This document summarizes a critical scoping review of medical education training for chronic pain management. The review identified 39 relevant research articles. Key findings included:
1) A historical shift in medical education from concerns about "opiophobia" (underprescribing opioids) to a focus on managing "inappropriate opioid prescribing" and monitoring for addiction, reflecting broader concerns about opioid overprescribing and deaths.
2) Evidence that current chronic pain training is inadequate, with limited curriculum hours, fragmented approaches, and students becoming less empathetic towards patients.
3) Implications that improved training could help physicians better identify addiction risks and alternative treatment approaches to opioids.
The document discusses several topics related to conducting research, including:
1. The importance of assessing knowledge, attitudes, and barriers towards research among medical students to promote research involvement.
2. Previous studies on this topic have found moderate knowledge but room for improving attitudes, and that barriers like workload and lack of support negatively impact research involvement.
3. The objective of the presented study is to assess knowledge, attitudes, and perceived barriers to research participation among medical students in Saudi Arabia, Bahrain, and Kuwait to inform efforts to strengthen research training in those regions.
This research proposal outlines a quantitative study that aims to investigate nurses' attitudes, knowledge, and experiences in prioritizing comfort measures for dying patients in an acute hospital setting. A literature review identified key themes in end-of-life care including identifying the dying phase, providing comfort care, and managing symptoms. Several studies found that nurses and doctors differed in their approaches, with nurses more focused on comfort and doctors on cure, hindering optimal end-of-life care. The proposal will survey 200 nurses using questionnaires to assess their perspectives on comfort care for the dying. The goal is to identify needed interventions through education, training, and management to improve end-of-life care for patients in Irish hospitals.
This document discusses various epidemiologic study designs including descriptive and analytic designs. Descriptive designs like case studies, cross-sectional studies, and ecological studies focus on assessing samples without making causal inferences, while analytic designs like cohort studies, case-control studies, and experimental studies utilize comparisons to evaluate relationships between exposures and outcomes. Meta-analysis involves statistically combining results from multiple separate but related studies to obtain an overall effect or relationship.
This document provides an overview of descriptive epidemiology. It defines descriptive epidemiology as involving observation, definitions, measurements, interpretations, and dissemination of health-related states and events by person, place and time. The key steps in descriptive studies are outlined as defining the population and disease, describing disease distribution by time, place and person, measuring disease prevalence, and formulating an etiological hypothesis. Descriptive epidemiology aims to describe patterns of disease occurrence and identify characteristics associated with disease.
This document discusses cross-sectional studies, which measure exposure and health outcomes at the same point in time. It notes that cross-sectional studies can be descriptive, providing prevalence rates, or analytic, examining associations between exposures and outcomes. While able to generate hypotheses, cross-sectional studies cannot determine causation due to their inability to assess temporal relationships. The document also briefly touches on case reports and case series, which lack control groups for formally assessing relationships.
Cross-sectional studies collect data from subjects at a single point in time to measure prevalence of characteristics. They provide a snapshot of variables like behaviors, attitudes, and beliefs in a population but cannot determine causation or change over time. One example documented increasing acceptance of racial equality over decades, while another examined relationships between beer consumption and obesity measures. Cross-sectional designs are useful for descriptive analyses but have limitations like inability to establish causality.
This document discusses various epidemiologic study designs used to identify and investigate risk factors for disease. Descriptive designs like case reports, case series, and cross-sectional studies measure disease frequency and exposure levels. Analytic designs like case-control and cohort studies attempt to specify disease causes. Case-control studies identify existing diseases and look back at previous exposures, while cohort studies follow subjects over time to compare disease incidence between exposed and unexposed groups. Experimental studies randomly allocate subjects to exposure groups to establish causality but have ethical and cost disadvantages compared to observational designs. The appropriate study design depends on factors like the question, resources, disease frequency, and data quality.
This document describes different types of epidemiological study designs, including observational studies like cross-sectional, case-control, cohort, and experimental studies like randomized controlled trials. It provides details on descriptive versus analytical epidemiology and cross-sectional studies specifically. Cross-sectional studies measure prevalence at a single point in time by surveying exposures and disease status simultaneously in a population cross-section. They are useful for assessing disease burden, comparing prevalence between populations, and examining trends over time.
The document discusses several topics related to conducting research, including:
1. The importance of assessing knowledge, attitudes, and barriers towards research among medical students to promote research involvement.
2. Previous studies on this topic have found moderate knowledge but room for improving attitudes, and that barriers like workload and lack of support negatively impact research involvement.
3. The objective of the presented study is to assess knowledge, attitudes, and perceived barriers to research participation among medical students in Saudi Arabia, Bahrain, and Kuwait to inform efforts to strengthen research training in those regions.
This research proposal outlines a quantitative study that aims to investigate nurses' attitudes, knowledge, and experiences in prioritizing comfort measures for dying patients in an acute hospital setting. A literature review identified key themes in end-of-life care including identifying the dying phase, providing comfort care, and managing symptoms. Several studies found that nurses and doctors differed in their approaches, with nurses more focused on comfort and doctors on cure, hindering optimal end-of-life care. The proposal will survey 200 nurses using questionnaires to assess their perspectives on comfort care for the dying. The goal is to identify needed interventions through education, training, and management to improve end-of-life care for patients in Irish hospitals.
This document discusses various epidemiologic study designs including descriptive and analytic designs. Descriptive designs like case studies, cross-sectional studies, and ecological studies focus on assessing samples without making causal inferences, while analytic designs like cohort studies, case-control studies, and experimental studies utilize comparisons to evaluate relationships between exposures and outcomes. Meta-analysis involves statistically combining results from multiple separate but related studies to obtain an overall effect or relationship.
This document provides an overview of descriptive epidemiology. It defines descriptive epidemiology as involving observation, definitions, measurements, interpretations, and dissemination of health-related states and events by person, place and time. The key steps in descriptive studies are outlined as defining the population and disease, describing disease distribution by time, place and person, measuring disease prevalence, and formulating an etiological hypothesis. Descriptive epidemiology aims to describe patterns of disease occurrence and identify characteristics associated with disease.
This document discusses cross-sectional studies, which measure exposure and health outcomes at the same point in time. It notes that cross-sectional studies can be descriptive, providing prevalence rates, or analytic, examining associations between exposures and outcomes. While able to generate hypotheses, cross-sectional studies cannot determine causation due to their inability to assess temporal relationships. The document also briefly touches on case reports and case series, which lack control groups for formally assessing relationships.
Cross-sectional studies collect data from subjects at a single point in time to measure prevalence of characteristics. They provide a snapshot of variables like behaviors, attitudes, and beliefs in a population but cannot determine causation or change over time. One example documented increasing acceptance of racial equality over decades, while another examined relationships between beer consumption and obesity measures. Cross-sectional designs are useful for descriptive analyses but have limitations like inability to establish causality.
This document discusses various epidemiologic study designs used to identify and investigate risk factors for disease. Descriptive designs like case reports, case series, and cross-sectional studies measure disease frequency and exposure levels. Analytic designs like case-control and cohort studies attempt to specify disease causes. Case-control studies identify existing diseases and look back at previous exposures, while cohort studies follow subjects over time to compare disease incidence between exposed and unexposed groups. Experimental studies randomly allocate subjects to exposure groups to establish causality but have ethical and cost disadvantages compared to observational designs. The appropriate study design depends on factors like the question, resources, disease frequency, and data quality.
This document describes different types of epidemiological study designs, including observational studies like cross-sectional, case-control, cohort, and experimental studies like randomized controlled trials. It provides details on descriptive versus analytical epidemiology and cross-sectional studies specifically. Cross-sectional studies measure prevalence at a single point in time by surveying exposures and disease status simultaneously in a population cross-section. They are useful for assessing disease burden, comparing prevalence between populations, and examining trends over time.
Litman emil 100427053_majorindividualassignmentEteron7431
This document provides an overview of epidemiology including definitions, key concepts, study designs, and applications. It begins with defining epidemiology as the study of health-related states and events in populations. It describes the role of epidemiology in public health such as disease prevention, control, and treatment. It also outlines concepts like the epidemiology triangle of agent, host, and environment; levels of prevention; and classifications of diseases. The document discusses descriptive and analytic study designs and statistical inference. It concludes with mentioning topics like chronic disease epidemiology, clinical epidemiology, and evaluating screening tests.
Medical research involves many epidemiology study scheme
The study design is decided by The nature of the research question.
Descriptive study,analytical study, exploratory study
Clinical trial,cross sectional study,case control study (diseases and non disease group/ ) cohorte study (exposed and non exposed)
This document discusses the gap between health researchers and policymakers in the Eastern Mediterranean region. It finds that while research has increased knowledge about improving health, this evidence is rarely used in policymaking, especially in developing countries. A key reason is the lack of communication between researchers and policymakers. The document proposes strengthening communication between these groups at the regional and national levels to increase translation of research evidence into effective policies that can improve health systems and population health. It identifies several factors contributing to the research-policy gap in the region and recommends developing a strategy to bridge this gap.
Cross-sectional studies examine the relationship between a disease and exposure in a population at a single point in time. They provide a snapshot of disease prevalence and exposure prevalence simultaneously. While they can describe disease burden and identify potential risk factors, the temporal relationship between exposure and disease is unclear since they involve simultaneous rather than longitudinal measurement.
This document discusses cross-sectional studies. It defines a cross-sectional study as an observational study that measures exposure and health outcomes in a population at a single point in time, providing a "snapshot" of prevalence. It describes key characteristics, including simultaneously collecting exposure and outcome data, estimating prevalence rather than incidence, and inability to determine temporal relationships between variables. The document outlines advantages as being quick and inexpensive but also limitations such as inability to establish causation.
This document provides an overview of descriptive epidemiological study designs including ecological, case reports/series, cross-sectional studies. It defines key terms like prevalence, analyzes examples, and discusses the strengths and limitations of each design. Specifically, it examines a cross-sectional study example looking at the prevalence of trachoma associated with poor hygiene. The prevalence of trachoma in the population of 1900 is found to be 796/1900 = 41.8% while the prevalence ratio of trachoma among those with poor hygiene (54/391 = 13.8%) versus good hygiene (50/1509 = 3.3%) is 4.2, indicating trachoma is associated with poor hygiene.
A cross-sectional study involves identifying a population at a single point in time and measuring variables like exposures and outcomes simultaneously. It can be descriptive by measuring single variables or analytical by examining associations between variables. While able to estimate disease prevalence and exposure proportions quickly, cross-sectional studies cannot determine causation due to issues like recall bias and inability to assess temporal sequence. Analysis uses contingency tables to calculate prevalence rates and measures of association like prevalence rate ratios.
This document discusses descriptive studies, specifically cross-sectional and longitudinal studies. It provides the characteristics and objectives of descriptive studies, as well as the steps involved in conducting a cross-sectional study. Some common issues with descriptive studies are validity, bias, and sample size. Longitudinal studies are described as a series of cross-sectional studies conducted over time on the same population.
What clinicians want (psychotherapy tasca et al 2014)Daryl Chow
This document summarizes a study that aimed to identify psychotherapy research priorities according to clinicians. Researchers conducted focus groups with 82 clinicians to identify relevant research topics. These topics were developed into a 41-item survey that was completed by over 1,000 clinicians. Factor analysis identified 9 key research themes, led by the therapeutic relationship and mechanisms of change. Additional focus groups helped interpret the results. The study aims to better align research with clinician needs to reduce the gap between practice and research.
Cross sectional study by Dr Abhishek Kumarak07mail
This document discusses cross-sectional studies. It defines a cross-sectional study as an observational analytical study that determines exposure and disease simultaneously. Both chronic and acute diseases can be studied, and it provides a snapshot of disease distribution in a population. Cross-sectional studies can be descriptive, providing information on single or multiple variables, or analytical, assessing associations between variables. Key steps include identifying a reference population, determining sample size, sampling, data collection, and analysis of prevalence and prevalence ratios. Advantages are quick results and cost-effectiveness while disadvantages are inability to determine disease incidence or prove causality.
The STUDY of the DISTRIBUTION and DETERMINANTS of HEALTH-RELATED STATES in specified POPULATIONS, and the application of this study to CONTROL of health problems."
1. Cross-sectional studies measure exposures and outcomes in a population at a single point in time and are commonly used to estimate disease prevalence and describe population characteristics.
2. They can provide clues about associations but cannot determine causation due to their observational nature.
3. Planning is important for cross-sectional studies including clear objectives, sampling, data collection methods, and analysis of results with descriptive statistics.
General principles of research methodology. Terms frequently used in this chapter. It is a course subject for fourth Pharm D in The Tamilnadu Dr.MGR. Medical University, Chennai.
This document summarizes a presentation given by Rachel Baker on eliciting societal values and perspectives on the relative value of life extension at the end of life. Baker discusses a study using Q methodology to identify viewpoints on this issue among experts and the public. The study identified three perspectives: valuing wider benefits and quality of life (Factor 3), a population perspective focusing on value for money (Factor 1), and valuing life extension and patient choice (Factor 2). The research then used Q survey methods to quantify how common these viewpoints are in the general UK population, finding pluralism with Factors 1 and 2 more dominant.
XNN001 Introductory epidemiological concepts - Study designramseyr
This document provides an overview of key epidemiological concepts and study designs. It defines epidemiology and discusses why epidemiological data is collected through monitoring and surveillance and to identify relationships between exposures and disease. The main observational study designs covered are ecological, cross-sectional, case-control, cohort studies as well as randomized controlled trials. For each study design, the document outlines their structure, advantages and limitations.
This document provides an overview of epidemiology, including definitions, key concepts, study designs, and examples from the history of epidemiology. It defines epidemiology as the study of health-related states and events in populations and applying this to disease control. Some key points covered include:
- Descriptions of landmark epidemiological studies that advanced understanding of diseases like cholera, scurvy, lung cancer.
- Explanations of common epidemiological study designs like cohort studies, case-control studies, and their strengths/weaknesses.
- Details on the global burden of musculoskeletal disorders like back pain based on studies like the Global Burden of Disease.
- Discussions of epidemiology's role in population health management
Social and Preventive Medicine Classroom discussion topic on types of Epidemiological study designs available.
sole reference is Park text book 20th edition
Telaah jurnal Prevalence of hypochondriac symptoms among health science stude...Rindang Abas
Hypochondriac symptoms are commonly reported in health science students. With their incomplete medical knowledge, they may compare their own bodily symptoms with disease symptoms during the process of learning, which can lead to mental distress and the need for repeated medical reassurance.
Evidence based medicine in mass gathering public health and emergency medicin...Pubrica
The articles were gathered into their subject matter category, as resolute by the WHO. The types comprised of:
1. Epidemiology
2. Event Operations
3. Disease Surveillance and Outbreak Response
4. Point of Entry Health……
Continue Reading : https://bit.ly/3I9NmIz
Our Services : https://pubrica.com/services/physician-writing-services/clinical-literature-review-for-an-evidence-based-medicine/
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Bio statistical experts | High-quality Subject Matter Experts.
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The document summarizes the findings and recommendations of the Future of Family Medicine Project, which aimed to define a vision for the future of the family medicine specialty. The project found that patients want convenient access to primary care physicians with good communication skills. It recommended a new identity for family physicians focused on whole-person care. Key recommendations included implementing a personal medical home model of team-based and patient-centered care, reforming medical education to emphasize evidence-based holistic care, and ensuring universal healthcare coverage that supports primary care. The project sees opportunities for complementary and alternative medicine to be further integrated into family medicine through a focus on whole-person health.
Litman emil 100427053_majorindividualassignmentEteron7431
This document provides an overview of epidemiology including definitions, key concepts, study designs, and applications. It begins with defining epidemiology as the study of health-related states and events in populations. It describes the role of epidemiology in public health such as disease prevention, control, and treatment. It also outlines concepts like the epidemiology triangle of agent, host, and environment; levels of prevention; and classifications of diseases. The document discusses descriptive and analytic study designs and statistical inference. It concludes with mentioning topics like chronic disease epidemiology, clinical epidemiology, and evaluating screening tests.
Medical research involves many epidemiology study scheme
The study design is decided by The nature of the research question.
Descriptive study,analytical study, exploratory study
Clinical trial,cross sectional study,case control study (diseases and non disease group/ ) cohorte study (exposed and non exposed)
This document discusses the gap between health researchers and policymakers in the Eastern Mediterranean region. It finds that while research has increased knowledge about improving health, this evidence is rarely used in policymaking, especially in developing countries. A key reason is the lack of communication between researchers and policymakers. The document proposes strengthening communication between these groups at the regional and national levels to increase translation of research evidence into effective policies that can improve health systems and population health. It identifies several factors contributing to the research-policy gap in the region and recommends developing a strategy to bridge this gap.
Cross-sectional studies examine the relationship between a disease and exposure in a population at a single point in time. They provide a snapshot of disease prevalence and exposure prevalence simultaneously. While they can describe disease burden and identify potential risk factors, the temporal relationship between exposure and disease is unclear since they involve simultaneous rather than longitudinal measurement.
This document discusses cross-sectional studies. It defines a cross-sectional study as an observational study that measures exposure and health outcomes in a population at a single point in time, providing a "snapshot" of prevalence. It describes key characteristics, including simultaneously collecting exposure and outcome data, estimating prevalence rather than incidence, and inability to determine temporal relationships between variables. The document outlines advantages as being quick and inexpensive but also limitations such as inability to establish causation.
This document provides an overview of descriptive epidemiological study designs including ecological, case reports/series, cross-sectional studies. It defines key terms like prevalence, analyzes examples, and discusses the strengths and limitations of each design. Specifically, it examines a cross-sectional study example looking at the prevalence of trachoma associated with poor hygiene. The prevalence of trachoma in the population of 1900 is found to be 796/1900 = 41.8% while the prevalence ratio of trachoma among those with poor hygiene (54/391 = 13.8%) versus good hygiene (50/1509 = 3.3%) is 4.2, indicating trachoma is associated with poor hygiene.
A cross-sectional study involves identifying a population at a single point in time and measuring variables like exposures and outcomes simultaneously. It can be descriptive by measuring single variables or analytical by examining associations between variables. While able to estimate disease prevalence and exposure proportions quickly, cross-sectional studies cannot determine causation due to issues like recall bias and inability to assess temporal sequence. Analysis uses contingency tables to calculate prevalence rates and measures of association like prevalence rate ratios.
This document discusses descriptive studies, specifically cross-sectional and longitudinal studies. It provides the characteristics and objectives of descriptive studies, as well as the steps involved in conducting a cross-sectional study. Some common issues with descriptive studies are validity, bias, and sample size. Longitudinal studies are described as a series of cross-sectional studies conducted over time on the same population.
What clinicians want (psychotherapy tasca et al 2014)Daryl Chow
This document summarizes a study that aimed to identify psychotherapy research priorities according to clinicians. Researchers conducted focus groups with 82 clinicians to identify relevant research topics. These topics were developed into a 41-item survey that was completed by over 1,000 clinicians. Factor analysis identified 9 key research themes, led by the therapeutic relationship and mechanisms of change. Additional focus groups helped interpret the results. The study aims to better align research with clinician needs to reduce the gap between practice and research.
Cross sectional study by Dr Abhishek Kumarak07mail
This document discusses cross-sectional studies. It defines a cross-sectional study as an observational analytical study that determines exposure and disease simultaneously. Both chronic and acute diseases can be studied, and it provides a snapshot of disease distribution in a population. Cross-sectional studies can be descriptive, providing information on single or multiple variables, or analytical, assessing associations between variables. Key steps include identifying a reference population, determining sample size, sampling, data collection, and analysis of prevalence and prevalence ratios. Advantages are quick results and cost-effectiveness while disadvantages are inability to determine disease incidence or prove causality.
The STUDY of the DISTRIBUTION and DETERMINANTS of HEALTH-RELATED STATES in specified POPULATIONS, and the application of this study to CONTROL of health problems."
1. Cross-sectional studies measure exposures and outcomes in a population at a single point in time and are commonly used to estimate disease prevalence and describe population characteristics.
2. They can provide clues about associations but cannot determine causation due to their observational nature.
3. Planning is important for cross-sectional studies including clear objectives, sampling, data collection methods, and analysis of results with descriptive statistics.
General principles of research methodology. Terms frequently used in this chapter. It is a course subject for fourth Pharm D in The Tamilnadu Dr.MGR. Medical University, Chennai.
This document summarizes a presentation given by Rachel Baker on eliciting societal values and perspectives on the relative value of life extension at the end of life. Baker discusses a study using Q methodology to identify viewpoints on this issue among experts and the public. The study identified three perspectives: valuing wider benefits and quality of life (Factor 3), a population perspective focusing on value for money (Factor 1), and valuing life extension and patient choice (Factor 2). The research then used Q survey methods to quantify how common these viewpoints are in the general UK population, finding pluralism with Factors 1 and 2 more dominant.
XNN001 Introductory epidemiological concepts - Study designramseyr
This document provides an overview of key epidemiological concepts and study designs. It defines epidemiology and discusses why epidemiological data is collected through monitoring and surveillance and to identify relationships between exposures and disease. The main observational study designs covered are ecological, cross-sectional, case-control, cohort studies as well as randomized controlled trials. For each study design, the document outlines their structure, advantages and limitations.
This document provides an overview of epidemiology, including definitions, key concepts, study designs, and examples from the history of epidemiology. It defines epidemiology as the study of health-related states and events in populations and applying this to disease control. Some key points covered include:
- Descriptions of landmark epidemiological studies that advanced understanding of diseases like cholera, scurvy, lung cancer.
- Explanations of common epidemiological study designs like cohort studies, case-control studies, and their strengths/weaknesses.
- Details on the global burden of musculoskeletal disorders like back pain based on studies like the Global Burden of Disease.
- Discussions of epidemiology's role in population health management
Social and Preventive Medicine Classroom discussion topic on types of Epidemiological study designs available.
sole reference is Park text book 20th edition
Telaah jurnal Prevalence of hypochondriac symptoms among health science stude...Rindang Abas
Hypochondriac symptoms are commonly reported in health science students. With their incomplete medical knowledge, they may compare their own bodily symptoms with disease symptoms during the process of learning, which can lead to mental distress and the need for repeated medical reassurance.
Evidence based medicine in mass gathering public health and emergency medicin...Pubrica
The articles were gathered into their subject matter category, as resolute by the WHO. The types comprised of:
1. Epidemiology
2. Event Operations
3. Disease Surveillance and Outbreak Response
4. Point of Entry Health……
Continue Reading : https://bit.ly/3I9NmIz
Our Services : https://pubrica.com/services/physician-writing-services/clinical-literature-review-for-an-evidence-based-medicine/
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Bio statistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-1618186353
The document summarizes the findings and recommendations of the Future of Family Medicine Project, which aimed to define a vision for the future of the family medicine specialty. The project found that patients want convenient access to primary care physicians with good communication skills. It recommended a new identity for family physicians focused on whole-person care. Key recommendations included implementing a personal medical home model of team-based and patient-centered care, reforming medical education to emphasize evidence-based holistic care, and ensuring universal healthcare coverage that supports primary care. The project sees opportunities for complementary and alternative medicine to be further integrated into family medicine through a focus on whole-person health.
This document summarizes a study that surveyed health policy researchers about their use and perceptions of social media for disseminating research findings to policymakers. The study found that researchers rated the efficacy of social media similarly to traditional dissemination methods like traditional media and direct outreach. However, researchers rated social media lower than other methods in terms of their confidence using it, their peers' respect for its use, and how much academic promotion values it. Just 14% of researchers reported tweeting about their research in the past year and 21% reported blogging. Researchers described social media as incompatible with research, professionally risky, of uncertain effectiveness, and an unfamiliar technology they did not know how to use.
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
The Meaningful Assessment of Therapy OutcomesIncorporating .docxcherry686017
The Meaningful Assessment of Therapy Outcomes:
Incorporating a Qualitative Study Into a Randomized Controlled Trial
Evaluating the Treatment of Adolescent Depression
Nick Midgley
University College London and Anna Freud Centre, London,
United Kingdom
Flavia Ansaldo
Southwark Targeted Services—CAMHS, London,
United Kingdom
Mary Target
University College London
For many years, there have been heated debates about the best way to evaluate the efficacy and
effectiveness of psychological therapies. On the one hand, there are those who argue that the randomized
controlled trial (RCT) is the only reliable and scientifically credible way to assess psychological
interventions. On the other hand, there are those who have argued that psychological therapies cannot be
meaningfully assessed using a methodology developed to evaluate the impact of drug treatments, and that
the findings of RCTs lack “external validity” and are difficult to translate into routine clinical practice.
In this article, we advocate the use of mixed-method research designs for RCTs, combining the rigor of
quantitative data about patterns of change with the phenomenological contextualized insights that can be
derived from qualitative data. We argue that such an approach is especially important if we wish to
understand more fully the impact of therapeutic interventions within complex clinical settings. To
illustrate the value of a mixed-method approach, we describe a study currently underway in the United
Kingdom, in which a qualitative study (IMPACT-My Experience [IMPACT-ME]) has been “nested”
within an RCT (the Improving Mood With Psychoanalytic and Cognitive Behavioral Therapy [IMPACT]
study) designed to evaluate the effectiveness of psychological therapies in the treatment of adolescent
depression. We argue that such a mixed-methods approach can help us to evaluate the effectiveness of
psychological therapies and support the real-world implementation of our findings within increasingly
complex and multidisciplinary clinical contexts.
Keywords: adolescent depression, randomized controlled trials (RCTs), qualitative research, mixed-
methods design, outcome research
For many years, there have been heated debates about the best
way to evaluate the efficacy and effectiveness of psychological
therapies. On the one hand, there are those who argue that the
randomized controlled trial (RCT) (and meta-analyses of such
trials) is the only reliable and scientifically credible way to assess
psychological interventions. The RCT has long been considered
the “gold standard” approach, placed at the top of the “hierarchy of
evidence” and given almost exclusive credence by bodies such as
the Cochrane Collaboration and guideline developers such as the
National Institute for Health and Clinical Excellence (NICE). On
the other hand, there are those who have argued that psychological
therapies cannot be meaningfully assessed using a methodology
developed to evaluate the impact of drug treatme ...
From personalized medicine to personalized science - a new concept in biogero...Anna Ericsson
This document proposes a new model for patient-driven, goal-oriented biomedical research. The key aspects of the model are:
1) Patients with chronic conditions and no known cures would engage directly in research efforts by providing funding, samples, and project management expertise to a multidisciplinary research team.
2) Research organizations would assemble teams of scientists and physicians and announce specific research projects focused on patients' medical issues. Teams would be selected and funded by the interested patients.
3) The model is proposed to better integrate research and clinical practice by having patients directly involved in coordinating goal-oriented research projects aimed at their conditions.
Evidence based medicine in mass gathering public health and emergency medicin...Pubrica
The articles were gathered into their subject matter category, as resolute by the WHO. The types comprised of:
1. Epidemiology
2. Event Operations
3. Disease Surveillance and Outbreak Response
4. Point of Entry Health……
Continue Reading : https://bit.ly/3I9NmIz
Our Services : https://pubrica.com/services/physician-writing-services/clinical-literature-review-for-an-evidence-based-medicine/
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Bio statistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44-1618186353
A broken paradigm? What education needs to learn from evidence-based medicine...eraser Juan José Calderón
A broken paradigm? What education needs to learn from evidence-based medicine Lucinda McKnight & Andy Morgan.
ABSTRACT
The paradigm of evidence-based education continues to inform the development of policy in a number of countries. At its simplest level, evidence-based education incorporates evidence, often that provided by randomised controlled trials, into classroom practice. England’s Education Endowment Foundation is in the process of exporting evidence-based school education, promoted as a medical approach, to other countries, including Australia. Australia is in the process of establishing an Education Evidence Base, informed by the government’s 2016 Productivity Commission report. While the literature around evidence-based education is explicit in identifying its basis in medicine, there has been little medical input into its development. Interdisciplinary examination of the medical literature reveals the contested nature and troubled state of evidence-based medicine and what policymakers need to consider to maximise the benefits of this translation into education.
Running Head QUANTITATIVE RESEARCH SUMMARY1QUANTITATIVE RESE.docxtodd581
Running Head: QUANTITATIVE RESEARCH SUMMARY 1
QUANTITATIVE RESEARCH SUMMARY 10
QUANTITATIVE RESEARCH SUMMARY
Student’s Name: Letzy Reyes
Institution: Grand Cayon University
Date: 06/10/2018
Nursing Practice Problem
P-(Problem) – elderly patients aged above 50 years admitted in hospital and having shown blood pressure disease signs. Patients not included in the research were pregnant women.
I-(Intervention) – the patients who are subject in this research will be subjected to therapeutic routine concerning hypertension. The blood pressure of all the patients was tested after administering hypertension medicine to the subjects. The resultant changes were recorded every day to determine the reaction and thus the group will make a conclusion.
C-(Comparison) – institutionalized quality methods will be regulated for hypertension and subjected to the group. The comparison between the groups will be done towards the end of the month in the group.
O-(Outcome) - there will be good relation between the hypertension medication and blood pressure.
T-(Time) – for the next one month the blood pressure will be monitored closely.
The nursing practice portion should be in paragraph form.
PICOT Statement
Elderly patients under hypertension medication together with pharmacological interventions can be maintained in hospitals to improve their blood pressure and with understanding the background and culture of the patients will be of great help in dealing with hypertension. Comment by Doreen Farley: Letzy, I know that this is not the PICOT question that we decided on. What happened to the PICOT?
In patients with hypertension, does the use of meditation along with pharmacological interventions compared to medications alone improve blood pressure? This was the PICOT from out last discussion on 6-1-18
This paper is supposed to be double space only. I am not sure why there is so much space in between concepts.
Introduction
Background of the study
The purpose of the study was to evaluate analyze how patients using hypertension medication along with pharmacological interventions compared to medications alone improve blood pressure. The bottom line of the study was to evaluate how different opinions on hypertension and the treatment of the disease and how such opinions differ from one place to another especially due to the difference in culture or ethnicity of these groups. In addition, the study will be evaluated on what the proposed interventions would do to improve the adherence to these groups. Comment by Doreen Farley: The study evaluated…
The proposed interventions from the research on the two articles will be of importance to the nursing field. There is the need for the nurses to connect, care and convey treatment for various groups of patients in our diverse community. These include taking treatment to patients from different ethnic and racial groups. When it comes to hypertension, nurses have been faced with challenges .
This document describes a qualitative study that explored lupus patients' perceptions of their current medication and treatment regimens. The study used a phenomenological approach and interviewed 4 female lupus patients to understand their lived experiences. The interviews were analyzed and several themes emerged around patients' feelings about the healthcare information and care they receive, as well as their views on educational programs. The study aimed to gain insights that could help improve disease management and education for lupus patients.
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method.
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This document provides background information for a proposed qualitative study examining the experiences and perceptions of healthcare practitioners in long-term recovery from addiction. The study aims to understand how perceptions of stigma, social support, and spirituality change throughout the recovery process. 18 participants who entered non-punitive recovery programs at least 5 years prior will be interviewed. Modeling and Role Modeling theory guides the study by taking a holistic, client-centered approach. Key concepts of stigma, social support, and spirituality are defined. The proposed method is a phenomenological analysis of interviews to identify themes in practitioners' recovery journeys and how their views have changed over time.
Evidence-based practice is defined as translational research that applies research findings to improve patient care. The framework for evidence-based practice involves identifying issues, reviewing literature, collecting and analyzing data, implementing solutions, and evaluating outcomes. The document discusses childhood obesity using this framework. It proposes researching the causes of rising childhood obesity rates and developing interventions. This research could inform future doctoral studies on specific intervention effectiveness and social determinants of obesity.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
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EVIDENCE –BASED PRACTICES 1
Evidence-Based Practices
Stephanie Petit-homme
Miami Regional University
Professor: Garcia Mercedes
07/05/2021
Evidence-Based Practices to Guide Clinical Practices
In other terms recognized as evidence-based medication, evidence-based scientific practice is elucidated as the careful, obvious, and judicious use of the best indication in creating results for the outstanding care of separate patients. It helps those who brand the choices to device best healthcare practices while drawing the roadmaps for the health system. In clinical trials, the integration of the EBCP entails clinical respiratory medicine considers two fundamental principles. For example, the principle is the hierarchy of the evidence and the art of clinical decision-making.
The interrelationship between the theory, research, and EBP
The relationship between the theory, research, and the EBP supports the three recognition programs. They still relate in terms of the magnet model component of modern knowledge, innovation, and advancement. They describe in a way in which they lead to the promotion of quality in a setting that makes supports professional practices. Second, there is the identification of excellence in giving nursing services to sick people or the people who stay around. For instance, the model, which is other terms the magnet theory, has got five components ( Reddy, 2018).
The first constituent includes transformational management; the additional is structural authorization. The third one is archetypal specialized practices, new information, invention, and upgrading. Lastly, in the model, there are the empirical quality outcomes. For the achievement of the aims of the goals that have been set, there is a need to make sure that the theory, current knowledge innovation, and the improvements and the components that are found in view all the nurses who are located in the levels of the healthcare company need to get involved.
The research has its primary purpose for the help of coming up with knowledge or the validation done for the knowledge that has always been there from before based on the theory. There is systematic, scientific questioning in the research to give the answers to some of the specific questions. It can use the test hypotheses and the rigorous method, the primary purpose of the study being for investigation knowing of the new things and the exploration. There is a need to understand the philosophy of science.
Second, on the EBP, there is no development of the new knowledge or even the learning being validated. The primary purpose of the EBP is to translate the evidence and then apply it to medical executive. It uses the indication available to brand patient-care choices. The EBP goes yonder the exploration as fine as the persevering penchants and ideals. The EBP retains into deliberation that the best indication is for the opinion leaders and the experts. Even though there is the existence of definitiv ...
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
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Running head SEARCHING AND CRITIQUING THE EVIDENCE1SEARCHING .docxtoltonkendal
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SEARCHING AND CRITIQUING THE EVIDENCE 4
Searching and Critiquing the Evidence
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There are various research studies that have been done on the outcome of self-care on Type 2 Diabetes Mellitus patients. In most of the studies, the most prevalent results are that self-care is an effective method of improving the health and lifestyle outcomes of Type 2 Diabetes patients. Krishna and Boren (2008) conducted a systematic review of evidence-based studies done between 1996 and 2007. The study analyzed 18 researches done within the selected time period and found that using phone calls and text messages to assist diabetes patients could improve the self-management outcomes. Shrivastava et al. (2013) analyzed the effectiveness of self-management for the diabetes mellitus patients. The study found that self-care helps to reduce the rate of morbidity and mortality among diabetes patients.
In addition, Steinsbekk et al. (2013) conducted a meta-analysis comparing the differences between the outcomes of group based self-management education and routine treatment for Type 2 diabetes patients. The study analyzed 21 studies that included studied on 2833 participants. The results of the meta-analysis showed that group-based self-management education helped to improve the psychosocial, clinical, and lifestyle outcomes among the diabetes patients. Lastly, Tang et al. (2008) examined the impact of social support and quality of life on the self-care behaviors of African American Type 2 diabetes patients. The study followed an observational design with 89 African-American adults, who were aged 40 and above. The study found that social support is vital for self-management to be effective in diabetes treatment.
The selected studies have helped to strengthen the merit of my selected theoretical framework. The theory selected for the study was Dorothea Orem’s Self Care Theory. These studies have helped to demonstrate some important evidence-based facts about the effectiveness of self-care for diabetes patients hence helping to prove the credibility of the theory. The scrutiny of these studies has helped to discover the degree of effectiveness of this theory and the best application methods that can make it an effective approach to improving the outcomes of patients with Type 2 Diabetes Mellitus.
Levels of Evidence in the Articles
The classification of the level of evidence of a given research is important in evidence-based studies because they help to show how accurate, credible, or reliable a research is (Gray, Grove & Sutherland, 2017). The most prevalent evidence in the research articles analyzed is Level II evidence. Level II evidence is one that is obtained from at least one randomized control trial (Moran, Burson & Conrad, 2017). The articles by Krishna and Boren (2008) and Steinsbekk et al. (2013) conducted meta-analyses of various rese ...
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Webster 2017 from opiophobia to overprescribing- a critical scoping review of medical education training for chronic pain
1. Original Research Article
From Opiophobia to Overprescribing: A Critical
Scoping Review of Medical Education Training
for Chronic Pain
Fiona Webster, PhD,* Samantha Bremner, MD, MSc,†
Eric Oosenbrug, MA,‡
Steve Durant, PhD(c),* Colin
J. McCartney, MBChB, PhD,‡
and Joel Katz, PhD¶
*Institute of Health Policy Management and Evaluation
and Wilson Centre for Education Research, University
of Toronto, Toronto, ON, Canada; †
Michael G.
DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada; ‡
Department of Psychology,
York University, Toronto, ON, Canada; ¶
Department of
Anesthesiology, University of Ottawa, Ottawa, ON,
Canada
Correspondence to: Fiona Webster, PhD, Institute of
Health Policy Management and Evaluation, Dalla Lana
School of Public Health, University of Toronto, 155
College Street, Room 623, Toronto, Ontario M5T 1P8,
Canada. Tel: (416) 795-5946; E-mail:
fiona.webster@utoronto.ca.
Funding sources: This study was funded by an oper-
ating grant through the Canadian Institutes of Health
Research (CIHR). FW is funded by a CIHR New
Investigator Award. JK is funded through a CIHR
Canada Research Chair.
Conflicts of interest: The authors have no competing
interests to declare.
Abstract
Background. Chronic pain is a significant health
problem strongly associated with a wide range of
physical and mental health problems, including ad-
diction. The widespread prevalence of pain and the
increasing rate of opioid prescriptions have led to a
focus on how physicians are educated about
chronic pain. This critical scoping review describes
the current literature in this important area, identify-
ing gaps and suggesting avenues for further re-
search starting from patients’ standpoint.
Methods. A search of the ERIC, MEDLINE, and Social
Sciences Abstracts databases, as well as 10 journals
related to medical education, was conducted to iden-
tify studies of the training of medical students, resi-
dents, and fellows in chronic noncancer pain.
Results. The database and hand-searches identified
545 articles; of these, 39 articles met inclusion crite-
ria and underwent full review. Findings were classi-
fied into four inter-related themes. We found that
managing chronic pain has been described as
stressful by trainees, but few studies have investi-
gated implications for their well-being or ability to
provide empathetic care. Even fewer studies have
investigated how educational strategies impact pa-
tient care. We also note that the literature generally
focuses on opioids and gives less attention to edu-
cation in nonpharmacological approaches as well as
nonopioid medications.
Discussion. The findings highlight significant dis-
crepancies between the prevalence of chronic pain
in society and the low priority assigned to educat-
ing future physicians about the complexities of pain
and the social context of those afflicted. This sug-
gests the need for better pain education as well as
attention to the “hidden curriculum.”
Key Words. Scoping Review; Medical Education;
Chronic Noncancer Pain; Opioids
Introduction
Chronic pain is a significant global public health con-
cern associated with risk of depression, anxiety, un-
employment, and opioid abuse [1]. Worldwide,
approximately 20% of people experience some form of
pain [2]. A recent Canadian study found the preva-
lence of chronic pain in adults to be 18.9% [3]; using
different measures, the Institute of Medicine estimates
that half of all American adults live with some form of
chronic pain [4]. In a study of 15 European countries
and Israel, where an average prevalence of 19% was
VC 2017 American Academy of Pain Medicine.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.
org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly
cited. For commercial re-use, please contact journals.permissions@oup.com 1
Pain Medicine 2017; 0: 1–9
doi: 10.1093/pm/pnw352
2. found, 61% of adults living with chronic pain reported
being unable to work outside the home, 19% reported
they had lost a job, and 21% reported being diag-
nosed with depression [5].
While chronic pain can be devastating, common treat-
ments also carry significant risk. Addiction is a major
concern, and deaths from prescription opioids are on
the rise [6]. In a cohort of 32,499 patients started on
chronic opioids in Ontario, Canada, between 1997 and
2010, 58 (0.2%) had succumbed to opioid-related death
at the end of data collection in 2011, with a median of
2.6 years from initial prescription to death. The small
subset (1.8%) of patients who were escalated to high-
dose therapy were 24 times more likely to die than
those who stayed on lower doses [7]. Canadian phar-
macies dispensed 23% more high-dose opioids in 2006
than 2011 [8]. Prescription opioid use continued to rise
in Canada, with the exception of Ontario, between 2010
and 2013 [9]. While opioids are now considered an in-
appropriate or less optimal treatment for many cases of
chronic pain and are well-known causes of other signifi-
cant health issues for patients such as addiction, our re-
view casts a unique and important light on the history of
how we arrived at what is now commonly referred to as
an opioid epidemic.
Some physicians report having inadequate training in
management of chronic conditions; others who under-
went additional training reported it had a positive effect
on their attitudes toward caring for people with chronic
disease [10]. These findings have led to recommenda-
tions that medical schools and residency programs
modify their curricula [10], in particular by including
chronic noncancer pain training early in all residency
programs, in order to foster compassion [11].
As part of a larger ethnographic study of Chronic Pain
Management in Family Medicine (COPE) [12] funded by
the Canadian Institutes for Health Research, we set
out to describe the current literature on chronic pain
management training in undergraduate and postgradu-
ate medical education. Going beyond typical scoping
review methodologies that “map” the literature and
identify gaps [13,14], we took a critical approach to
scoping the literature, using a historical lens and bring-
ing in theoretical concepts to arrive at a more contex-
tual understanding of the body of literature we
explored. This review presents a “history of the pre-
sent”[15] that demonstrates at least partially how an
addictive pharmacological treatment became the
lynchpin of medical care for those with chronic pain.
This historical emphasis on pain medication as the
treatment of choice may have led to an underemphasis
on the provision of alternative treatments as well as
compassionate communication.
Methods
For study selection and data extraction, we relied on the
team-based method recommended by Levac and
colleagues [16], which builds on Arksey and O’Malley’s
seminal framework for scoping reviews [14]. Given our
focus on education research as well as practice, the
availability of relatively recent reviews of curricula that fall
within our scope [17], and our desire to engage critically
with the existing research, we used a narrower scope
than that recommended by Arksey and O’Malley,
searching only for peer-reviewed studies and excluding
grey literature.
We applied a critical, historical lens to our review in or-
der to capture conceptual changes occurring over time
and bring in contextual evidence to challenge founda-
tional assumptions of the literature we scoped. Critical
research can be seen as a means of “making strange”
the assumptions of a particular field of knowledge [18].
Making strange brings to light the historically contingent
power relations that coordinate daily life yet are often
taken for granted in everyday conversation. Analyzing
the statements, or discourses, through which knowl-
edge is constructed enables everyday assumptions to
be problematized [19]. Seeing the “everyday world as
problematic” [20] enables one to imagine and make ar-
guments about how it might be organized differently,
which is a crucial step toward imagining social change.
Thus, critical discourse analysis, and critical thinking in
general, can be seen as both a rigorous form of analysis
with deep philosophical roots and a means of imagining
innovative solutions to the most pressing social prob-
lems [21]. Our critical approach proceeds from this ra-
tionale, and it is reflected in our findings, which are
organized thematically according to potential lines of fur-
ther critical research and avenues for change in educa-
tion and practice.
Context
Although there is a vibrant tradition of critical scholarship
in the social sciences, including medical education, we
were unable to find guidance on how to incorporate crit-
ical perspectives into scoping reviews [13,14,16]. To ad-
dress this limitation, we considered the critical
approaches commonly used in other types of studies,
particularly the use of historical and conceptual frame-
works [18]. In recent years, Macdonald and Lang [22]
have applied social science theory to interpret scoping
review findings, and Martimianakis and colleagues have
used team-based, critical discourse analysis methods
similar to our own [23]. We see our study as another
step toward scoping reviews that not only identify gaps,
but interrogate the space between gaps where con-
cepts are commonly accepted rather than met with
questions such as “why” and “in whose interest?”
Literature Search
We searched ERIC and Social Sciences Abstracts using
the following terms: (medical education OR curriculum)
AND (chronic pain OR opioids OR analgesics). We
Webster et al.
2
3. searched MEDLINE using the following terms: medical
education (graduate medical education OR undergradu-
ate medical education OR internship and residency) OR
curriculum (competency-based education OR interdisci-
plinary studies OR mainstreaming education OR
problem-based learning) AND pain (musculoskeletal
pain OR chronic pain) OR analgesics (non-narcotic anal-
gesics OR short-acting analgesics OR narcotics OR opi-
oid analgesics).
A further search using the broad terms (opioid OR pain
OR analgesics) was conducted of 10 key journals:
1) Academic Medicine; 2) Medical Education; 3) Advances
in Health Sciences Education: Theory and Practice;
4) Postgraduate Medical Journal; 5) Simulation in
Healthcare; 6) Advances in Physiology Education;
7) Journal of Continuing Education in the Health
Professions; 8) Journal of Surgical Education; 9) Evaluation
and the Health Professions; and 10) Medical Teacher.
Reference lists of articles identified in the database search
were also hand-searched for potentially relevant titles.
All titles and abstracts were screened by one researcher
(SB) for primary research pertaining to undergraduate or
postgraduate medical education in chronic noncancer
pain. Searches were limited to articles published in
English in the past 20 years. Case reports, news, edito-
rials, and commentaries, as well as studies of training
related to acute, cancer, and palliative pain manage-
ment, were excluded, as were studies focused on con-
tinuing medical education in already-licensed physicians
or on training in other health care professions. The pri-
mary author (FW) screened the titles and abstracts of all
short-listed articles for relevance, as well as approxi-
mately 5% of all titles and abstracts to ensure concor-
dance and quality. Articles that met the criteria for
inclusion in the critical scoping review were divided
among three authors (SB, FW, EO) for extraction of key
data points: publication year, population, purpose, de-
sign, and intervention.
Critical Review
Once full-text articles had been filtered for relevance,
the senior author and other members of the study team
reviewed all articles included in the final scoping study.
In a series of face-to-face meetings, the study team dis-
cussed the research findings, identifying key concepts
including historical trends in the data and potential ave-
nues for critical research. Data were then reorganized,
and points related to these themes clarified with refer-
ence to the full-text articles. These thematic findings are
presented alongside the descriptive results of our scop-
ing review.
Results
The database search identified 545 articles, 23 of which
were duplicates; 51 were selected for full-text review
(Figure 1), and seven more were identified from refer-
ence lists. Of 457 titles and abstracts identified in the
broad search of medical education journals, five were
selected for full-text review. Of the 63 articles that
underwent full-text review, 39 were included in our criti-
cal scoping study (Figure 1).
Findings are grouped into four inter-related themes:
1) the historical shift from concerns regarding opiopho-
bia to overprescribing; 2) the inadequacy of the current
chronic noncancer pain training landscape;
3) implications of training for the development of physician
empathy; and 4) implications for physician well-being.
The Historical Shift from Concerns Regarding
Opiophobia to Overprescribing
Our review identified a recent shift in thinking about the
use of opioids. In five older papers (2000–2009), the
emphasis was often on teaching medical students and
residents that there was a low risk of addiction with opi-
oid pain medications. The term “opiophobia” was some-
times employed to describe physicians who
underprescribed [24,25]. Authors were concerned that
the percentage of patients with chronic pain whom stu-
dents believed to be drug seekers increased after clerk-
ship [26] and that residents tended to overestimate the
risk of addiction [27].
By contrast, six more recent articles (2009–2014) fo-
cused on managing the “inappropriate” prescribing of
opioids and monitoring patients for signs of addiction
[17,28–32], and we found no mention of “opiophobia” in
this period.
Students’ understanding of opioid addiction was found
to be lacking [31], as was their ability to interpret urine
drug tests [28]. A curriculum review of Canadian and
American medical schools critiqued the lack of educa-
tion in substance abuse and addiction [17]. In 2014,
Persaud found that one medical school was offering lec-
tures supported by pharmaceutical companies without
disclosing this conflict of interest to students and cri-
tiqued medical educators for downplaying the adverse
effects of opioids and allowing industry to influence cur-
riculum [32].
After participating in case-based learning aiming to iden-
tify opioid use disorder in patients with chronic noncan-
cer pain, residents reported feeling more prepared in
identifying illicit substance use [30]. When the charts of
residents who participated in training for chronic pain
management were reviewed, an emphasis on urine test-
ing and documentation of discussions around use of a
controlled substance was evident [29]. Hence there is
some evidence that management strategies that poten-
tially would have been considered opiophobic would
now potentially be considered best practice. However,
within the medical education literature, this has not
been accompanied by research or commentary on the
need for guidance on alternative approaches in light of
Scoping Review Chronic Pain Training
3
4. the growing recognition of the drawbacks of prescribing
opioids.
The current emphasis on the rise of deaths from opioids
often sidesteps the important issue of why so many
highly addictive and dangerous drugs were prescribed
in the first place. The discursive shift from “opiophobia”
to “inappropriate prescribing” highlights the inherent ten-
sions between the widespread prevalence and debilitat-
ing effects of chronic pain, the often unacknowledged
role of the pharmaceutical industry in pain-management
training, and the conflicted role many physicians face
between offering symptom relief with opioids and pre-
venting addiction. Fields [33] constructs this as a “doc-
tor’s dilemma,” contrasting the viewpoint that it would
be “unconscionable to withhold adequate treatment
from any patient complaining of severe pain” with the
viewpoint that “addiction is a significant risk” among
chronic pain patients using opioids.
The Inadequacy of the Current Chronic Pain Training
Landscape
Most of the curricula were positively evaluated.
However, other studies demonstrated that students be-
came “less idealistic” about chronic pain patients during
medical school [26] and performed poorly on evaluating
the psychosocial sequelae of chronic pain [34]. Two
studies found that the number of hours dedicated to
pain management during medical school was limited
and the lack of a dedicated pain course led to a frag-
mented training approach [17,35]. Another reported that
residents were found to underuse pain scales and
opioid-equivalence tables, underprescribe patient-
controlled analgesia, and overestimate the risk of
addiction [27]. The focus on underprescription and
overestimation of the risk of addiction in this latter study,
published in 2005, stands in stark contrast to contem-
porary concerns about overprescribing.
Twelve surveys were included in our analysis
[25,26,28,31,35–41]. Of five surveys of program direc-
tors [37,38], two reported that directors believe training
in chronic pain to be generally inadequate [40,42], an-
other found directors of programs whose curricula of-
fered little formal pain management training nonetheless
reported them to be adequate [39], and the other two
found that directors report chronic pain management to
be of lower importance and interest to residents than
other areas of study [37,38]. Meanwhile, a survey of
medical students found that they report a lack of inter-
disciplinary training and less emphasis on the sociologi-
cal issues pertaining to pain as compared with its
pathophysiology [43]. Another survey found that medical
students developed behaviors during training, such as
increased authoritarianism, that contributed to subopti-
mal pain management for patients [24].
Four studies were surveys of medical residents, primarily
in internal medicine [11,27,28,36]. Residents in one
study reported an absence of chronic pain management
teaching in medical school and residency [36]; another
found residents felt it was less rewarding to work with
patients with chronic noncancer pain [11].
Despite the mostly positive evaluations of curricula, the
survey data indicate that students, residents, and edu-
cators consider the current training landscape to be
inadequate.
It is also worth noting that the literature on pain man-
agement in medical education focuses almost exclu-
sively on evaluations of educational outcomes and
surveys of learners and educators. The limitations of this
approach have been noted in other studies [44]. Few
studies have assessed the impact of training on stu-
dents’ clinical management of patients, with the excep-
tion of one pre- and postprescription audit [45] and one
study involving evaluation of residents’ charts [29].
Twenty-one studies included in our analysis were evalu-
ations of existing or new chronic pain curricula, 11 at
the medical student level [26,34,41,45–52] and 10 at
the resident level [25,27–30,53–57]. Twelve of these re-
lied on pre- and post-tests of students’ knowledge to
assess the effectiveness of curricula [25,29,30,47–
49,51,53–57], while one used a multiple-choice knowl-
edge assessment [52] and three asked students to
complete a questionnaire [26–28].
The lack of educational interventions in clinical settings
makes it difficult to assess the impact that educational
interventions have on patient care. Meanwhile, the dis-
crepancy between survey and post-test data suggests a
need for research into the suitability of the latter ap-
proach as a standalone assessment mechanism. Given
Figure 1 Results of the modified scoping review process.
Webster et al.
4
5. that care physicians often describe their training in pain
management as poor [10], there is a clear need for fur-
ther investigation of how training in pain management
impacts patient-physician interactions, as well as the
outcome this has on treatment approaches offered to
patients.
Implications of Training for the Development of
Physician Empathy
Four studies addressed the psychosocial impact of man-
aging patients with chronic noncancer pain on medical
students and residents [11,26,58,59]. Encounters with
patients with chronic pain were found to have profound
and often unacknowledged effects on future physicians’
attitudes toward complex patients, their role as care-
givers, and the profession of medicine itself [26]. A re-
view of reflective journals written by 86 medical students
found that their opinions of chronic pain patients were
mostly negative; they worried about patients’ trustworthi-
ness and identifying those who had “true pain” vs “drug
seekers” [58]. Again, this highlights the historical reliance
on opioids, as the question of whether or not patients
are drug seekers only becomes relevant when addictive
medications are offered as standard treatment. The im-
portance of empathy in the provision of high-quality clini-
cal care has been frequently advocated, and yet training
in “compassionate care” has been shown to be absent
[60]. This review demonstrates that few articles on edu-
cation in the management of chronic pain touch on this
important area of research.
Implications for Physician Well-Being
Corrigan and colleagues have found that uncertainty is
central to medical students’ attitudes toward chronic
pain patients [58]. Indeed, uncertainty is a common ele-
ment of all aspects of chronic pain, and opioid treat-
ment adds new dimensions of uncertainty. Worries
about the trustworthiness of chronic pain patients and
the potential of being manipulated by drug seekers sug-
gest a profound unease with the uncertainty of pain
treatment. These worries initially gave rise to the now-
abandoned discourse of “opiophobia” and continue to
be captured in surveys of attitudes and beliefs about
chronic pain patients. Given the inadequacy of pain cur-
ricula, it is unsurprising that students find dealing with
the clinical realities of chronic pain management chal-
lenging and exhausting [58]. More fundamentally, the
dominance of issues surrounding opioids in discussions
about pain management suggests that learners may not
be receiving adequate guidance in the full range of
strategies for helping patients manage pain, including
both alternative forms of symptom relief and helping pa-
tients find ways to cope with the limitations of pharma-
cological approaches.
In addition to the risk of creating unnecessary strain in
the patient-physician relationship, the lack of early and
comprehensive pain education may also affect medical
students’ perceptions of the profession as a whole. The
finding, cited above, that internal medicine residents
found caring for chronic pain patients to be less reward-
ing than other types of medical work, was accompanied
by the finding that 58% of those surveyed indicated that
chronic nonmalignant pain patients negatively influenced
their opinion of primary care as a career option [11]. As
students become less idealistic toward the medical pro-
fession in general during training, they begin to place
more faith in pharmaceutical interventions than patient-
dependent therapy [26]. Aside from being an important
issue in its own right, the impact of uncertainty on phy-
sician well-being is also closely related to the quality of
patient care.
Discussion
Our first theme, the shift from labeling physicians as
“opiophobic” when they failed to prescribe opioids to
viewing those who do prescribe as “inappropriate pre-
scribers,” requires further attention as it informs the cur-
rent situation of high rates of prescription opioid use
[6,7,9] and highlights the need for adequate physician
training in this important area. The paucity of evidence
around the impact of educational interventions on the
clinical performance of students is particularly concern-
ing given the discrepancy we found between the mostly
positive results of curriculum evaluation studies and sur-
vey research indicating widespread agreement that the
training landscape is inadequate.
As well as providing insights about transfer of formal
training to the clinic, further investigation of chronic pain
education outcomes in clinical settings could establish
knowledge about how informal training affects students’
and residents’ practice and attitudes. In the medical ed-
ucation context, “hidden curriculum” has been used to
describe the unwritten, and often unseen, “socialization
process of medical training” [61]. Previous studies have
demonstrated how the hidden curriculum impacts stu-
dents’ behavior and affects their empathy and compas-
sion [61].
However, our second finding, a theme of perceived in-
adequacy of the training landscape in much of the liter-
ature, can also be extended to the fact that research in
chronic pain education largely focuses on formal train-
ing. Curriculum reviews, such as Mezei and Murinson’s
extensive study [17], provide important evidence of the
inadequacy of formal training, but there has not been
similarly extensive investigation of the informal training
landscape. This is especially problematic given the par-
ticularities of pain management, which requires com-
passion and the ability to sensitively communicate
complex knowledge on a range of topics, from alterna-
tive treatment modalities and lifestyle changes to expec-
tations and the limits of biomedical therapies to the risk
and reality of addiction.
Fishman and colleagues’ competency-based framework
[62], published in 2013, represents an important
Scoping Review Chronic Pain Training
5
6. advance in developing and disseminating knowledge
about the importance of openness to alternatives to
pharmacology and understanding of context. We see
our review, and call for further research into informal
learning, as complementary to this advance. Even if all
of the relevant facts are covered in an ideal curriculum,
knowing when and how to draw upon them is a skill
that learners necessarily develop informally, from the
framing of issues in the classroom and from interactions
during their clinical training. Research on the impact of
the hidden curriculum on perceptions and practice with
regard to chronic pain patients could complement fur-
ther study of the impact of formal pain management
curricula in clinical settings.
One area of particular importance for education practice
and research is informal learning around the risk of ad-
diction. Some physicians report that they fear facing
sanctions as a result of prescribing opioids [63]. Primary
care physicians have been found to be especially con-
cerned with causing physical harm when prescribing
opioids to their older patients, and have also identified
diversion of drugs to family members as a pressing con-
cern [64]. It has been hypothesized that increased scru-
tiny may lead physicians to reduce their prescribing of
opioids without having access to alternative methods of
pain relief, thereby undertreating chronic pain [65]. While
cases of addiction and overdose death are all too real,
the tone and direction of recent concerns about addic-
tion and drug-seeking in patients with chronic pain may
nonetheless reflect a moral panic [66,67] in which blame
for the institutionalized lack of support and treatment is
transferred to the most vulnerable actors in the social
organization of care.
When this framing is uncritically accepted, inadequate
medical treatment of chronic pain is redefined as being
the problem of poorly behaved patients or poorly per-
forming physicians, rather than a complex series of is-
sues pertaining to the largely pharmaceutical-based
solutions used in current practice. Among other things,
informal training may reinforce perceptions that patients,
especially the elderly, are at unacceptably high risk of
physical harm if prescribed opioids; that patients divert
their medications to addicts or are addicts themselves;
and that, in many cases, complaints about pain are in
fact drug-seeking behavior. These perceptions in turn
lead to a sense that dealing with opioids and the pa-
tients who use them is a distinct downside of primary
care practice in general, and of chronic pain manage-
ment in particular. This particular finding reinforces the
need for further research extending from our third
theme, to address the implications of training for the de-
velopment of physician empathy toward patients, as
well as our fourth theme, the implications of learning
and practice surrounding chronic pain for the well-being
of physicians themselves.
Evidence from surveys of students’ attitudes and reflec-
tions, as well as the reflections of experienced practi-
tioners, would seem to suggest that the cautious tone
of today’s curriculum is compounded by a formidable
hidden curriculum. Hidden curriculum is typically in-
voked in critical analyses that seek to problematize ev-
eryday phenomena, and indeed that is how we have
employed the concept here. However, we are also
mindful of a tendency, discussed by Martimianakis and
Hafferty [68], to portray all informal socialization as an
inevitable barrier to humanistic practice. This need not
be the case; in reality, informal socialization is inescap-
able. We see hidden curriculum as a fertile ground for
critical reflection on how socialization processes could
be better structured and enacted.
In current medical thinking, chronic pain treatment
should focus on rehabilitation rather than interventions
aimed at symptom relief [69]. As chronic pain typically
persists over the long term, opioid treatment involves
greater risk of addiction, tolerance, and adverse events
[8,70]. Accordingly, several professional organizations
have provided physicians with guidelines on safe opioid
prescribing to address the ambiguity faced in managing
chronic pain.
However, our review suggests that medical education
has barely touched on nonpharmacologic approaches
to managing pain. While these are less widely re-
searched in a medical education context and less com-
monly used in mainstream practice, they may offer an
effective means of mitigating opioid use on an individual
and societal level [71]. Conversely, if research in medical
education is limited to the issues emerging from con-
ventional practice, rather than taking a critical perspec-
tive on how issues such as over- and underprescribing
are framed and what these framings leave out, there is
a risk of reinforcing the tendency to conflate prescribing
opiates with the humanistic imperative of helping pa-
tients manage their pain.
Research surrounding our fourth theme, implications for
physician well-being, indicates that trainees find manag-
ing chronic noncancer pain stressful and emotionally
taxing. An underlying etiology often cannot be found
and many patients exhibit high levels of distress [69],
making it difficult to apply guidelines intended to deter-
mine who should be given a prescription for acute
symptom relief and who should be referred to a biopsy-
chosocial approach. As concern about addiction and
adverse events has increased, the medical profession
has fallen under scrutiny. Practitioners and students
worry that they have insufficient skills to identify “drug
seekers” and that even “legitimate” pain patients are po-
tential addicts or overdose deaths. As Corrigan and col-
leagues [58] observed, “[the topic of] ‘pain’ was painful
for students.”
Given the high prevalence of chronic pain, as well as
the medical and ethical importance of safely providing
care to the subset of opiate users who do experience
addiction, there is a clear need for research on how to
teach students about chronic pain management, partic-
ularly the full range of available treatment strategies and
Webster et al.
6
7. the importance of empathy toward patients. We see our
critical scoping review as a first step in identifying new
avenues of research to meet this need.
Authors’ Contributions
FW conceived of the study and led the design, data col-
lection, analysis, and drafting of the manuscript. SB par-
ticipated in study design and conducted data collection
and analysis and drafting of the manuscript. EO partici-
pated in data analysis and drafting of the manuscript.
FW, SB, EO, JK, SD, and CM participated in analysis
and contributed to the manuscript. All authors read and
approved the final manuscript.
Acknowledgments
We would like to acknowledge the members of the full
COPE team: Onil Bhattacharyya, Aileen Davis, Rick
Glazier, Paul Krueger, Ross Upshur, Albert Yee, and Lynn
Wilson, who did not participate in this particular project.
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