Student attitudes, comfort, and knowledge about pain were assessed using entry and exit surveys (Table 1). These surveys were used to measure insight into what the summer experience was like and how students’ perceptions of pain and pain research changed during the summer. All collected data was blinded and the study was approved by the Duquesne University Institutional Review Board for Human Studies. For all measures, increases or relevant decreases were seen including a number of measures that showed significant differences between entry and exit surveys (Fig. 1). Descriptions of each activity follow along with outcomes.
Demographics
Students (n = 10; eight female; all GPA >2.5; variety of years in college) came from Duquesne University (n = 8) or two external “liberal arts” institutions. Duquesne students came from three different schools on campus (science, health science, pharmacy) indicative of the multi-disciplinary nature of pain research. All students reported strong qualitative support from their home institutions and previous research and academic mentors on entry surveys. To the question “On a scale of 1–5, how would you evaluate the quantity of academic interactions with your mentors at your home institution?” the average student response was 4.4 ± 0.2. To the question “On a scale of 1–5, how would you evaluate the quality of these interactions at your home institution?” the average student response was 4.4 ± 0.2. To the questions “On a scale of 1–5, to what extent did your home institution mentor encourage you to participate and help you find a summer research program?” the average student response was 4.2 ± 0.3. To the question “On a scale of 1–5, how well do you feel your home institution has prepared you in terms of conceptual and theoretical knowledge?” the average student response was 4.3 ± 0.3.
In addition, interactions with faculty members in the PURE were reported strongly positive and extensive on exit surveys. To the question “On a scale of 1–5, how would you evaluate the quantity of academic interactions with your mentors in the PURE program?” the average student response was 4.6 ± 0.2. To the question “On a scale of 1–5, how would you evaluate the quality of these interactions in the PURE program?” the average student response was 4.9 ± 0.1. To the question “On a scale of 1–5, to what extent did your PURE mentor help you set these goals?” the average student response was 4.5 ± 0.2. Students reported quality gains in technical knowledge related to pain. To the question “On a scale of 1–5, how would you evaluate the quality of technical expertise, in terms of conceptual and theoretical knowledge, you gained from the program?” the average student response was 4.6 ± 0.2.
Pain research
Students were placed in research labs working on some aspect of pain. All faculty involved were part of the Duquesne CPRC. This consortium includes faculty involved in basic science pain research (pain biology and pharmacology, pharmaceutics, medicinal chemistry, natural products chemistry, nanomedicine, molecular imaging, pain in aging), pain clinical practice, and pain education. In combination with all of the clinical exposure from the planned activities, students were exposed to basic science research into mechanisms of pain, how to treat pain with mechanical interventions, analgesic drug discovery, pain education research, nanoemulsions for pain drug delivery, and understanding pain circuitry from a biological perspective.
Pain journal club and didactic pain seminar
A solid understanding of primary literature and the current state of the field is important for young researchers. The journal club was presented by graduate students and faculty involved in pain research. Articles were chosen from a variety of fields and perspectives and sent to students 1 week before presentations. Presenters gave a brief background on the general topic and then broke down the paper and went through its main assumptions and results. Students were encouraged and asked to provide their input on these topics as well. This allowed students to be exposed to how literature can be evaluated and critically assessed. Sessions would typically end with a discussion about what the next steps in the research should be or how the paper might alter or affect their own research. In addition to this monthly journal club, PURE students were also encouraged to attend a didactic pain course run by PhD graduate students. In this informal course, a single graduate student went through chapters of Wall and Melzak’s The Textbook of Pain [21] each week. Consistent with expectations of learning from the journal club and course, didactic training significant improvements were seen in student’s “comfort with pain terminology” comparing entry and exit surveys (Fig. 1). Although students’ comfort with pain terminology increased during the summer, their ability to define pain did not significantly change (entry 2.3 ± 0.3 vs exit survey 2.8 ± 0.3 out of possible 9, paired t-test, P = 0.34; exit/entry score 142 ± 21 %, one-sample t-test compared to hypothetical “no change” value of 100 %, P = 0.08). Discussions during the journal club and in students’ research labs also likely contributed to increases in students’ “comfort…explaining pain and/or chronic pain to another researcher” (Fig. 1). To the question “On a scale of 1–5, how would you evaluate the effectiveness of the PURE/URP speakers/seminars?” the average student response was 4.5 ± 0.2.
Interaction with the clinical side of pain
In designing the PURE program, we wanted students to appreciate why they were doing basic science research. While part of the answer to this question lies in the specific research project that each student worked on, the bigger answer focuses primarily on the needs and experiences of individuals living with pain. To develop the skill-set and empathy necessary to interact with patients and other clinicians, students participated in three “clinical” activities. They shadowed pain doctors at a pain clinic, met informally at Duquesne with a pain patient, and had lunch with a pain psychologist.
For the clinical shadowing component of the program, students went individually or in pairs to one of two pain clinics in Pittsburgh, PA. Students spent ~4 h at the pain clinic where they observed doctor-patient interactions and pain intervention procedures. Both clinicians reported these events as positive experiences; “The students were eager, engaging, and interacted well with staff and patients” (e-mail conversation between BJK and clinicians). To the question “On a scale of 1 to 5, how would you evaluate the PURE off-site clinical experience visit?” the average student response was 4.9 ± 0.1.
For the on-campus visit with a pain patient, students were able to interact informally with a long-term (>15 year) fibromyalgia patient. This patient had been briefed prior to the session to establish appropriate boundaries and expectations. These boundaries were then shared with the students prior to the start of the session. During this informal 1-hour session, the patient described her experience living with chronic pain and her experiences interacting with various pain clinicians. The students were encouraged (by the patient) to then ask questions. One of the advantages of this situation compared to patient interactions in a formal clinic is the freedom that the students felt. They were able to ask “stupid” questions that would be deemed inappropriate in a clinical setting. The patient described the experience as positive and was encouraged to see so many young scientists working in pain basic science research (personal correspondence between BJK and patient). To the question “On a scale of 1 to 5, how would you evaluate the PURE on-site interaction with a chronic pain patient?” the average student response was 4.5 ± 0.3.
Finally, on-campus at Duquesne, students also had the opportunity to have an informal lunch with a pain psychologist. This clinician described their reasons for being a pain specialist as well as the day-to-day activities involved in their clinical practice. The goal of this session was for students to once again be able to ask “prying” questions about life as a clinician. To the question “On a scale of 1 to 5, how would you rate the PURE on-site interaction with the clinician?” the average student response was 4.5 ± 0.2.
Overall, the patient and clinical interactions were seen as universally positive by students, clinicians, and the on-site patient. In exit surveys students reported significant increases in their ability to “understand what it is like to live with chronic pain” and to “explain pain and/or chronic pain to a patient in lay terms” (Fig. 1).
Pain empathy kit
At Duquesne University, two members of the CPRC, Diane Rhodes and Dr. Lynn Simko, run a semester-long interprofessional course (Pharmacy and Nursing students) dedicated to pain. As part of the course, these researchers developed a pain “empathy kit” that allows people to empathize with chronic pain patients by altering their abilities and sensations to match those of a pain patient. In the PURE program, students were tasked with putting together and using the empathy kit as well as trying to think of new simulations or activities to add to the kit. When using the kit with groups, the session began with a brief overview of pain assessment and etiology, which was then followed by the use of activities to simulate life with chronic pain. The activities were designed to not cause personal harm to users. Examples of activities were walking around the room with popcorn kernels in the bottoms of one’s shoes to simulate peripheral neuropathy or wearing a belt with a golf ball attached at the lower back to simulate chronic low back pain. This kit can easily be assembled and utilized by other programs and courses in order to not only teach and demonstrate physical detriments caused by chronic pain but also to increase empathy and emotional understanding of the daily struggle of pain patients. Improvement of empathy with patients has been shown to improve patient outcomes in the clinic [9]. To the question “On a scale of 1 to 5, how would you evaluate learning and building a pain empathy kit?” the average student response was 4.1 ± 0.3.
Ethics program
All students participated in a 6-week long ethics program that is used by Duquesne’s non-discipline specific Undergraduate Research Program. This ethics program involves groups of students tackling published scientific and medical ethics problems. Students identify the problem, the events that led to the ethical lapse, and methods to avoid similar mistakes in the future. Each group of students is mentored by a faculty member or graduate student during the 6-week process.
Pain conference
Finally, to again expose students to a diversity of pain research topics and to improve their ability to discuss their own research, students participated in two additional activities. After 5 weeks, students spent 2 days at the University of Pittsburgh attending a pain-research conference (http://paincenter.pitt.edu/barriers.htm). Although this conference was a singular event, the incorporation of additional exposure to world-class pain research allowed the students to appreciate the diversity of open questions with the pain research field. The final activity of the summer involved students presenting the results of their research at a 1-day regional scientific conference at Duquesne to a broad audience of researchers. Their research was presented in the form of scientific posters. As a group, the students were given a lesson in poster layout and presentation style and practiced draft versions of their posters prior to the research conference. Students reported significant gains in their ability to “prepare a scientific abstract” and to “prepare a scientific poster” (Fig. 1). Several students have gone on to present their research at additional regional or international conferences after the summer program concluded.