What is EPM Lite?
The Essential Pain Management Programme (EPM) was originally developed in Australia and New Zealand by Roger Goucke and Wayne Morriss as an educational tool for health care workers in low- and middle-income countries. The first course was held in Papua New Guinea in April 2010. In 2013, the EPM UK Working Group was established, with the purpose of running EPM courses across Africa. EPM Lite is a scaled-down version of the full EPM course, and is designed to be delivered to medical undergraduates in half a day. It was developed with the additional help of Linda Huggins, a UK pain medicine trained anaesthetist now working as a Palliative Medicine Specialist in New Zealand. The UK Faculty of Pain Medicine took on introducing EPM Lite as a project in 2014, and the first UK EPM Lite course was held in Bristol in September that year. The course helps students understand classifications of pain, why pain should be treated, and an overview of different drug and non-drug treatments. The half day course is flexible as the content and timings can be amended to suit group size and level of teaching.
Why EPM Lite?
A survey of pain education (Briggs et al) within undergraduate medical studies estimated that ‘the identification, assessment and treatment of pain represent less than 1% of the university-based teaching for healthcare professionals’. The aim of EPM Lite is to expand the level of pain management knowledge taught at undergraduate level.
Where is EPM Lite being delivered?
EPM Lite has successfully been delivered in seven UK medical schools. EPM Lite was piloted at The University of Bristol Medical School in 2014 and delivered to a total of 240 fourth year medical students over four sessions. In the current academic year it has been delivered to the entire year group of third year medical students on a single half day session!
Since the pilot colleagues in Aberdeen, Newcastle, Oxford, Plymouth, Durham, and St Andrews have now run EPM Lite in a variety of guises: as an ‘ extra-lite’ version for hour-long weekly medical student seminars, for small group teaching in year 2 and 3, in the fourth year during the students’ Anaesthesia Specialty Study Modules, and on a Final Year ‘survival’ course in preparation for taking up FY1 posts.
EPM Lite is also in various stages of consideration or implementation in Cardiff, Edinburgh, Exeter, Nottingham and Plymouth. For further information on individual medical schools, please click on the relevant boxes below.
How is EPM Lite delivered?
EPM Lite is centred on a three-letter acronym, ‘RAT’ (Recognise, Assess, Treat). This is designed to allow rapid recall of a logical, stepwise system for pain management, akin to the Airway, Breathing, Circulation approach used in Advanced Life Support training. This structure provides the basis for an evidence-based, standardised and reproducible training session in pain medicine, with its own handbooks for both trainers and students, slide sets and references.
Recognising pain involves a multimodal approach, including looking for verbal, behavioural, physical and physiological signs, and then communicating the findings to the wider team.
Assessment focuses on a logical classification including severity, type, cause and mechanism. A variety of scoring systems are discussed, alongside benefits and potential disadvantages. Students are encouraged to classify the pain by duration (acute, chronic, acute on chronic), cause (cancer, non-cancer) and mechanism (nociceptive, neuropathic, mixed). Each area is explained in terms of pathophysiology and common descriptors for symptoms. Use of a biopsychosocial approach is encouraged, with reference to additional factors which may affect the perception of pain in a particular individual.
The students are taught to treat patients in an individual way and to avoid using a ‘one size fits all’ model. Nonpharmacological therapies, including physical and psychological techniques, are discussed. Whilst pharmacological management includes the World Health Organisation Pain Ladder, there is an emphasis on tailoring this to the individual, particularly with respect to use of appropriate anti-neuropathic agents. Opioids are promoted for use in acute, severe non-cancer pain, such as in the postoperative period and following trauma, and also when treating cancer pain. There is room for discussion of their use and side-effects in chronic non-cancer pain.
The format of the course is short lectures, punctuated with small group discussion sessions covering all elements of the RAT approach, and culminating in a wide series of case based discussions. Handbooks, slide sets and references are provided for trainers and students.