Table 1.

Characteristics of pain medicine curricula

Date and author of publication and country	Number of medical schools included in study/total number of schools in the country	Pain medicine course structure, compulsory status, learning objectives, elective opportunities	Time in hours spent in formal pain medicine education (range)	Main department/s delivering the pain medicine education	Pain medicine course topics	Teaching method	Tools for assessment of pain medicine knowledge, attitudes, and skills
1988 Marcer et al., United Kingdom [40]	27/28	85% of medical schools provided formal teaching in pain/pain control. Specific details of a defined curriculum such as learning objectives, and mandatory teaching, and elective opportunities were not described	Mean 3.5 h (range 0.5–10)	Anaesthesia, pharmacology and medicine	Not specified	22% of schools offered all their students experience in a pain relief clinic or hospice	37% included questions on pain control in formal examinations
1999 Poyhia et al., Finland [46]	5/5	All medical schools provided pain medicine education. No university had developed its own defined curriculum on pain for undergraduate medical teaching. Pain was taught in an inconsistent way, with an overlap of the same topics. No details of defined learning objectives, mandatory teaching, or elective opportunities in pain medicine were described	Mean 32.7 h and median 30 h (range, 28.5–45.5) in 1994/5	Not specified	Most hours were devoted to pharmacology of pain, anatomy, physiology, anesthesiology, and physiotherapy. There was a serious lack of teaching in psychology of pain	Not specified	Not specified
2004 Watt Watson et al., Canada [37]	1/17	Specific mandatory integrated pain curriculum for all 2nd- or 3rd-year pre-licensure students from six health science faculties/departments. Learning objectives were clearly defined in terms of knowledge and clinical skills. No details of elective opportunities in pain medicine were described	20 h	Not specified	Epidemiology, principles of assessment and management, relevant neuropathology as a basis for pain and related management, impact of pain on patient, family, and society, pharmacotherapy basics and clinical issues; complementary and alternative strategies; common acute pain challenges; pain in children/adolescents with arthritis; pain guidelines; treatment of arthritic and neuropathic pain; addiction prevalence, screening and universal precautions; pain, genetics and sex; pain and work; inter-professional approaches/roles; cancer pain; pain mechanisms, assessment, and management; inter-professional team acute and persistent pain assessment and management; development of team comprehensive pain management plans	Didactic teaching, self-learning, case-based education and inter-professional small group sessions	Questionnaire and a comprehensive pain management plan
2005 Poyhia et al., Finland [36]	5/5	27% of students received specific pain medicine education in addition to pain medicine teaching within other modules; 34% of students were offered advanced studies on pain management and 15% had been offered research projects in pain medicine. Specific learning objectives were not identified	This was not measured	Anesthesiology	Anatomy, biochemistry, physiology, and pharmacology of pain were well covered. The definitions of pain, pain research, sociological issues, pediatric, and geriatric and intellectually disabled patients’ pain were poorly taught. The lack of teaching about the multidisciplinary pain clinic was recognized by almost all students	Didactic lectures, small group teaching, case-based education, and self-learning	Not specified
2009 Stevens et al., USA [34]	1/128	Pain medicine education was mandatory for all 2nd-year medical students. Specific goals and learning objectives were identified. No details of elective opportunities in pain medicine were described	8 h	Not specified	Pain pathophysiology; assessment; pharmacotherapy, behavioral therapy, alternative treatment; attitudes to pain; acute, chronic and cancer pain; and assessment of pain, development of a therapeutic relationship, emotion handling and negotiation of a treatment plan	Lectures, small group, case-based seminars	Formative OSCE
2009 Yanni et al., USA [33]	1/128	Pain medicine education was mandatory for all 3rd-year medical students. The curriculum was organized into six modules that covered 20 specific competency-based objectives. No details of elective opportunities in pain medicine were described	Time to complete the course was not stated	Not specified	The following topics were included: assessing chronic pain, treating chronic pain with a multidisciplinary approach; reviewing the management of specific pain syndromes; confronting challenges including prescription drug misuse; and reviewing laws and regulations that govern controlled substance prescribing	E-learning self-directed study	Online electronic pre- and post-intervention questionnaires
2009 Watt-Watson et al., Canada [42]	9/17	32.5% of health science programs identified specific mandatory pain course content. Electives were offered at some institutions but no details were described. Specific details of a defined curriculum such as learning objectives were not described	Mean 16 h (range, 0–38)	Not specified	Neurophysiology and pharmacological management were the subjects covered most thoroughly. The least number of hours were allocated to pain misbeliefs, assessment, and follow-up. Respondents indicated that pain was mentioned in many different courses, but only as a diagnostic indicator of etiology related to the presentation of illnesses and the need for investigation	Most respondents indicated that they did not combine their content with other professions but specific details were not described	Not stated
2011 Briggs et al., UK [30]	9/32	There was a lack of a formal pain curriculum in the majority of programs. Pain medicine content was mostly integrated throughout several modules. Separate pain modules tended to be optional courses. The educational content was largely fragmented throughout the curricula. Specific details of a defined curriculum such as learning objectives and elective opportunities were not described	Median 13 h (range 6–50)	Not specified	Neurophysiology and pharmacological management were most frequently taught topics. 5% of the pain teaching content was devoted to pain assessment and 5% to non-pharmacological methods of pain management	Lectures (88%), case-studies (78%), student-led enquiry or problem-based learning 42%). Inter-professional education around pain was rare and only 19% shared content with another health disciplines, and this was typically lectures suggesting a multi-professional approach of learning alongside one another rather than IPE	70% of programs included examination or case-based assessment
2011 Mezei et al., USA and Canada [43]	117/145	Only 4% of US medical schools reported having a mandatory specific pain medicine course. Pain was mostly taught in the context of a more generalized course; 20% of US and 8% of Canadian medical schools do not require any pain sessions within the curriculum; 16% of medical schools offered a designated pain elective. Specific details of a defined curriculum such as learning objectives were not described	USA: Mean 11 h and median 9 h (range 1–31) Canada: Mean 28 h and median 19.5 h (range, 3–76)	Not specified	Pain neurobiology, visceral pain, clinical assessment, and pharmacological management were commonly included in the medical school curricula. Cancer pain, pediatric pain, geriatric pain, and the medico-legal aspects of pain care were virtually unaddressed	Not addressed	Not addressed
2011 Murinson et al. USA [32]	1/128	A mandatory pain medicine course was delivered to all 1st-year medical students. Learning objectives were specified. The core content was delivered in a specific 4-day pain course and also in other parts of the 4-year medical school curriculum. No details of elective opportunities in pain medicine were described	35 h	Not specified	Topics covered in the course included pain neurobiology, the human and social cost of pain; clinical assessment of pain; non-pharmacological pain management; pharmacological pain management; interventional approaches to pain management; acute and chronic pain; pediatric pain, geriatric pain; cancer pain; impact of culture and ethnicity of pain and medicolegal aspects of pain care	Didactic (less than 60% of the course), small-group, laboratory, and team-based learning sessions; and design-built elements to strengthen emotional skills including a brief pain narrative, self-reflection, use of fine-art images	Multiple-choice exam, a brief assessment portfolio, and a paired-work assignment
2013 Tauben, Loeser. USA [35]	1/128	An integrated structured pain medicine course was mandatory for all 3rd and 4th year students. Elective pain education opportunities for selected students. Specific details of learning objectives were not described	25 h. 320 h in a pain elective	Not specified	Course focuses on pain interviewing skills, patient narrative, co-occurring biopsychosocial conditions and risks, common office-based primary care chronic pain conditions, and opioid, non-opioid, and nondrug treatments, with less attention to pain pathways, research design, and surgical and neuromodulatory interventions	Case-based teaching, didactic lectures, interactive workshop, clinical exposure, e-learning opportunity, with an emphasis on inter-professional education	OSCE evaluation
2015 Briggs et al., selected European countries [44]	242/249	In 55% of schools, pain was taught only within compulsory non-pain-specific modules. The curricula of 7% of schools showed no evidence of any pain teaching. Where pain modules were provided, they were compulsory in only 18% of all schools; 88% of all schools documented some form of compulsory pain medicine teaching (range from 40% in Bulgaria to 100% in Denmark, Poland, Sweden and Romania). Five schools with available information enrolled a mean of 22 students (range, 15–50) in elective dedicated pain modules, representing 4–11% of the schools’ students in that year group. Specific details of a defined curriculum such as learning objectives were not described	Median 12 h (range, 4-56) for compulsory dedicated modules and median 9 h [range 1–60] for other compulsory non-pain-specific modules	Pharmacology, anesthesiology, physiology/pathology, emergency medicine, and palliative care modules	Not specified	95% of the schools used classroom teaching, 48% used placements, and 26% used case-based learning	Examinations (93%), assignments (24%). Placements, practical assessments, attendance, presentations, group work, clinical methods or problem-based learning was each used for assessment by < 10% of schools
2017 Bradshaw et al., USA [45]	1/128	Fragmented teaching was mandatory for all students. 660 total instances of the term “pain” and selected pain-related terms in the 2 years. Specific details of a defined curriculum such as learning objectives were not described. No details of elective opportunities in pain medicine were described	Not addressed	Not specified	Early emphasis on nociceptive transduction and signaling mechanisms followed by minimal attention to the social and multidimensional nature of pain. Overall, pain was presented as a symptom of other conditions rather than a disease entity per se. By subject, clinical anatomy, microbiology and infectious disease and reproductive health contained the highest number of terms	Not addressed	Not addressed
2018 Shipton et al., Australia and New Zealand [41]	19/23	95% of schools taught pain medicine only as a topic integrated into other compulsory subject areas over the entire curriculum. Learning objectives were identified by 58% of medical school but, in general, these were not comprehensive, 53% of schools offered electives in pain medicine	Mean of 19,6 h and median of 20 h (range, 5–43 h)	Anesthesia (74%), physiology/neurophysiology (58%) and pharmacology (47%)	Neurophysiology of pain, clinical assessment, analgesia use and the multidimensional model of pain medicine, palliative/cancer pain and the concept of peripheral/central sensitization. Fewer than half the schools covered the topic of psychological methods for managing pain, medical interventions, and ethics. The multidisciplinary pain clinic, medico-legal aspects of pain medicine, geriatric pain and pediatric pain were topics covered by the least number of schools	Didactic teaching methods (100%), clinical exposure (84%), tutorial teaching methods (47%) and case-based learning (42%), problem–based learning (26%), e-learning (21%). Self-directed learning and simulation-based learning were used very infrequently. 79% of medical schools indicated that medical students were not exposed to IPL in the context of pain medicine education	Multiple choice questions (MCQs) were used by 63% of schools and the objective structured clinical examination (OSCE) was used by 32% of schools. 16% of schools unsure of whether any assessment took place