Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught

Background and aims: Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education. Methods: An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers’ Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management. Results: A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training. Conclusions: Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement. Implications: This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies

What influences chronic pain management? A best–worst scaling experiment with final year medical students and general practitioners

Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives. Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management. Results: All three cohorts considered the patients’ pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students. Conclusion: This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education

Developing indicators of the impact of scholarly communication is a massive technical challenge – but it’s also much simpler than that

Conversations on impact tend to revolve around technical issue of measurement and finding appropriate metrics. To widen the conversation J. Britt Holbrook presents a list of 56 indicators of impact developed by the Center for the Study of Interdisciplinarity to help simplify the question of impact. By moving beyond technical aspects there is a greater opportunity for academics to embrace and explore other facets of impact

He Was So Well Provided for That He Could Sweep the World for Gain : the Supply of Sherman\u27s Armies during the Atlanta Campaign, 1864

Forward: The following study is in some ways not a traditional treatment of the American Civil War. Consequently, it is the purpose of this introduction to prepare any potential reader for what lies ahead. Civil War historians have long written of the American Iliad, as it is sometimes called, as if it simply appeared, from a military perspective, out of nowhere, with no preceding experiences which influenced its course nor any consequences which resulted from it. In short, tunnel vision has been a characteristic trait of many chroniclers of the War of the Rebellion. This work, therefore, attempts to go beyond the usual limits of Civil War history to examine what effects the preceding three hundred years of European and American military history had on the effort of General William Tecumseh Sherman to feed, clothe, arm, and accoutre his bluecoats during the Atlanta Campaign of 1864. And further, the results of this experience on later attempts by Americans and Europeans to feed their armies in time of war are briefly traced through World War One, when all western armies came to rely on their own internally administered and organized supply systems to fill their armies\u27 material needs. Because this study endeavors to take the so-called long view of the Atlanta Campaign and how it fits into the whole of western military history, it may be helpful to read it in a certain order. Read the first chapter in its entirety, and then peruse the last four pages of the text. In this way, the long view will become apparent. Next, go back and read all of chapters two through six. The result should be a much clearer understanding of the supply of Sherman\u27s armies during the Atlanta Campaign. And finally, to all but the most dedicated of military historians, a logistical study would seem to be endlessly boring and inconsequential. In truth, however, logistics or supply has had more effect on military history than is commonly recognized, and the first few pages of chapter one should firmly establish that fact. Hence, it is a further purpose of this work to dispel some of the widely held myths concerning the way in which Sherman\u27s blue columns were provisioned on their march to Atlanta and how the ultimate Union victory was in one way at least due greatly to a superb supply network. (c) J. Britt McCarle

Pottery and mobility: A functional analysis of Intermountain Brownware

Intermountain Brownware, is a late prehistoric ceramic type made by mobile hunter-gatherers that is found throughout southern Nevada, western Utah and northern Arizona. Most hunter-gather groups around the world are not pottery producers. Through interdisciplinary analysis, I examine the physical and morphological characteristics to understand the amount of labor invested in the construction and production of Intermountain Brownware. I then evaluate these results amongst environmental, historical, ethnological, and archaeological data to conclude that Intermountain Brownware possesses lower porosity, and is thinner and stronger than commonly reported. Gas Chromatography-Mass Spectrometry (GC-MS) is performed to empirically characterize food residues remaining in the pores of each sherd. Seed and root residues were predominant in our archaeological samples and meat was not. This study demonstrates that Intermountain Brownware ceramics are of better quality than previously thought, that labor investment was significant, and that these vessels were primarily constructed for cooking seed and root stews