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Deficiencies in practice, knowledge, and competence among physicians are important contributing factors to the unsatisfactory level of analgesic care in hospitalized patients. By way of a comprehensive survey, we characterized these deficiencies within an internal medicine residency program as an initial step in designing remedial educational strategies. To do so, an anonymous 43-item survey was administered to residents in an internal medicine program. A total of 61 residents (69 percent) responded. The results indicated that patient-controlled analgesia (PCA), a standardized pain scale, and an opioid equivalence table were underused. Competence in opioid conversion was suboptimal, but completion of an oncology rotation and familiarity with the opioid equivalence table predicted greater competence in this area (p = 0. 00 7 and p = 0.001, respectively). Self-perceptions of adequacy of training and pain-management competence were predictors of knowledge (p = 0.026 andp = 0.038, respectively). Attitudes regarding opioid analgesia were generally satisfactory (i.e., low "opiophobia " score), although the risk of addiction was still overestimated. The characterization of deficiencies in pain management in a residency program is an essential step in the design and implementation of educational interventions. Administration of a comprehensive survey is a simple and effective method of gathering this data and has the additional benefit of promoting awareness of pain management issues. Our experience served to establish, among other findings, the didactic value of experience on an oncology floor; this result substantiates the value of practical experience in the gaining of clinical competence in pain management. Interventions that capitalize on the findings of the survey and the interest in pain management generated by its administration are currently ongoing at our institution.

Use of a comprehensive survey as a first step in addressing clinical competence of physicians-in-training in the management of pain