The Anesthesia/Pain Medicine Fellowship at Penn State Health Milton S. Hershey Medical Center is a one-year (12-month), ACGME-accredited program that admits three fellows per year.
Candidates for the Anesthesia/Pain Medicine Fellowship must be diplomates in good standing of the ABPMR, ABA or ABPN and apply for subspecialty certification through their respect boards. Diplomates of other ABMS member boards may apply for certification in pain medicine through their board if their board becomes a cosponsor of the Pain Medicine Examination.
The Pain Medicine Center utilizes a multidisciplinary, comprehensive approach to manage more than 7,000 outpatient visits per year.
Fellows will spend nine four-week blocks in the Pain Medicine Center. This rotation exposes the fellow to a wide variety of chronic pain conditions and is the true core of the fellowship program. The full spectrum of currently accepted interventional pain management procedures are performed under direct supervision of the faculty. Additionally, an interventional pain management course on an injection phantom occurs in the beginning of the academic year that decreases the learning curve for fluoroscopically guided injections. Early on in their training, fellows are involved in evaluation and treatment of chronic pain patients who are referred to the pain center by both primary care physicians as well as specialists from various fields of medicine.
Depending on their conditions, up to 60 percent of our patients are being offered interventional pain management procedures. These include epidural steroid injections, selective nerve root injections, facet joint injections, sacroiliac joint injections, discograms, implantable pain management technologies and other procedures.
Depending on their primary specialty, fellows will do four four-week rotations in the following:
- Acute Pain Service and Anesthesiology/OR (two weeks each)
- Neurophysiology and Neuroradiology (two weeks each)
- Palliative Care and Psychiatry (two weeks each)
- Physical Medicine and Rehabilitation
- Spine Surgery
As the clinic schedule and coverage requirements allow, fellows will spend occasional days at Lehigh Valley Hospital with Dr. Bruce Nicholson, Caron with Dr. Dean Drosnes, and Rehab Options with Dr. Christopher Ziegler. Outside rotations to ACGME-accredited institutions are also possible.
We offer a strong didactic program, which consists of weekly lectures, monthly journal clubs, case presentations, monthly spine rounds, two annual OSCEs with simulation, interventional sessions with simulation, fluoroscopic case presentations, quarterly multidisciplinary patient comfort conferences, and daily patient-related teaching.
Fellow education is centered on three major areas:
- Acquiring comprehensive knowledge of diagnosis and treatment of the more common chronic pain conditions
- Becoming proficient with a wide variety of interventional pain management procedures
- Providing an overview of the information required to become a consultant in pain management and preparing for the subspecialty board examination
Fellows are on home call one week in three. During call, the fellows will be exposed to consultative care of in-patients with chronic pain conditions. In addition, they will work with our opioid stewardship program and regional anesthesia teams.
Two-week block – Acute Pain Management (anesthesia graduates exempt)
During this rotation, the fellows are exposed to a variety of regional anesthesia techniques such as thoracic and lumbar epidural catheters, upper and lower extremity plexus catheters, paravertebral catheters and peripheral nerve catheters, as well as experience in ultrasound-guided procedures.
Fellows will learn the administration of neuraxial anesthesia, including placement of a minimum of 15 thoracic or lumbar epidural injections using an interlaminar technique.
They learn the management of patients in acute post-operative period during daily rounds. There is a strong didactic curriculum including lectures, reading material and discussions. The acute pain inpatient experience is supervised in the assessment and management of inpatients with acute pain. The fellow must document involvement with a minimum of 50 new patients. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Two-week block – Anesthesia/OR (anesthesia graduates exempt)
The fellow will learn how to obtain intravenous access in a minimum of 15 patients and basic airway management, including mask ventilation in 15 patients and endotracheal intubation in 15 patients. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Four-week block – Spine Surgery
This rotation provides the fellow with an understanding of the surgical options available for patients with pain related to spinal pathology. Fellows also learn a varied perspective on the assessment, diagnosis, and treatment of patients with the most common presenting symptoms to all pain management centers. This rotation could also involve pump implantation exposure with neurosurgery. This rotation may be done with either neurosurgery or orthopedics. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Two-week block – Psychiatry (psychiatry graduates exempt)
This rotation provides the fellow with the ability to carry out a complete psychiatric history with special attention to psychiatric and pain comorbidities. The fellow must conduct a complete mental status examination on a minimum of 15 patients, and must demonstrate this ability in five patients to a faculty observer. The program will provide
educational experience in frequent psychiatric and pain co-morbidities, which include substance-related, mood, anxiety, somatoform, factitious and personality disorders. The program will also provide educational experience in the effects of pain medications on mental status. The fellow must understand the principles and techniques of the psychosocial therapies, with special attention to supportive and cognitive behavioral therapies, sufficient to explain to a patient and make a referral when indicated. The fellow will spend time at Rehab Options, a multi-disciplinary pain rehabilitation program. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Four-week block – Physical Medicine and Rehabilitation (PM and R graduates exempt)
This rotation provides the fellow with ability to perform a comprehensive musculoskeletal and appropriate neuromuscular history and examination with emphasis on both structure and function as it applies to diagnosing acute and chronic pain problems and developing rehabilitation programs. This will include assessments of static and dynamic flexibility, strength, coordination and agility for peripheral joint, spinal and soft-tissue pain conditions.
Fellows will gain an understanding of the natural history of various musculoskeletal pain disorders and be able to appropriately integrate therapeutic modalities and surgical intervention in the treatment algorithm as well as have an understanding of the indicators and interpretation of electro-diagnostic studies.
Fellows must gain significant hands-on experience in the musculoskeletal and neuromuscular assessment of 15 patients, and demonstrate proficiency in the clinical evaluation and rehabilitation plan development of a minimum of five patients. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Two-week block – Palliative Care
This rotation provides the fellow with a supervised longitudinal experience in an ambulatory and inpatient population that requires palliative care. The experience will include understanding a clinical approach to the multi-dimensional treatments that comprise palliative care, and an understanding of strategies to integrate pain management into this multi-dimensional treatment model.
The fellow must document longitudinal involvement with a minimum of 10 patients who require palliative care. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Two-week block – Neurophysiology
During this rotation, the fellow will become familiar with basic neurophysiology. The fellow shall have an understanding of the indications and interpretation of electrodiagnostic studies, with a basic understanding of the difference between demyelinating and axonal disease, myopathic versus neuropathic findings, and radiculopathy versus peripheral nerve/plexus findings. The significance of nerve conduction velocity and amplitude, as well as motor unit morphology and spontaneous activity, should be understood. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Two-week block – Neuroradiology
This rotation provides the fellow with an understanding of the imaging studies such as MRI, CT scans and X-rays for the diagnosis of spine related disorders. In addition, there may be exposure to discography and kyphoplasty or vertebroplasty. The Clinical Competence Committee Evaluation form is used for assessment. The Rotation Director in charge of the fellow during the elective reports to the Pain Fellowship Director.
Simulation OSCE (Objective Structured Clinical Exam) and CRM (Crisis Resource Management)
- The OSCE is an examination to test clinical skill performance and competence in skills such as communication in clinical skills during an H and P examination as well as during an interventional procedure. Two OSCEs will be conducted within the year. There will be two stations set up. The first station will be a new patient H and P exam with a standardized patient present. You will be given an initial pain assessment form, which has already been filled out by a nurse. One of the faculty will evaluate your performance. The other station will be a procedure. You will talk to one of the faculty as the “patient” as far as introduction and consent, and then talk to the phantom as the “patient” when the procedure starts. One of the faculty will be the voice of the phantom. One of the other faculty will run the fluoro machine and there will be a nurse present. You will be given the procedure set up form to read prior to entry into the procedure room. All faculty involved will evaluate the fellows, and results of the OSCE are discussed at your next evaluation with the Program Director.
- CRM Training is a three-hour interactive program to provide teams with the skills needed to identify common communication and teamwork problems and, through simulation scenarios, correct or avoid issues. The session includes introduction to the environment and the simulation, two scenarios with a video debrief of performance after each scenario, lecture on the principles of CRM and an evaluation of the program. Upon completion the participants should be able to verbalize key concepts of CRM for optimal performance in a crisis, recognize common errors in self and others in a crisis situation, and articulate the application of CRM principles to the work environment and daily life activities.
Off-Site One-Day Rotations
- Lehigh Valley Hospital with Dr. Bruce Nicholson: Fellows will spend random Mondays, schedule permitting, working with Dr. Nicholson in the OR at Lehigh Valley Hospital to enhance exposure to implantable technologies.
- Lehigh Valley Hospital with Dr. Robert Wilson: Fellows will spend random Wednesdays, schedule permitting, working with Dr. Wilson in the OR at Lehigh Valley Hospital to enhance exposure to discography.
- Caron Foundation with Dr. Dean Drosnes: Fellows will spend a random day, schedule permitting, working with Dr. Drosnes at Caron Foundation to learn about drug addiction and treatment program.
- Rehab Options with Dr. Christopher Ziegler: Fellows will spend a random Thursday, schedule permitting, working with Dr. Ziegler at Rehab Options to learn about multidisciplinary pain rehabilitation programs.
Depending on the fellow’s primary specialty, rotations will take place in the following:
- Spine surgery, where the fellow will participate in the evaluation of patients with spine surgeons and gain an understanding of the surgical options available for patients with pain related to spinal pathology
- Neurophysiology, with exposure to EMG and nerve conduction studies
- Oncology, with exposure to cancer pain
- Palliative care, with exposure to end-of-life care
- Neuroradiology, which offers a full range of diagnostic and interventional procedures
- Physical medicine and rehabilitation in patients with disabilities resulting from musculoskeletal disorders including spine-related disorders, spinal cord injury, arthritis, trauma and limb amputations
- Acute pain service, with a high volume of epidural and peripheral nerve catheters placed for perioperative pain control
- Psychiatry, where fellows will become familiar with the basics of psychiatric assessment
- Anesthesia, where the fellow will gain experience with airway management, peripheral vascular access, intravenous sedation and management of side effects and complications associated with intravenous sedation.
Outside rotations to ACGME-accredited institutions are also available.
Please fill out your application through ERAS.
Penn State Anesthesiology and Perioperative Medicine
500 University Drive, HU32
Hershey, PA 17033
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