Guidance on Higher Pain Training for Inpatient Pain Medicine

Higher pain training as a requirement for trainees wishing to work in an inpatient pain service (Affiliate Fellowship of the Faculty of Pain Medicine).

The changing face of the NHS and rising patient expectations are driving a need for change in the way that pain management services are organised and commissioned (1). In a resource limited NHS, traditional roles and practices may not be the most efficient way of delivering patient-centred care.  Cost savings may be made through service redesign. This offers opportunities for different ways of working for patients’ benefit. Integrated secondary care pain management services are seen as optimal in the emerging NHS landscape (2).

The preamble for the higher pain training section of the CCT in anaesthesia curriculum already states “the FPM recommend that these higher competencies are the minimum required for a trainee to consider a future consultant post with an interest in Acute Pain”. This advice is not being followed in most cases, and a recent national survey highlighted the need for a more comprehensive training programme for trainees wishing to work within or lead inpatient pain services (3).

Some of the skills required of inpatient pain consultants overlap with other higher and advanced training modules. These skills, including non-technical / human factors and regional anaesthesia may not be fully developed by the end of higher pain training. It is expected that trainees will focus on these aspects during their advanced anaesthesia training.

This advice document outlines curriculum learning outcomes for higher pain training for trainees in anaesthesia intending to lead an inpatient pain service and post CCT anaesthetists taking on this role.

This document may be used to tailor higher pain training for those wishing to work in inpatient pain management who do not intend to progress to advanced pain training. This approach does not preclude trainees from advanced pain training and is intended to provide advice for Regional Advisers, LPMESs and Trainees.

Trainees planning to continue to advanced pain training and work primarily in chronic pain outpatients may continue with the current approach to higher pain training if they wish.

Completion of higher pain training will allow trainees to apply for Affiliate Fellowship of the Faculty of Pain Medicine, without sitting the FFPMRCA exam. This will allow doctors working in acute pain medicine to become part of the FPM and access resources on the FPM website.

Trainees would be expected to complete higher pain training during years ST5-ST6, although completion of higher training may happen during the ST7 year. Ideally, the training should be completed within a 3 month block of at least 20 sessions, with minimal interference from general anaesthetic duties. In reality, it is accepted that on call requirements often continue during higher training, and that trainees will also need to maintain their skills in anaesthesia.

It is expected that post CCT anaesthetists will have achieved generic pain medicine competencies to the level of intermediate training in pain medicine within a GMC recognised anaesthetic program before undertaking this period of training. Post CCT anaesthetists would be expected to undergo the same period of higher pain training as trainees.

Completion of higher pain training is dependent upon satisfactory completion of the curriculum learning outcomes highlighted in annex A.

Assessment in anaesthesia is changing to reflect the GMC credentialing programme, with an outcomes based system utilizing the generic professional capabilities (GPC) framework. This document references the 2010 Anaesthesia CCT curriculum and the GPC framework domains.

The generic professional capabilities framework, sets out standards for training under nine key domains. These domains are:

Domain 1: Professional values and behaviours

Domain 2: Professional skills

Domain 3: Professional knowledge

Domain 4: Capabilities in health promotion and illness prevention

Domain 5: Capabilities in leadership and team working

Domain 6: Capabilities in patient safety and quality improvement

Domain 7: Capabilities in Safeguarding vulnerable groups

Domain 8: Capabilities in education and training

Domain 9: Capabilities in research and scholarship

Annex A (Page 5) outlines how training in inpatient pain medicine maps to the GPC framework.