Using the Knowledge to Action Cycle to Implement Evidenced Based Pain Competencies Into Pre-Licensure Entry-Level Physical Therapy Curriculum.
The purpose of this presentation is to define the Knowledge to Cycle (KTA) and apply KTA phases to: 1) develop a professional learning community related to pain curriculum, 2) assess entry level physical therapy curricula and compare this to the International Association for the Study of Pain (IASP) standards, and 3) to evaluate student knowledge and attitudes throughout a pre-licensure entry-level physical therapy curriculum.
The KTA framework was used to create a three-phase study design. In phase one, a professional learning community (PLC) was formed to assess and examine current pain literature and the current curriculum. The PLC, in phase two determined gaps in the pain content of the current curriculum compared to the literature and the IASP core competencies using a curriculum mapping matrix. Phase three involved students from trimesters 1, 2, 4, and 7, who were evaluated on their pain knowledge and attitudes using the City of Boston’s Rehabilitation Professional’s Knowledge and Attitudes Survey Regarding Pain (COBS) with an additional seven multiple choice questions specific to their pre-licensure entry-level physical therapy curriculum.
Two main content areas were found from analyzing the gaps on the curricular maps: a) the multidimensional nature of pain and b) pain assessment and management. In terms of the multidimensional nature of pain, there were issues found with missing biopsychosocial aspects, ethics, and political / societal issues. Differing definitions across trimesters on acute and chronic pain were also revealed. The gaps in analysis of pain assessment and management included missing development of interprofessional consultant networks, quantitative tools, measurement of psychologic status, measurements for special populations, treatment considerations, and a pharmacology gap of equianalgesic dosing.
The COBS survey results revealed some significant findings as well. Students were incorrect on items addressing malingering, patient dishonesty and clinical intuition. For example, ~70% felt malingering is common in chronic pain, ~70% felt that non-drug interventions such as heat and ice are not effective in treating moderate or severe pain, and ~50% felt chronic nonmalignant pain is primarily psychological. In addition, pain attitudes and beliefs actually declined for the worse from Trimester 1 compared to Trimester 7, with no class obtaining a passing score overall as defined by the COBS study.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Given the gaps in curriculum and poor student attitudes, the next phase will be to implement phase four of the KTA Cycle. It will involve the implementation of changes in order to correct the curricular gaps and enhance pain content. This will require a common use of terms and language by faculty, addition of missing content, and a common image known as the, “Bread Crumb” to connect the material when discussing pain in all courses.
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