The Hawthorne effect in the assessment of pain by house staff

Internal medicine residents are one component of the healthcare delivery team in the hospital setting. Their ability to assess and treat pain should be considered in quality improvement efforts. We surveyed our residents, using a 0 to 10 scale to determine how well they assessed their patients' level of pain. We then asked half of these residents to write down their patients' pain score as a fifth vital sign in the medical record. We repeated the house staff survey three weeks later. The residents improved their assessment as a whole, with the nonintervention group faring better on the follow-up surveys. We believe that the residents' improvement can be attributed to the Hawthorne effect, in which a group that is singled out for special study or consideration has its performance positively affected. The residents' ability to accurately rate patients with moderate and severe pain is still an area for further development. Improvements in our palliative care curriculum have been implemented to enhance our residents' education and performance in this area.