Comparison of Computer-Mediated Learning and Lecture-Mediated Learning for Teaching Pain Management to Pharmacy Students

Article excerpt

INTRODUCTION

Proper pain management is a concern for patients and healthcare professionals. Pain is the primary complaint in over 50% of patients seeking medical care. (1) In a survey of community pharmacists, 73% reported that they routinely dealt with pain management issues. (2) In one study, 44% of those who sought medical attention for moderate to very severe acute pain reported no significant pain relief. (3) Similarly, 40% of patients with moderate to severe chronic pain suffer from inadequate relief. (4) The National Institutes of Health (NIH) estimated that the cost of pain in the United States including medical expenses, lost wages, and time lost from work exceeds $100 billion each year. (5) Given the magnitude of this problem, the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now treat pain as a "fifth vital sign." However, it is often a topic that is not adequately taught in pharmacy curricula. One survey found that of 28 schools of pharmacy, only 2 schools had a standalone elective course in pain management. (6) Most pain management was discussed in the therapeutics or pharmacotherapy sequence or as a component of the oncology module. Typically, the schools did not mandate the instruction of pain management.

At Xavier University of Louisiana College of Pharmacy, pain management also has been taught in a fragmented way and at times omitted from the formal curriculum all together, mainly because of time constraints. As an innovative way of incorporating this topic into the curriculum, a CD-ROM on pain management was purchased for students to use on their own time in the University's Computer Assisted Instruction Laboratory (CAIL) in conjunction with a laboratory course. The current study was conducted to assess whether using this computer-mediated instruction (CMI) is a viable alternative to the traditional lecture-mediated instruction (LMI) of pain management. The primary outcome measure was the effectiveness based on examination scores of CMI versus LMI in learning pain management. Secondary outcomes were efficiency and student satisfaction as determined by a survey.

METHODS

This prospective study consisted of 2 arms that compared the effectiveness of CMI to LMI in the instruction of pain management to third-year doctor of pharmacy (PharmD) students. It was conducted through the Pharmacy Skills Laboratory course, which consisted of 4 class sections and 3-hour lecture periods. A convenience sample was used and prior to registration, the authors selected sections 1 and 2 to complete CMI and sections 3 and 4 to complete LMI. All students enrolled in the Pharmacy Skills Laboratory course were included in the study.

An interactive, multimedia program, Pain Management: An Interactive CD-ROM for Clinical Staff Development (Aspen Publishers, Inc, Frederick, MD, 2001) was used in the CMI group to instruct the students on pain management in adults. Based on the authors' review, this CD-ROM was deemed appropriate for education of pharmacy students as the major areas of pain management are covered at an appropriate level. The CD-ROM breaks down the major areas of pain management into 4 modules: (1) "Pain Assessment," (2) "Anatomy and Pathophysiology of Pain," (3) "Pharmacology," and (4) "Treating the Whole Patient." According to the software manufacturer, each module required between 1 hour and 1 hour, 30 minutes, to complete. Students assigned to the CMI group were given the opportunity to complete 2 of the 4 modules in the CAIL during 2 normally scheduled 3-hour Pharmacy Skills Laboratory class periods. However, this schedule was not strictly enforced and students were allowed to complete the modules on their own time if they wished. The LMI group was instructed over two 3-hour lecture periods. The material presented was based on the material presented in the CMI. Two modules of the CMI were covered in each of the lecture periods. A different instructor taught each of the lecture periods. …