The Provision of Stage 3 and SIA Pain Training: Guide for Trainers and Trainees

Published: 09/03/2021

Core Standards for Training Centres

  1. The pain service must be conducted in accordance with the General Medical Council’s principles of good medical practice and the Core Standards for the Provision of Pain Management Services in the UK
  2. A service providing training in Pain Medicine must be multidisciplinary and multi-professional - Consultant Anaesthetist led, and include nurses, psychologists, physiotherapists, occupational therapists and ancillary staff, able to deliver pain management required in a timely and efficient manner. 
  3. The overall clinical workload of the pain management service would be expected to be large enough to provide a breadth and depth of clinical experience sufficient to meet the learning needs of the pain trainees that it supervises. 
  4. The training centre(s) should cumulatively achieve a minimum of 300 new cases each year; there should be a minimum of five (5) outpatient consultant half day sessions per week within the pain service devoted to Pain Medicine consultations and treatments. Total therapeutic interventions should be at least 500 per year. It would be expected that for acute post-operative pain there would be a minimum of 200 new patients managed by the service per annum with daily nurse or doctor led acute pain in-patient rounds per week. Where a training centre has more than one Stage 3 Special Interest Area (SIA) pain trainee per year there must be sufficient cumulative cases to fulfil the training requirements of each trainee and sufficient monitoring of clinic timetables and on call commitments to facilitate this. 
  5. There must be supervision and training available throughout the whole working week. Initially very close supervision will be needed and as competencies develop more independent working should be possible. However trainees must always be able to access support from their supervisors. 
  6. The majority of the consultant sessions should be provided by a minimum of two (2) different consultant anaesthetists who have a substantial sessional commitment to Pain Medicine.  
  7. Trainees are encouraged to attend Consultant sessions in other specialties such as, neurology, orthopaedics, rheumatology, rehabilitation medicine and psychiatry in recognition of the multi-disciplinary working essential in the management of patients with complex chronic pain. These sessions should however not exceed more than twenty percent of the overall numbers of training sessions. The FTP and/or RAPM should ensure that these Consultants in other specialties are familiar with the aims and objectives of Stage 3 SIA training of anaesthetists in Pain Medicine. 
  8. If specialised procedures such as intrathecal drug delivery, complex spinal procedures and spinal cord stimulation are not performed in the institution, then there must be an opportunity for the trainee to gain core knowledge of these techniques in another institution. 
  9. Clinical input to the pain service from a psychologist with expertise in Pain Medicine is essential; there should be an appropriate number of identified sessions for this input. This may vary if there are a number of hospitals providing training but should be a significant aspect for at least 3 months of training. Each trainee is expected to participate in a Psychologist led pain management programme. If the service does not have a pain management programme, then there must be a guaranteed opportunity for the trainee to participate in a pain management programme in another institution. 
  10. Specialist nurses provide an integral part of both outpatient chronic pain services and acute in patient pain services. 
  11. Pain Management Services (and programmes) must have a rehabilitative focus and must include a Health and Care Professionals Council (HCPC) registered Physiotherapist within the multidisciplinary team.   
  12. It is recommended that there should be an HCPC-registered occupational therapist with specialist experience in pain management employed within a pain management service. 
  13. Training centres should have collaborative pathways with various mental health teams, including liaison psychiatry, substance misuse teams, old age psychiatry and community mental health teams. 
  14. There must be provision of diagnostic services eg laboratory, radiology and neurophysiology.
  15. There must be links with necessary clinical support services including social services, pharmacy, medical physics and orthotics. 
  16. There must be full time secretarial, administrative and clerical support staff. Adequate IT support is essential. Access to provision of up-to-date patient notes/records is imperative. 
  17. The configuration of existing services may well be variable and a reflection of differing local needs, support and infrastructure as well as variation in practice. However, there must be a well-defined management structure for the pain service. 
  18. Regular multidisciplinary case conferences and clinical review sessions must occur to formulate management plans and review the progress of individual patients.
  19. The pain service should document and respond to critical incidents and must be able to demonstrate that risk management strategies are in place.  
  20. Audit must occur regularly and adequate records should be kept of audit meetings and outcomes.