Physicians' pain management confidence versus competence.

Objective: To assess awareness of existing pain management guidelines and compare physicians' confidence versus competence in selected pain management skills.

Design: Prospective survey study.

Setting: A large urban tertiary medical center.

Patients, Participants: All Department of Medicine interns, senior residents, and attending physicians were sent a questionnaire; the overall response rate was 30 percent (91/304).

Interventions: The questionnaire assessed physicians' awareness of the institution's pain management guidelines, their self-reported comfort level (confidence) with, and a knowledge assessment (competence) of three pain management skills (managing chronic-continuous pain, equianalgesic dose conversion, and managing breakthrough pain) using validated, standardized case vignettes.

Main Outcome Measures: A comparison of physicians' confidence with their competence in these pain management skills.

Results: A total of 23 percent (21/91) of the respondents reported an awareness of the institution's pain management guidelines. Interns were significantly less confident than senior residents in all three pain management skills (p < 0.001, 0.006, 0.02) but nonsignificantly more competent in two of three skills (chronic-continuous pain, dose conversion). Attendings were generally more confident and nonsignificantly more competent than senior residents in all three pain management skills.

Conclusions: The underutilization of the pain management guidelines illustrates that the mere existence of these resources as a means of ensuring optimal pain management is insufficient. Creative pain management educational initiatives are needed to address the disparity between physician confidence and competence.