Welcome back to season 2 of PT Elevated where we are broadening our topics to include more researchers but still focusing on topics that you can use in your clinic every day.
On our seventh episode of season 2, Dr. Craig Wassenger, PT, PhD, who currently works in the Tuffs University School of Medicine hybrid DPT Boston program will be telling us about the pain manual that was published by the Pain Special Interest Group within the Academy of Orthopaedic Physical Therapy that he was instrumental in producing.
Here are some of the highlights:
The pain manual Craig and his colleagues produced is an expansion of the International Association for the Study of Pain (IASP). The IASP has a curricular outline for teaching pain to physical therapists. It has a list of topics that should be included in physical therapist education. Around three years ago Craig and his colleagues led by Mark Shepherd were able to join and make something out of the IASP, the Pain Education Manual for Physical Therapist Professional Degree Programs.
“Collectively as healthcare professionals we have learned a ton about pain in the past two decades and I do not think that the content that has been included in physical therapists’ education has been able to keep pace with that. As we learn more through psychology and neuroimaging particularly of the brain, we can understand more from a basic science perspective then the application of that content to clinicians treating patients daily and it really has not been done, so this is an attempt to bring those things together as well as an understanding of educators and physical therapists on that topic.”
Although the pain manual focuses on education there is a role for clinicians to take content from it. “The way that I look at it from an educator’s perspective, is we had this guideline document which was the IASP outline, and it was just a list of stuff telling what you should be teaching. I think of that as if you have a recipe that being your ingredients list, but you didn’t really know what to do with it. We tried to take the list of ingredients and add the recipe to it. Here are some things that you can do, here is how you put it together, here are examples of how we have put it together to try to help educators pull that information. If you are an experienced cook for that recipe, like an experienced educator you can take what we offered and then mold it to fit your specific needs, just like the way that an experienced cook would do.”
“In addition to just having an extrapolation of the checklist of content from IASP we offer and provide examples of learning activities both active and lecture for educators to incorporate into their classes. The manual is also supported by asynchronous content, so we have partnered with the APTA and the APTA learning center, so the developers of the manual put together lectures to get faculty current on all topics. The document has supported material from an asynchronous learning site so they can see how we present the details as well as opportunities and examples of assignments that could be used within class as homework for students on the educator’s side of things.”
On pain Craig says, “I think the best way to do it is to have integrated pain content with an additional stand-alone course.” One of the challenges with pain both logistically within the association and from an educational perspective is that it crosses all clinical areas. The pain specialist group is housed within orthopaedics but the course is not only a orthopaedic thing, it is all clinical areas and when you don’t have a focus point around it, it gets diluted across a lot of different areas. That is why I think it needs to be integrated across lots of different courses. But have a place where it is centered and have the focus time to evaluate it and study it as a student. Also provide that opportunity to our post graduate students as well, primarily talking about DPTs.”
The pain education manual is housed on the Orthopaedic Academy website.
We’ve also partnered with APTA, and have prerecorded lectures for educators and people that are more audio or visual learners.
In teaching about pain Craig says, “Pain science is centered around patient education. I use a scaffolded approach to that because it is one of the key things that I cover within the course and one of the main assignments I have with all the universities that I teach this course at. First step is understanding the background information, the research, the content, to substantiate what the education should be centered around, and it comes down to the psychosocial contribution to pain as well as what we understand now around the nociplastic pain and the changes in the central nervous system that are not very well understood by many healthcare providers or the public. The students watch me delivering it to a patient and we watch the interactions and break down the interaction. They then have a practice session with each other.
Our training is improving, and this is one step to try to make it better and provide resources but there are still gaps that we recognize. I’m hopeful other healthcare providers do too. There is a role for us to contribute medical, nursing, and pharmacist education and all the other healthcare providers that we and our patients interact with to try to bolster this. I’m hoping there is a shift in the criteria that we are using for our accreditation and or licensure because unless a change is forced it is hard to make people change.
Craig’s Clinical Pearl: “One thing I wish I knew when I started clinical practice was that I didn’t have to have all the answers. You come out of school you’ve spent so much time studying and learning all this content and you’ve had expert clinicians and educators telling you all this information and there is so much you must learn. You take your board exam, and you pass it and then you get a patient in front of you, and you don’t have the clinical instructor to lean on and you may or may not have a mentor and I just felt like I had to know it all. You certainly do not know it all. You’ll never know it all or have all the answers. But that is one thing to not worry about and this will tie back into the pain manual to show that there are resources available for you to help you. My strong recommendation even if it isn’t a formal process is to get a mentor and learn much as you can from them. Lastly, it certainly is not all about knowledge it is a whole lot about relationships, people, trust, caring and those other things that are hard to teach but are maybe more important than all the content we talk about in PT education.”
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