Veterinary and medical undergraduate attitudes to pain in animals and non-verbal humans

Abstract

Attitudes have the potential to influence future behaviour and may affect how people respond to pain in animals and non-verbal humans. The attitudes of veterinary and medical students towards pain are unknown. In order to develop future teaching methods which promote patient beneficial attitudes to pain in future veterinary and medical clinicians, it is essential that we have an understanding of the baseline attitudes students hold when entering University; what influences these attitudes and if these change during the course of training. A mixed methods study, using both quantitative and qualitative approaches, was used to study veterinary and medical undergraduates’ attitudes to pain and the factors associated with these attitudes. Undergraduates were studied from entry to Edinburgh University’s College of Medicine and Veterinary Medicine, to final year of training. Data collection comprised of 3 techniques: 1) Questionnaires distributed to students in their first year to gather quantitative data on student characteristics, prior experience and attitude to pain in various animal species (Chimpanzee; Dog; Cat; Horse; Rabbit; Pig; Cow; Rat; Bird; Snake; Fish; Insect) and non-verbal humans (Foetus; Learning difficulties; Dementia; Coma; Anaesthetized) as measured by the Expectation of Pain (EP) attitudinal scale. The EP questionnaire was repeated when the students were in third and final year to investigate changes in attitude as students progressed through their training. 2) Interviews at the start of second year and final year were used to gather qualitative data on factors which influenced attitude to pain in animals and non-verbal humans. 3) Empathy and pain assessment scoring to determine the influence of student empathy, as measured by the previously validated Empathy Quotient (EQ), on attitude to pain in animals and non-verbal humans. Initially 280 veterinary and 216 medical students completed the EP questionnaire when entering University. The EP completion rate reduced in third year (55 veterinary and 23 medical) and final year (14 veterinary and 10 medical). In the animal species EP was rated lowest in Snake, Fish and Insect; and highest in Chimpanzee. For the non-verbal humans EP was lowest in Anaesthetized, Coma and Foetus; and highest in Learning difficulties. Veterinary students rated EP higher than medical students in 10 of the 12 animal species, and also in Anaesthetized. There was no difference in veterinary and medical student EP ratings for the remaining non-verbal humans, or Horse and Cow. Attitudes did not change significantly during training, but differences emerged in how students perceived clinical versus non-clinical learning had influenced their attitudes. Eight students participated in initial interviews, with Empathy; Education and Personal-social factors identified as influences on the development of student attitude to pain. Although students discussed empathy as an influence in their attitude development was not associated with attitude to pain in animals and nonverbal humans in the 176 students who completed the EQ. The lack of overall change in attitudes of students towards pain in animals and non-verbal humans during University training, also means a potential lack of improvement in attitudes in those students who entered University with less caring attitudes to pain in some animal species and non-verbal humans. Many of the factors identified as influencing student attitude to pain are beyond the control of the educational setting – these include student gender, prior experience, and observation of animals and people in pain. The student experience of clinical role models and clinical culture is an area which potentially can be influenced by clinical educators. In order to promote patient beneficial attitudes to pain in animals and nonverbal humans, efforts should concentrate on improvement of the clinical training experience. Clinical role models who convey positive attitudes to patient pain and contribute to improving the hidden curriculum regarding pain are essential to improving the attitude of future veterinary and medical clinicians to pain in animals and non-verbal humans.