There is an area for further discussion (already started) about tidying up paperwork to avoid overburdening trainers and producing a manual for running the course (in progress).
- In the UK medical schools the spreadsheet is at the early stages of introduction
and takes a little getting used to, trainers using it for the first time missed elements
such as allowing time for post-course MCQs. This will settle down with familiarity.
- Continue to demonstrate misunderstandings about opioids in all kinds of pain. Globally, pre-existing knowledge was poor and did not much improve after EPM!
- Q1b (an oral opioid is appropriate for an open fracture of the hand) is often answered
incorrectly. Partly because there has been confusion between ‘comminuted’ and ‘compound’. Partly because local practice would not be to give intravenous opioids in this situation (particularly in resource limited environments). In many places practice seems to be to give oral opioids, but is this more or less safe than an intravenous opioid even in resource limited environments? Should we change the question or use it as a basis for discussion – particularly as a barrier?
The Delphi walls (free text feedback)
- Show that participants like the course; of the 395 comments, 306 were about things participants learned or liked.
- Comments made about how to improve the course were valuable and point the way to adapting the course to more senior staff, with experience of pain management, for example, qualified doctors in training grades.
- A large number of comments made about how to improve the course were from medical
students about the electronic voting system in Bristol. This reflects trying to adapt to teaching very large groups at one time.
What participants liked and learned
Expertise and charisma of teachers
Structured case discussions
Clear interactive lectures
Multidisciplinary case discussion
Concept of pain and classification of types of pain
The RAT model
Application to daily clinical practice:
Non-pharmacological pain management
The WHO ladder
Pain management reduces hospital stay
What participants thought needed to be improved
Problems with Turning Point voting technology for Bristol Medical Students
The majority of the other comments were about venues: ease of access, temperature, catering.
Increased multidisciplinary involvement, from places where there were mostly doctors
involved, plus suggestions for greater involvement of e.g. pharmacists
Most trainer comments have come from UK medical school teaching
The ‘3 questions’ don’t work well for year 3 medical students
Some apparent unprofessional behaviour related to use of mobile phones during lectures
Feedback from Newcastle Experience (13 half a day workshops covering approx.
200 final year MBBS students over 2 academic years)
- Students Like RAT nomenclature
- Students don’t like long PowerPoints, within minutes they are looking at their phones…
- They have very poor understanding of pain pathway and mechanism of action of drugs
- Hence making it interactive flip chart drawing of pain pathway and mechanism/ site of action of drugs engages their attention
- Reinforcing of the non-pharmacological strategies RICE is important.
- Educating future doctors about rational prescription of opioids is crucial
- Students like case examples, the more the better.. that’s been a constant feedback
- Bringing in the barriers to treatment as a discussion at the start engages their attention.
From other sites including Aberdeen, Plymouth and Manchester (planning EPM)
The need to relate EPM to the needs of newly qualified doctors – for example using EPM to actually practice writing opioid prescriptions
Collaboration EPM is fortunate to receive ongoing financial support from ANZCA, the ASA, the Ronald Geoffrey Arnott Foundation, WFSA, RACS and the ANZCA Research Foundation
Courses delivered by the EPM UK Working Group have been funded by Association of Anaesthetists of Great Britain and Ireland Foundation and The Royal College of Anaesthetists.
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