Typical Rotation Schedule
Below is a typical rotation schedule:
- Anesthesiology – * Requirement for non-anesthesiology physicians * A clinical anesthesia experience involving patients undergoing intravenous sedation during surgery. This experience is designed to improve a fellow's airway management skills and improve their understanding of levels of sedation, analgesia, and various regional techniques.
- General Pain Management – This rotation involves learning the neuroanatomy and pathophysiology of pain as well as clinical experiences in managing various pain syndromes such as acute pain, chronic pain, low back pain, neck pain, radicular pain, complex regional pain syndrome, neuralgias, central pain, myofascial pain, headache syndromes, and cancer-related pain. You will learn a multimodal and multidisciplinary management approach in the treatment of various types of pain including but not limited to neuropathic pain, visceral pain, somatic pain, nonorganic pain, and referred pain.
The primary training site for this rotation is at the Institute for Pain Medicine at West Penn Hospital. The Institute is a true multidisciplinary “enhanced” Pain Center, incorporating on-site acupuncture, medical massage, behavioral health, nutrition counseling, smoking cessation counseling, medication assisted treatment of addiction, and medical marijuana evaluations.
- Headache Medicine – This rotation involves learning how to evaluate patients with headache disorders by further developing your history-taking and physical examination skills with emphasis on taking an appropriate headache history in addition to a neurological examination. Fellows are to gain a better understanding of the neuroanatomy and the modulation of head pain in the central nervous system as well as the neuronal phenomenon of cortical spreading depression and the pathophysiology of migraine headaches. Fellows will improve their understanding about various types of primary and secondary headaches while improving their understanding of various available treatments. Each trainee will get a better understanding of the indications, contraindications, drug interactions, mechanisms of action, pharmacokinetics, side effects, and toxicities of migraine specific medications such as triptans and ergot alkaloids as well as the new ketamine infusion protocol employed at the West Penn Hospital AHN Neuroscience Institute Headache clinic. Fellows will become familiar with non-pharmacological migraine treatment approaches including vagal nerve stimulation, TSNS (transcutaneous supraorbital nerve stimulation), biofeedback, behavioral therapies, dietary modifications and the newest herbal treatments recommended by the West Penn Hospital AHN Neuroscience Institute Headache clinic.
- Neurology – Fellows will learn about basic neuroimaging, neurological assessment, and understanding of the indications for and interpretation of electro-diagnostic studies of pain and the management thereof. This rotation includes experiences in the detailed neurological examination of the patient’s mental status, cranial nerves, motor nerves, sensory nerves, reflexes, cerebellar examinations, and gait. This rotation also includes an experience in interpreting and evaluating CT and/or MRI findings of the brain, cervical, thoracic, and lumbar spine.
- Neurosurgery – This rotation allows each fellow to experience and gain better insight into the clinical, operative, and perioperative aspects of neurosurgery. Goals of this experience include developing skill and proficiency in performing a complete and thorough history and physical examination and in ordering and interpreting a workup for a neurosurgical patient to include laboratory evaluation and imaging workup (such as CT scan, MRI, or any other initial diagnostic studies) with an understanding of the tests to be ordered. The fellow will gain an improved understanding of the indications, the interpretation, and the clinical usefulness of these tests. Each trainee will gain a basic understanding of the pathophysiology of neurosurgical disorders, conservative management, and indications for surgical management. During the rotation you will get to assist in neurosurgical procedures, thus gaining exposure to spinal cord stimulation surgical lead and generator placement and/or removal, intrathecal pump placement and tunneling and/or removal, and occipital nerve stimulator placement and/or removal.
- Physical Medicine & Rehabilitation – * Requirement for non-PM&R physicians * A clinical experience learning about the basic mechanisms and techniques of performing a comprehensive musculoskeletal and neuromuscular H&P emphasizing both structure and function as it relates to diagnosing acute and chronic pain problems; this includes assessments of static and dynamic flexibility, strength, coordination, and agility for peripheral joints as well as spinal and soft tissue pain conditions.
- Psychiatry – An educational experience providing advanced training in the assessment and management of psychiatric considerations in acute and chronic pain, based on direct involvement in patient care under the direct supervision and instruction of full-time faculty. The fellow is to develop the skills necessary to elicit a directed and thorough psychiatric history, with special attention to psychiatric and pain co-morbidities, learn and employ the skills necessary to perform a complete mental status examination, and gain an appreciation of psychiatric and pain co-morbidities including substance-related, mood, anxiety, somatoform, factitious, and personality disorders. Each trainee will gain an understanding of the effects of pain medications on mental status, the principles and techniques of psychosocial therapies with particular attention to supportive and cognitive behavioral therapies sufficient to explain to a patient, and understand indications for psychiatric referral.
Weekly didactic lectures are held. These lectures are presented on a wide range of topics pertaining to patient care, medical knowledge, systems-based practice, quality improvement, etc.
Fellows will participate in the didactic curriculum by giving up to 6 presentations during the fellowship year on various high yield Pain Medicine topics in order to improve their understanding of Pain Medicine and to help prepare themselves and their colleagues for the pain boards.
Each fellow will also participate in scholarly activity by giving a Journal Club presentation and participate in a grand rounds presentation It is important for physicians to be able to critically appraise the literature and evidence based guidelines, develop critical thinking skills, gain an understanding of research methodologies, participate in clinical discussions, and develop a spirit of inquiry and scholarship. As part of a healthy and robust clinical learning environment, each fellow participates in scholarly activity and research - this may take the form of a case report, poster presentation at a conference, an IRB-approved study, or other similar project.