Date of Award


Degree Name

Doctor of Philosophy (College of Medicine)

Schools and Centres


First Supervisor

Professor Eric Visser

Second Supervisor

Professor Carole Steketee

Third Supervisor

Professor Frank Bate


Background: Unrelieved pain is a significant public health challenge in Australia and New Zealand. Medical practitioners play an essential role in the management of acute, cancer and chronic non-cancer pain.

Aim: This thesis aimed to examine the delivery of pain education at medical schools in Australia and New Zealand, and to determine how effectively it equips medical students with pain medicine competencies required for internship.

Methods: An explanatory sequential mixed methods approach was used. Quantitative studies focused on gathering information regarding the pain-related content of medical curricula of all medical schools; and on testing pain medicine competencies of final-year medical students and interns across different universities and hospitals. Qualitative methods were used to appraise perceptions of healthcare practitioners and students working alongside interns regarding the extent to which the existing medical student education programme prepared interns to manage patients with pain.

Results: Nineteen out of 23 medical schools completed the curriculum audit and innovative Medical School Pain Curriculum Questionnaire. Medical schools do not have well-documented or comprehensive pain curricula. Pain medicine education is not delivered and assessed using pedagogically sound approaches considering the complexity of the topic, and the prevalence and public health burden of pain. Important barriers and enablers influencing the delivery of successful pain medicine education were identified.

The Medical Students Pain Attitudes and Knowledge Questionnaire, designed to assess pain medicine knowledge and attitudes, was completed by 351 students from 10 universities and 36 interns from two geographical areas. Twenty-one medical students participated in a pain-focused objective structured clinical examination. Gaps in students’ and interns’ pain medicine competencies were evident in basic concepts of pain processing, multidimensional aspects of pain, pain assessment and management, multiprofessional approach to pain management and pain medicine ethics.

Fifteen healthcare practitioners and students participated in the qualitative interview study. The three major themes emerged: 1) gaps in the current medical curriculum regarding pain medicine education; 2) interns’ competencies not matching their pain medicine responsibilities; and 3) gaps in interns’ pain medicine competencies affecting the patient and wider community, the intern themselves and the hospital system.

Conclusion: This research has highlighted the necessity for major changes to the current medical curriculum in Australia and New Zealand so that medical students are adequately prepared to address the pain management needs of the communities they will serve in the future. The Pain Medicine Curriculum Framework for improving pain medicine education for medical students is proposed to assist in the ongoing process of ensuring that medical graduates meet the professional and ethical challenges that arise in caring for those in pain.

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