The Pain Management Fellow's clinical program includes treatment of both inpatients and outpatients in acute and chronic pain management. A multidisciplinary approach is stressed, with frequent use of all appropriate physician as well as non-physician consultations.

When assigned to the Faculty Practice Associates suite, the fellow is responsible for interviewing patients, developing treatment plans and following the patients' clinical course under attending supervision. Office hours are scheduled five days a week. The trainee is instructed in the appropriate use of consultants and is encouraged to learn from the expertise of colleagues in other fields of medicine. Fellows are also instructed in, and responsible for, proper medical record documentation. The Pain Management trainee is instructed in management of the Faculty Practice suite. Specifically, they are taught the processes of making appointments, referring patients to other services, training of other non-physician personnel, establishing policies relating to management of pain problems, and coordinating the activities of the pain center, such as procedures in the operating room suite.

An attending and a fellow see all patients on the Chronic Inpatient Pain Service daily. Continuity of care is stressed. Periodically during the week, and on weekends, pain management fellows and anesthesiology residents round on the Acute Inpatient Pain Service. While on overnight call, the fellows maintain direct clinical responsibility for both acute and chronic inpatients under the direct supervision of the weekly on-call attending physician. Clinical, as well as academic teaching, is integrated into clinical rounds. As with the outpatient population, the fellow, after discussion with the attending, is responsible for planning and providing treatment. As the year progresses, the trainee is given increasing amounts of responsibility and independence by the attending physician.

The fellow learns the interventional aspects of pain management in the operating room, under the direct visual supervision of an attending, where procedures are performed four days per week. In addition to the operating room, certain procedures are performed in the office and in the surgical holding area. The fellow is always supervised and is allowed increasing independence as his/her proficiency at these interventions increases.

Resident and medical students are continually rotating on the service. Fellows teach residents and students by presenting various topics for morning conferences. On a daily basis, the residents work with the fellows to evaluate and formulate treatment plans after seeing patients, both in the office and on the inpatient service. The fellows also teach and assist the attendings in supervising the residents in placement of epidural catheters and in the performance of interventional procedures. The trainees will also have a chance to observe and learn the principles of EMGs and acupuncture from some of the pain faculty.

The Pain Management Division has a weekly didactic lectures every Monday morning. The topics chosen are outlined in the Pain Management Core Curriculum of the American Board of Anesthesiology. The fellow is responsible for presenting the lectures. Faculty members are available to assist in the preparation of the lectures and advanced topics are presented by the attendings. Many faculty members attend the lecture, and contribute to the educational process by providing valuable information based on clinical experience. The lectures are also attended by nurses, nurse practitioners, medical students, as well as other subspecialty residents. Conferences foster development of skills and confidence for oral presentations.

Fellows have additional educational rounds every morning (except Wednesdays), where challenging cases are discussed. This is an informal forum that is specifically designed to encourage discussion among the attendings and fellows. Anesthesiology residents and nurses also attend these educational rounds. The goals are to review practical approaches to pain management as taught by the attendings. The specific points of discussion include the evaluation, diagnosis, and treatment of specific conditions,use of various medications, interventions and alternative therapies. Performance improvement issues are discussed.

On Wednesdays, fellows and attendings attend the main Department of Anesthesiology Morbidity and Mortality Case Conference and Anesthesiology Grand Rounds. Pain medicine is frequently a topic of discussion, and physicians who are well known in the field of pain medicine are invited as Grand Rounds speakers. Fellows may also attend neurosurgical and rehabilitation medicine grand rounds when the topics discussed are relevant to pain management.

The Department of Anesthesiology also provides ample opportunity for Pain Fellows to become involved in FDA-regulated clinical trials of new and evolving pain therapies. Recent opportunities included evaluating safety and efficacy of intrathecal ziconotide (Prialt) in patients with chronic severe pain as well as a large study of the safety and efficacy of a single epidural dose of an experimental long-acting epidural morphine in patients undergoing hip arthroplasty.