COVID 19: FPM statement on the ongoing impact on the provision of Higher and Advanced training

The Faculty of Pain Medicine remains committed to ensuring that our responsibility to train anaesthetic trainees at core, intermediate, higher and advanced pain training continues. The ongoing COVID-19 pandemic continues to have a major impact on our personal and professional lives. Although delivery of pain services continues¹, feedback from trainees² as well as Pain Regional Advisors (RAPMs) and Faculty Tutors in Pain (FTPs) has made it clear that the second surge of the pandemic has had a considerable impact on training at all levels.

Pain specialists are facing challenges of offering remote consultations, limitations on multidisciplinary group sessions, and a marked reduction in provision of pain intervention sessions.  In-patient pain services have also been impacted upon, as many acute pain nurses have been redeployed and most elective surgery has been cancelled. We are also starting to see patients with ‘Long COVID’. Trainees and trainers alike are suffering considerable levels of exhaustion.

In spite of all of this we are humbled by the response of all health professionals and our trainees both in their willingness to change their scope of practice and in accepting the inevitable upheaval that this has caused in their lives.

Trainee Survey 

A recent survey, conducted by the FPM in the first two weeks of January 2021, of our higher and advanced trainees found the following results

Free text comments from the survey allude to very limited training in the areas where services are still running, with most interventions currently on hold and very few face-to-face consultations being held.  Access to remote consultations by video and/or telephone does not appear to be occurring across the board even at this advanced stage of the pandemic.

The FPM would very much like to thank all the trainees who completed the survey as well as all the trainees who recently attended an online meeting with FPM Training & Assessment Committee (FPMTAC). The survey and feedback from that meeting clearly indicate significant and understandable concern as to how all the requirements for completion of advanced pain training can be met. It is apparent from trainee feedback and data from the FPM survey regarding provision of services that one size is not going to fit all, due to the significant regional variation in delivery of services as well as redeployment of trainees and trainers.

Meeting with FPM Training Leads

With this in mind, the FPM will in the next four weeks contact  each trainee who is currently registered with the Faculty as undergoing (or shortly due to start) advanced pain training to offer the opportunity of an online meeting with Dr Lorraine de Gray (Chair of FPMTAC and FPM Vice-Dean), Dr Victor Mendis (Deputy Chair FPMTAC), and Dr HooKee Tsang (RAPM Chair). Trainees are strongly advised to take up this opportunity.  Each trainee can ask for their FTP and/or RAPM to be present if they wish. Alternatively they can ask for one of their Consultant trainers to be present. During the meeting an individualised plan for each trainee will be made with the trainee’s and trainers’ agreement.  We will be taking a pragmatic approach but will also seek to support the best possible training experience in the current environment, whilst ensuring that trainees achieve the competencies required.

For trainees undergoing basic (core) and intermediate pain training, Training Programme Directors across the country are trying to adapt modules both in terms of contents and timings.  We would encourage you to take the opportunity to seek training in Pain Medicine by attending outpatient services or in-patient ward rounds if there is  flexibility in the department you are currently attached to, bearing in mind that most elective surgery bar cancer work is currently cancelled.

Using e-PAIN

The FPM is also updating FTPs and RAPMs to allow trainees to consolidate their pain training by reading e-Pain . We especially recommend the following modules:

For Basic Pain training for Core Trainees

Module 1: Introduction to pain management

For Intermediate Pain training 

Module 2: Acute Pain

Sessions include:

• Pharmacology for Acute Pain
• Pain Assessment and Basic Principles of Prescribing
• Acute Pain Management of Special Populations - Renal, Hepatic and Sickle Cell
• Adjuvant Analgesics
• Regional Anaesthesia

Module 3: Pain as a Long-term Condition

Sessions include:

• Biopsychosocial Model in Pain Management,
• Chronic Pain Management,
• Multidisciplinary Management of Chronic Pain,
• Psychological Assessment
• Approach to Treatment,
• Ways of Supporting Pain Self-Management Strategies

Module 4: Treatments and Therapies

Session includes

• Pharmacological and non-pharmacological treatment:
• Non-Steroidal Anti-Inflammatory Drugs
• Paracetamol
• Opioids - Basic Principles
• Opioids for Persistent Pain: Overview and Evidence
• Opioids for Persistent Pain: Using Opioids in Practice
• Local Anaesthetics
• Antidepressants and Anticonvulsants
• Multimodal Analgesia
• Assessing Treatment Effectiveness
• Interventional Procedures for Pain Relief
• TENS and Alternative Treatments

Module 11: Cancer Pain

Sessions include:

• Causes and Aetiology of Pain in Cancer
• Pharmacological Cancer Pain Management
• Non-Pharmacological Cancer Pain Management Pain in Cancer Survivors

Module 12: Basic Science

Sessions include:

• Anatomy of the ascending pain pathway
• Physiology of pain
• Modulation and plasticity in the nociceptive system Imaging and pain

Technology is also on our side and over the past 12 months we have all realised how good use of telecommunications can lead to both teaching and training as well as allowing us to interact and continue to provide care to our patients.

FPMLearning

The FPM will shortly be launching FPMLearning, an open resource for all trainees providing a variety of teaching materials including case reports, journal club, recommended reading, webinars, podcasts, updated exam resources to name a few. We hope that this resource will help you to feel supported in your training. Please do feedback to us in the coming months your views on the site and how we can improve it by emailing: contact@fpm.ac.uk

Seek help if needed

Please do take care of yourselves and your families.  Do look out for your colleagues who may be struggling. We encourage all to access resources that may be of use on the Faculty of Pain Medicine website, the Royal College of Anaesthetists website and the joint ICM Anaesthesia hub.

Please do seek help if you are experiencing difficulties, either through your local department or through the Faculty or College if you require our support. We are always ready to listen.

References

1. FPM COVID-19 Reset Guidance on Resumption of Pain Services. 15 May 2020. COVID-Reset-Guidance-on-Resumption-of-Pain-Services-May-2020.pdf (fpm.ac.uk)
2. FPM COVID-19 Higher and Advanced Trainee Guidance. 15 May 2020. FPM-COVID-19-Higher-Advanced-Training-Guidance-2020.pdf