A new Concordia-led study has found that many Canadian surgery residents scored below the threshold of adequate pain knowledge on a validated, widely used measure.
Researchers surveyed 110 general and orthopedic surgery residents from 27 residency programs across Canada. Residents are licensed physicians who practice under the supervision of an attending physician while completing their medical training.
The study revealed that many respondents felt unprepared to treat pain in both adults and children. Residents were also shown to have a limited grasp of the biopsychosocial model, an established, evidence-based framework used to understand and manage pain. The model accounts for the interplay of biological, psychological, and social factors in both acute and chronic pain.
“Chronic pain can be a common problem following routine surgeries like joint replacements or thoracotomies [open chest surgeries] and can affect between 30 to 80 per cent of patients, so it is important for surgeons and surgery trainees to know about pain,” says Nicole Alberts , PhD, an associate professor in the Department of Psychology and the paper’s corresponding author.
“Surgeons often play a primary role in managing pain, even in hospitals with dedicated pain teams following patients post-op. Their involvement is especially critical in rural and remote areas, where they are typically responsible for overseeing pain management and prescribing medications after surgery,” she says.
The study was published in the journal Pain Reports .
The researchers used online surveys to measure pain training, perceptions and experience. Residents were also asked to fill out a validated 41-item measure of provider pain knowledge called the Knowledge and Attitudes Survey Regarding Pain (KASRP).
The percentage of correct answers assessed residents’ pain knowledge and attitudes. Additional survey items captured sources of pain knowledge and training, perceived preparedness, personal pain experiences and knowledge of the biopsychosocial model, as well as demographic information such as medical specialty and sex.
Residents scored an average 75.1 per cent on the KASRP, below the 80 per cent considered a passing grade. Scores ranged from 44 per cent to more than 95 per cent, indicating substantial variability in knowledge among residents.
More than 70 per cent of respondents answered three questions on opioid tolerance and administration incorrectly. However, all respondents correctly answered the three questions related to pain assessment, patient-centred care and pediatric pain.
Sixty-one per cent of residents said they felt their medical school curriculum prepared them to treat pain in adults, but 59 per cent felt unprepared to treat pain in children.
The study also found that although 85 per cent of residents had heard of the biopsychosocial model, 44 per cent said they were uncomfortable or extremely uncomfortable with their level of understanding. Nearly 60 per cent said they would be unable to properly explain the model to others.
No resident demographic factors explained these differences, except one: prior experience with postsurgical pain, either personally or through someone close to them. Sex, years of training or area of specialization had no strong links to pain knowledge.
“The 75 per cent score indicates that residents did not quite meet the bar for adequate pain knowledge, but it did indicate a solid knowledge base with room to improve,” says Alberts, Canada Research Chair (Tier 2) in Behavioural Health Intervention and director of the Behavioural Health Innovations Lab .
Adam Burcheri helped lead the paper as a part of his Psychology honours thesis during his undergraduate studies at Concordia. Additional research and expertise were provided by PhD candidate Claire Galvin, as well as doctors Nelson Piché at CHU Sainte-Justine and l’Université de Montréal, Michael Frett at St. Jude Children’s Research Hospital in Memphis, TN, and Kevin Alschuler at the University of Washington School of Medicine, Seattle, WA.
Read the cited paper: “ Surgery resident pain knowledge and perceptions: gaps and implications for medical training in Canada ”
PAIN Reports
Data/statistical analysis
People
Surgery resident pain knowledge and perceptions: gaps and implications for medical training in Canada
30-Jan-2026
The authors have no conflict of interest to declare.