Table 1.
Summary of the papers included in this study.
| Author (year of publication) | Country | Study population | Research design | Instrument | Primary finding |
|---|---|---|---|---|---|
| Weiner et al. (2014)17 | United States | Third-year medical students: Intervention group (n = 27); Control group (n = 28) | Intervention: E-learning module on chronic lower back pain (CLBP) with Objective Structured Clinical Examination (OSCE) | OSCE – one CLBP station out of nine stations | Students exposed to CLBP module. Mean scores: 79.5 (SD: 10.4)Students not exposed to CLBP module. Mean scores: 62.0 (SD: 8.6)No significant group differences were detected |
| Owens et al. (2014)18 | United Kingdom | Paediatric nursing students: Intervention group (n = 45); Control group (n = 37) | Intervention: structure pain management programme; pre-/post-intervention questionnaire | Knowledge and Attitudes Survey Regarding Pain (KASRP) – modified | Intervention group showed greater improvement in knowledge. However, results suggest lack of knowledge in relation to pathophysiology, assessment and pharmacology of pain |
| Al-Khawaldeh et al. (2013)19 | Jordan | Final-year nursing students (n = 240) | Cross-sectional study | KASRP – modified. 38-item questionnaire containing true/false and multiple-choice questions (MCQ) that examine knowledge and attitudes regarding pain management | Lack of knowledge and training regarding pain management. Mean score: 34.1% (SD: 9.90) |
| Al Khalaileh et al. (2013)20 | Jordan | Fourth-year nursing students (n = 144) | Cross-sectional study | KASRP | Low knowledge levels of pain management. Mean score: 40% (SD: 12.75) |
| Briggs et al. (2013)21 | Australia | Final-year students: medicine (n = 176), chiropractic (n = 46), occupational therapy (n = 71), pharmacy (n = 138), physiotherapy (n = 171) | Cross-sectional study | Modified Health Care Providers Pain and Impact Relationship Scale (HC-PAIRS) – 13-item questionnaire that measures attitudes of clinicians towards patients with CLBP. Back Pain Beliefs Questionnaire (BBQ) – 14-item questionnaire that measures beliefs about consequences of future life with low back problems. Clinical vignette and questionnaire to assess likely practice behaviour | Physiotherapy and chiropractic students demonstrated more ‘helpful beliefs’ about low back pain. HC-PAIRS and BBQ scores were strongly associated with clinical recommendation scores |
| Duke et al. (2013)22 | United States | Junior and senior nursing students (n = 162) and faculty (n = 16) | Cross-sectional study | KASRP – modified | Most frequently missed items were related to knowledge about pain medications and administration. KASRP score increased with increased education, but faculty and final-year students were still below the threshold competent score of 80%. Mean score: 63% (SD: 8.78) |
| Hirsh et al. (2013)23 | United States | Medical students (n = 35) and physicians (n = 50) | Cross-sectional study | Medical Condition Regard Scale (MCRS) – 11-item measure of clinicians’ attitudes towards treating a given medical condition (chronic pain). Clinical vignettes with participants indicating likelihood to recommend 10 common pain treatments | Physicians gave higher ratings for physical therapy and lifestyle activities as treatment options compared to medical students |
| Morris et al. (2012)24 | United Kingdom | First-year (n = 202) and final-year (n = 146) medical students, and first-year (n = 62) and final-year (n = 61) business students (control group) | Cross-sectional study | Original HC-PAIRS –15 items | Improved overall attitudes towards patients with CLBP for both courses as they progressed. There was a greater change in medical students compared to business students |
| Kaki (2011)25 | Saudi Arabia | Sixth-year medical students (n = 325) | Cross-sectional study | Own instrument: 10 Qs from Weissman and Dahl,26 author wrote 8 Qs | Medical students had inadequate knowledge and a negative attitude towards cancer pain management |
| Murinson et al. (2011)27 | United States | First-year medical students (n = 118) | Intervention – 4-day pain course MCQ completed after the course only | MCQ test of pain knowledge, assessment portfolio, paired work assignment, attendance | Mean score for MCQ: 75 (SD: 11.00). Mean score for paired work: 87 (SD: 12.20). Median grade for portfolios was very good (qualitative scale: fair, good, very good and excellent). Students reported a high degree of satisfaction with the course |
| Rahimi-Madiseh et al. (2010)28 | Iran | Nursing students (n = 146) | Cross-sectional study | KASRP | No students answered >60% of the items correctly. Iranian nursing students had poor knowledge of pain management. Mean score: 37% |
| Ali and Thomson (2009)12 | United Kingdom | Final-year physiotherapy (n = 62) and medical (n = 126) students | Cross-sectional study | Own instrument: 16-item questionnaire that consulted the following: HC-PAIRS/Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT)/Pain Knowledge Questionnaire29 | Medical students had higher scores for questions relating to chronic pain management compared to physiotherapy students. Physiotherapy students had higher overall knowledge compared to medical students |
| Stevens et al. (2009)30 | United States | Control group: 2006 second-year medical students (n = 174). Intervention group: 2007 second-year medical students (n = 159) | Cohort study – Pain Assessment and Management (PAM) Curriculum implemented during Year 2. Testing conducted at the end of Year 3 | Comprehensive Clinical Skills Examination (CCSE) – three out of the eight stations were related to pain | The intervention cohort assessed acute pain and managed terminal pain more effectively than the control cohort. PAM curriculum may have made an impact on the ability to apply a systematic approach to patients with terminal pain |
| Hunter et al. (2008)31 | Canada | Final-year medical, dentistry, pharmacy, nursing, physical therapy and occupational therapy students (n = 817 in 2007) | Intervention: Interprofessional Pain Curriculum (IPC).Pre- and post-tests of the Pain Knowledge and Beliefs Questionnaire (PKBQ) | PKBQ, Daily Content and Process Questionnaire (DCPQ), Comprehensive Pain Management Plan (CPMP) | Statistically significant improvement in PKBQ scores from 2002 to 2006. DCPQ responses indicated students highly rated the patient panel and small interprofessional group sessions |
| Manalo (2008)32 | Philippines | Fifth-year medical students (n = 50) | Cross-sectional study | Questionnaire developed by Gallagher et al.33 to assess knowledge and confidence regarding cancer pain management | Poor knowledge of cancer pain management among all the students. Mean knowledge score: 6.6/13 (SD: 2.9) |
| Niemi-Murola et al. (2007)34 | Finland | Medical students from all-year levels (n = 430) | Cross-sectional study | Own instrument: 28-item questionnaire using 6-point Likert scale. Focused on attitudes and beliefs towards pain and assessment, use of opioids for cancer pain, anxiety about seeing a pain patient and attitudes concerning treatment of chronic pain | Intervention was associated with an increased empathy towards elderly patients’ pain, increased willingness to prescribe opioids and less anxiety towards seeing a patient suffering from chronic pain |
| Chiang et al. (2006)35 | Taiwan | Nursing students (n = 181) | Intervention: Paediatric Pain Education Programme (PPEP) with pre-/post-test questionnaire | Own instrument: 35 Qs adapted from KASRP and 13 MCQs adapted from Manworren.36 Measured student nurses’ paediatric pain knowledge, attitudes and self-efficacy in managing pain | Knowledge and attitudes – pre-test scores: 20/35 and post-test scores: 32/35. Self-efficacy – Pre-test mean score: 73.37% (indicating nurses were fairly confident in assessing and managing children’s pain) and post-test mean score: 87.07% |
| Goodrich (2006)37 | United States | Nursing students and faculty (n = 10). No numbers reported for nursing students | Survey administered at beginning and end of each academic semester for 2 consecutive years. Unknown if the same sample was tested | KASRP + Open-ended questionnaire on curriculum pain content (for faculty members only) | Seniors outperformed juniors, who outperformed sophomores. There were still deficiencies in many areas of knowledge and attitudes regarding pain management. Faculty tested satisfactorily on the KASRP and perceived themselves as competent in pain management |
| Greenberger et al. (2006)38 | Israel | First-year and fourth-year nursing students, and nurses beginning or completing a certification programme (n = 1149) | Cross-sectional study | Own instrument: 20 items from KASRP with 7 items from Patient Pain Questionnaire (PPQ). Items were modified to use a 7-point Likert scale instead of T/F and MCQ to examine knowledge and attitudes to pain | Knowledge and attitude levels were positively correlated with frequency of pain care delivery. However, the more participants knew about pain and the more positive their attitudes, the less they perceived themselves able to give good pain care |
| Niemi-Murola et al. (2006)39 | Finland | Fifth-year medical students (n = 97) | Two parts:(1) Questionnaire on status of pain education with regard to the International Association for the Study of Pain (IASP) curriculum administered pre-OSCE (3 weeks) and post-OSCE (3 months);(2) OSCE | OSCE – 10 stations | Communication skills were positively correlated with self-reported clinical experience. No correlation between self-reported content knowledge of IASP curriculum and OSCE results |
| Plaisance and Logan (2006)40 | United States | Nursing students (n = 313) | Cross-sectional study | KASRP | Only 3.8% of students answered >80% correctly. Poor knowledge reflected in the low KASRP scores. Mean score: 64% |
| Sloan et al. (2004)41 | United States | Third-year medical students (n = 96), 32 students in each of the four groups | Randomised Control Trial – Group 1: control, Group 2: Self-instruction module, Group 3: self-instruction module + Cancer Pain Structured Clinical Instruction Module (SCIM), Group 4: self-instruction module + SCIM + Hospice Patient Home Visit | OSCE – four stations to assess cancer pain management skills of pain history taking, physical examination, analgesic management and communication of opioid myths (used in Sloan et al.42) | Students who received all the components of the intervention did better than those in Group 1 or 2. All three treatment groups performed better than the control group in the pain management component of the Cancer Pain OSCE |
| Watt-Watson et al. (2004)11 | Canada | Final-year medical, dentistry, pharmacy, nursing, physical therapy and occupational therapy students (n = 540) | Intervention: Interprofessional Pain Curriculum (IPC) with pre- and post-tests of PKBQ | PKBQ, DCPQ, CPMP | Statistically significant change from 66% to 83% for pain knowledge and beliefs about pain. Overall student evaluations of content and format on DCPQ were positive |
| Chiu et al. (2003)43 | Australia/Philippines | Final-year nursing students: Australia (n = 81), Philippines 1 (n = 45), Philippines 2 (n = 24) | Cross-sectional study. Results from the two universities sampled in the Philippines were amalgamated and treated as one | 30-item questionnaire – 23 factual questions aim to measure knowledge of physical signs, neurobiological mechanisms, terminology and basic management principles,29 and 7 questions related to demographic data and perceptions of pain management education | No significant group difference in overall mean scores. Common questions answered poorly included those related to complex regional pain syndrome, pharmacology and central sensitisation |
| Sloan et al. (2001)42 | United States | Third-year medical students (n = 34) | Cross-sectional study | OSCE – four stations to evaluate clinical competence in cancer pain assessment and management | Students did best on the cancer pain history taking station. Physical examination station performance was poor |
| Sloan et al. (1998)44 | United States | Final-year medical students (n = 96) | Intervention: 4-week course with lectures, small-group sessions, clinical sessions with a multidisciplinary chronic pain and acute pain service. Pre-/post-test questionnaires | Own instrument: 22-item questionnaire of attitudinal statements regarding appropriate use of morphine for cancer pain | Overall improvement in knowledge scores following course completion |
SD: standard deviation.