PM2

Guidelines for Units Offering Training in Multidisciplinary Pain Medicine

1. Introduction                                                                Download PDF ( 34.1 kB)

1.1 These guidelines establish the recommended standards for Units offering training in Multidisciplinary Pain Medicine for Fellowship of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists.

1.2 The term Unit is the Faculty’s preferred designation for the personnel and facilities that together may constitute all or part of the training program of a trainee.

1.3 The term “program” refers to the experience and exposure devised for a trainee. A Trainee’s program may be pursued through more than one Unit.

1.4 A Multidisciplinary Pain Medicine Unit must include practitioners from at least three relevant medical specialties and from relevant allied health professions.  These health professionals specialise in diagnosis and management of patients with chronic pain, acute pain and cancer pain, referred to generically as “patients with pain”. They should have experience working together in an interdisciplinary context.

1.5 The Multidisciplinary Pain Medicine Unit must have access to rehabilitation services, cancer/palliative care services, psychological and psychiatric services and an Acute Pain Service. Coordination between these services is highly desirable.

1.6 The Multidisciplinary Pain Medicine Unit must be approved prospectively by the Board of the Faculty of Pain Medicine for training purposes.

1.7 Trainees are expected to spend 0.9 FTE in Pain Medicine.  The trainee may work in their primary specialty outside normal hours.

2. Administrative Structure and Staffing 

2.1 Funding for a training position(s) is required and remains the responsibility of the Unit(s) involved.

2.2 All medical practitioners involved in the Unit must be accredited by their institutions for the duties and procedures they perform.

2.3 The Director of a Multidisciplinary Pain Unit must be a Fellow of the Faculty of Pain Medicine.

2.4 The Supervisor of Training must be a Fellow of the Faculty of Pain Medicine. The Supervisor of Training has the responsibility for coordination and oversight of the trainee’s program, including where that program is pursued in more than one unit.

2.5 A session in Pain Medicine is a notional period of 3.5 hours devoted exclusively to the specialty.

2.6 There must be a minimum of eight (8) scheduled medical specialist sessions provided in the Unit(s) and available to the trainee each week.  A maximum of 2 sessions allocated to the Acute Pain Service can be counted. At least four (4) sessions per week should be conducted by medical practitioners holding Fellowship of the Faculty of Pain Medicine.

2.7 Regularly scheduled specialist sessions are essential.  These sessions can be provided by:

2.7.1   Anaesthetists, Neurologists, Neurosurgeons, Palliative Medicine Physicians, Psychiatrists, Rehabilitation Physicians, Rheumatologists, and other relevant specialties.

2.8 Specialist supervision appropriate to the level of clinical experience of the trainee must be available.

2.9 The following disciplines should be available: 

2.9.1 Nursing: a senior registered nurse should be available as appropriate. (Nursing staff for a procedural service see 3.2 and for an Acute Pain Service: see 2.20).

2.9.2 Clinical Psychology: a minimum of five (5) sessions weekly.

2.9.3 Physiotherapy: a minimum of five (5) sessions weekly.

2.10 Clinical input is desirable from: 

2.10.1 Occupational Therapy

2.10.2 Social Work

2.10.3 Other Allied Health disciplines such as Rehabilitation Counselling and Dietetics. 

2.11 Units must be able to offer training and or experience in the following areas:

2.11.1 Review of medical records.

2.11.2 History taking and physical examination relevant to Pain Medicine.

2.11.3 Psychological assessment and treatment including cognitive behavioural approaches.

2.11.4 Diagnosis and formulation of a management plan.

2.11.5 Consultative input from other medical specialities.

2.11.6 Medical and pharmacological management.

2.11.7 Physical therapy.

2.11.8 Interdisciplinary meetings.

2.11.9 Communication with the patient’s general practitioner. 

2.12 Regularly scheduled educational sessions for all staff are essential.

2.13 Involvement in undergraduate and postgraduate medical, nursing and allied health education is essential.

2.14 Regularly scheduled quality improvement and peer review activities are essential.

2.15 A comprehensive patient record system is essential.

2.16 Documentation of treatment protocols and procedures for patients together with a statement of their rights and responsibilities is essential.

2.17 Secretarial assistance to the Unit(s) is essential.

2.18 An active research program related to Pain Medicine is highly desirable.

2.19 A computerised data review system for both diagnosis and treatment is highly desirable.

2.20 The Acute Pain Service associated with the Multidisciplinary Pain Medicine Unit must have:

2.20.1 at least one (1) specialist anaesthetist session allocated each weekday.

2.20.2 a specialist anaesthetist should be available for consultation 24 hours a day.

2.20.3 at least one (1) registered nursing session allocated each weekday. 

3 Physical Components of the Facilities 

3.1 Appropriate consulting and examination rooms are essential.

3.2 Appropriate procedure rooms with adequate equipment and staffed by nurses, technicians and radiographers as required are highly desirable.

3.2.1 Anaesthesia and resuscitation equipment must comply with ANZCA College Professional Document T1 : Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and Other Anaesthetising Locations.

3.2.2 Recovery facilities and procedures must comply with ANZCA College Professional Document PS4 : Recommendations for the Post-Anaesthesia Recovery Room

3.3 Suitable office space for permanent staff and trainees is essential.  See ANZCA Professional Document TE1 : Recommendations for Hospitals Seeking College Approval for Vocational Training in Anaesthesia

3.4 Access to in-patient beds is essential.

3.5 Access to a library is essential.

4 Clinical Workload and Standards for a Multidisciplinary Pain Medicine Training Unit 

4.1 There must be sufficient numbers of new patients per annum to provide the trainee with exposure to:

4.1.1 Acute perioperative, medical and trauma related pain

4.1.2 Persistent non-cancer pain

4.1.3 Cancer pain. 

4.2 Formal interdisciplinary case conferences should be held at least once per week. Inclusion of more than one medical discipline in discussions is highly desirable.

4.3 Procedural sessions: (eg: diagnostic and therapeutic nerve blocks) are required to provide adequate exposure for trainees.

4.4 In-patient rounds: There must be regular scheduled attendances to inpatients under the care of the Unit(s).  There must be medical specialist input to the rounds.

4.5 Medical specialist cover: must be available 24 hours per day throughout the year.

4.6 Radiology:  There should be regular review sessions.

4.7 Psychiatry and Psychology therapy sessions: Trainees should gain adequate exposure.

4.8 Audit and clinical review sessions:  should be held at least monthly, and be minuted.

4.9 Compliance with all current Faculty Professional Documents is essential.

4.10 Recommended numbers of patients treated in the Unit per trainee per year should approximate: acute 500, chronic non-cancer 250 and cancer 50.

Faculty of Pain Medicine Professional Documents

Policy – defined as ‘a course of action adopted and pursued by the Faculty.  These are matters coming within the authority and control of the Faculty. 

Recommendations – defined as ‘advisable courses of action’.

Guidelines – defined as ‘a document offering advice’.  These may be clinical (in which case they will eventually be evidence-based), or non-clinical.

Statements – defined as ‘a communication setting out information’.

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this policy document in each case.

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version.  Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the College and Faculty endeavours to ensure that documents are as current as possible at the time of their preparation, they take no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

Promulgated: November 2001
Date of Current Document: October 2005

© This document is Copyright and cannot be reproduced in whole or in part without prior permission.