Cancer pain management skills among medical students: The development of acancer pain objective structured clinical examination

Recent surveys suggest that most physicians have inadequate knowledge to as sess and manage cancer pain; however, the important domain of clinical perf ormance has not yet been clearly evaluated. The Objective Structured Clinic al Examination (OSCE) has become a widely- used and accepted method to eval uate the clinical of medical students. The purpose of this study was to dev elop and test a Cancer PAin OSCE for medical students evaluating their clin ical competence in the area of cancer pain management. A four-component Can cer Pain OSCE was developed and presented to 34 third-year medical students during a sixteen-week combined medicine/survey clerkship. The content of t he objective criteria for the component of the OSCE was developed by a mult idisciplinary group of pain experts. The OSCe was designed to assess the st udents' cancer pain management skills of pain making-taking, focused physic al examination, analgesic management of cancer pain, and communication of o piod analgesia myths. Actual cancer survivors were used in the five-minute individual station. The students were asked to complete a cancer pain histo ry, physical examination, manage cancer pain using analgesics, and communic ate with a family member rewgarding opioid hyths. Clinical performance was evaluated using pre-defined checklists. Results showed the student's averag e performance for the history component was the highest of all four compone nts of the examination. Out of 34 points possible on this clinical skills i tem, students on average (SD) scored 24,5 (5.2), or 72%. For the short-answ er analgesic management component of the Cancer Pain OSCE, the overall scor e was 32%. Most students managed cancer pain wiht opiods, however, very few prescribed regular opioid use, and hte use of adjuvant analgesics was unco mmon. Students performance on the focused cancer pain physcial examination was, in general, poor. On average students scored 61% on the musculoskeleta l system, but only 31% on both the neurological and lymphativ examination. The overall percent score for the cancer pain OSCE was 48%. We conclude tha t the Cancer Pain OSCE is a useful performance-based tool to test individua l skills in the essential components of cancer pain assessment and manageme nt. Of the four components of the Cancer Pain OSCE, medical students perfor med best on the cancer pain history and performed poorly on the cancer pain physical examination. Information gained from this study will provide a fo undation on which future small-group medical student structured teaching wi ll be based. (C) U.S. Cancer Pain Relief Committee.