Accelerating Change: Reshaping Tufts’ Prelicensure Pain Curriculum to Meet the COVID-19 Challenge

Abstract

Tolstoy’s dictum that “Happy families are all alike; every unhappy family is unhappy in its own way” [1] is relevant to descriptions of the state, national and global responses by medical educators to the coronavirus disease 2019 (COVID-19) pandemic. Each affected institution brought to the table its own history, culture, circumstances, and participants as it strove to overcome an unprecedented educational challenge. The COVID-19 pandemic pressure-tested educational philosophies and processes, revealing different strengths and vulnerabilities of each institution. This brief report describes our experience as pain management educators at Tufts University School of Medicine (TUSM) in response to sudden initial COVID-19 educational needs and curriculum changes over the subsequent 2020/2021 academic year. The context in which we mobilized our pain educational resources at TUSM is distinctive, but has broader applicability for educators looking to expand pain curricula. Beginning in 2014, we began to collaborate with fourth year medical students enrolled in an annual elective on pain education, which we discuss in greater detail below. Concurrent statewide efforts to strengthen the prelicensure pain curriculum had been mobilized by our Massachusetts’ governor in light of the worsening epidemic of prescription opioid misuse and opioid use disorder. Ten competencies related to opioids and pain were developed by the deans and their faculty representatives of our state’s four medical schools [2] and adopted by each school during the 2015/2016 academic year [3]. Unrelated to specific concerns about opioid misuse, planning for a major curricular revision began at Tufts in 2017 with a sweeping set of reforms in pre-licensure medical education including new time and prominence for education in pain and pain management that were implemented beginning in the academic year 2019–2020. As a result, prior to the COVID-19 pandemic two novel elements had already been added to the Tufts curriculum. The first of these was mandatory pain medicine content structured into the first and second year curriculum. The second was our established fourth year elective for medical students interested in pain education, which included two components: student-faculty collaboration to create materials to expand pain education at Tufts and facultyled comprehensive education on pain management. In fact, teaching cases developed with fourth year students during the 2018 pain education elective were significant resources in the new preclinical curriculum. Thus, when the COVID-19 pandemic emerged in early 2020, we were fortunate to have multiple curricular materials in readiness, along with an urgent need to prepare, organize, and integrate newly developed material, much of it interactive, using remote platforms. The above interactions are illustrated in Figure 1.