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Department of Anesthesiology

Pain Management Fellowship Program Overview

The Community

Fellowship Overview

Facilities

Goals/Objectives

Rotations

Research Opportunities

Entry into the Program

Summary of Benefits

Program Director

The Community

The Department of Anesthesiology of the Texas Tech University Health Sciences Center (TTUHSC) is located in Lubbock, Texas. In the heart of West Texas; rich agricultural region, Lubbock is a growing educational, commercial, medical, and cultural center. The metropolitan population, in excess of 200,000 residents, lives in mild seasonal conditions with an average of 267 days of sunshine per year. With eight hospitals and no less than 85 health care clinics, Lubbock is known as the medical center for West Texas and Eastern New Mexico.

Lubbock's entertainment possibilities range from major theatrical touring companies, to weekend rodeos, to exhibits at the museum of Texas Tech University. The city maintains a symphony orchestra, ballet company, civic chorale and numerous community theatres. Regional outdoor activities are limitless with only short drives from the city. Depending on the direction of the excursion, residents can enjoy desert terrain sports, inland lake activity, or seasonal mountain adventures. New Mexico ski resorts can be reached in less than a five hour drive. For more information about the City of Lubbock, click here.

Fellowship Overview

Under the guidance of Director Miles Day, MD, the Department of Anesthesiology and International Pain Center offers three 12-month positions each year.

The fellowship program is, to a large extent, evaluation and management of complex pain problems by a multi-disciplinary team. The fellowship program trains candidates to be qualified in pain management by the American Board of Anesthesiology and the American Board of Pain Medicine. Fellows must have completed an anesthesiology residency at an accredited residency training program. Fellows completing a residency in a specialty other than anesthesiology will be considered on an individual basis. Fellowship training is available in common and advanced interventional techniques such as radiofrequency, cryoneurolysis, neuroaugmentation in the form of spinal analgesics, peripheral nerve stimulation and the use of spinal narcotics, continuous epidural infusion, and peripheral nerve infusions.  Behavioral management, pharmacological management, rehabilitative management, and cancer pain management are also encompassed in the program.  Fellows are also required to participate in teaching and research activities.

The Pain Center at Grace Clinic sees approximately 1,000 patients per month and performs 300-500 in-patient and out-patient procedures.  Of these, approximately ninety percent are chronic pain patients, forty percent are in-patients, six percent are acute pain patients, and four percent are cancer pain patients. Services directly available in the program include: physician evaluation, multi-specialty evaluation, and multi-disciplinary management (Anesthesia, Psychology, Neurology, Physical Medicine and Rehabilitation). The Pain Management Fellowship Program at Texas Tech University Health Sciences Center Department of Anesthesiology is fully accredited by the ACGME.

Please visit the American Board of Anesthesiology website in order to review the ABA Booklet of Information. The Booklet of Information provides information on the policies, procedures, regulations, and requirements regarding the certification and eligibility process to take the board examination.

Goals/Objectives

The purpose of the training program is to provide in-depth pain medicine training to fellows enrolled at TTUHSC.  The learning objectives encompass the six Core Competencies and include in-depth graduate medical training in key areas of modern pain medicine: Acute Pain, Chronic Pain, Cancer Pain, and Hospice and Palliative Care.  The core curriculum content reflects the current subspecialty pain management program published by the American Board of Anesthesiology. 

Patient Care

Goal: The fellow will provide care that is compassionate, appropriate, and effective for the treatment of the patient with acute and chronic pain. The fellow will develop manual dexterity and be able to develop and execute patient care plans appropriate for their level of training.

Objectives:

  1.  Learn and perform thorough assessments of patients in acute and chronic nonmalignant and malignant pain
  2. Develop and implement treatment plans using clinical and scientific data and patient preference
  3. Competently perform all medical and invasive procedures considered essential for managing pain which include, but not limited to:
    1. Image-guided cervical, thoracic and lumbar spinal injections
    2. Minor and major joint or bursa injections
    3. Trigger point injections
    4. Sympathetic blocks
    5. Neurolytic techniques including chemical and radiofrequency treatment for pain
    6. Intradiscal procedures including discography
    7. Spinal cord stimulators
    8. Placement of permanent spinal drug delivery systems
    9. Vertebral body stabilization techniques
  4. Collaborate and communicate effectively with patients and their families
  5. Achieve and document the required number of patient interactions required in each of the disciplines described in the ACGME Pain Medicine Fellowship Program Requirements

Medical Knowledge

Goal: The fellow will achieve detailed knowledge of the evaluation and management of pain patients. The fellow will learn to critically evaluate and demonstrate knowledge of how to access today’s scientific information.

Objectives:

  1. Develop an investigatory and analytical thinking approach to clinical situations
  2.  Recognize and apply knowledge of clinical sciences that is appropriate to pain management
    1. This includes, but no limited to, the topics stated in the ACGME Pain Medicine Fellowship Program Requirements
  3. Incorporate their didactic teaching in the field of pain management into the management of their patients pain 
  4. Stay current with up-to-date medical knowledge
  5. Develop and apply an algorithmic approach to the treatment of pain
  6. Develop the ability to critically appraise evidence about treatment effectiveness as it relates to pain management
  7.  Identify an area of pain management from which to create a Grand Rounds presentation
  8. Encouraged to establish new or participate in ongoing departmental pain research studies

Practice-based Learning and Improvement

Goal: The fellow will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and initiate improvement in patient care.

Objectives:

  1. Utilize their personal faculty, ancillary staff and patient evaluations to assess the effectiveness of their patient care activities
  2. Incorporate evidence from scientific studies relating to the treatment of pain into the patient’s treatment plan
  3. Use information technology to support medical decision-making processes
  4. Interact with the professional, technical, and clerical personnel as it relates to patient care
  5. Participate in quality assurance/improvement conferences

Interpersonal and Communication Skills

Goal: The fellow will learn to demonstrate interpersonal and communication skills that result in effective information exchange with patients, their families, and professional associates.

Objectives:

  1. Work with faculty, colleagues, and support staff  in an efficient, courteous manner that facilitates patient care
  2. Communicate and sustain a therapeutic and ethically sound relationship with patients and their families

Professionalism

Goal: The fellow will learn to demonstrate a commitment to carrying out professional responsibilities, adherence to organizational and ethical principles, and demonstrate sensitivity to diverse patient population.

Objectives:

  1. Maintain a professional appearance
  2. Observe HIPAA regulations at all times
  3. Apply professional and ethical principles to the practice of medicine
  4. Demonstrate sensitivity and responsiveness to patient’s culture, age, gender, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities
  5. Practice medicine that ensures patient safety
  6. Treat the anxious or distressed patient and/or family member with respect, compassion, integrity and kindness

Systems-based Practice

Goal: The fellow will demonstrate an awareness of, and responsiveness to, the larger context and system of healthcare and be able to call on system resources to provide care that is of optimal value to their patients.

Objectives:

  1. Provide clear and thorough documentation of the patient evaluation, including information from previous medical records
  2. Obtain appropriate medical records from other facilities
  3. Practice cost-effective healthcare that does not compromise quality of care
  4. Learn business skills necessary for effective practice management

Rotations

Rotations have been established with Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Palliative Care. Below is a brief description of each of the rotations each Fellow will experience in Pain Management Program at Texas Tech University Health Sciences Center.

Neuropsychiatry

4 week inpatient neuropsychiatry rotation at University Medical Center
Essentials of neurologic and psychologic examinations
Instruction in evaluation of neuroimaging studies
Fellow spends four weeks on block rotation

Physical Medicine and Rehabilitation

2 week inpatient (University Medical Center) and outpatient rotation (clinic)
Essentials of PM&R physical examination
Dystonia and spinal cord injury clinic
Fellow spends 2 weeks on block rotation

Palliative Care/Hospice

Inpatient hospice and home visits with faculty and staff
1 week Hospice rotation (5 consecutive Fridays)

Cancer Pain Clinic; UMC TTUHSC Cancer Center

Friday morning Tumor Board Conference
Every Friday morning
Acute and chronic cancer pain clinic
Inpatient consult service
Fellow attends at least 8 clinics

Research Opportunities

Pain fellows are required to either be involved in ongoing clinical, translational, or basic research, or initiate research.  Prior to completion of the fellowship, fellows will participate in the presentation of research in the quarterly Pain Grand Rounds and write a manuscript suitable for publication.The Anesthesia Research Laboratories have analytical chemistry and related equipment (HPLC, IR, and UV Spectrophotometers) that are used to measure concentration of drugs in biological samples (e.g. plasma).  The facility also contains equipment for doing invitro studies on isolated tissue and organs, and biochemistry studies.  Equipment for doing complex studies of single or multiple organ systems (e.g. nervous system, cardiovascular system, respiratory system) on intact animals and human volunteers is also available.  Research resources of other clinical departments and basic science departments in TTUHSC are available, along with access to the high quality animal resource facility that is available to all departments at the TTUHSC School of Medicine.  The Department of Anesthesiology research facility is directed by senior scientist, James E. Heavner, DVM, PhD, a world leader in pain research.

Entry Into the Program

Individuals who are interested in the Pain Management Fellowship Program should begin their application two years before their hopeful start date.  Applications are to be made by the candidates and will be screened by our Directors.  There is an interview required.  If there is formal acceptance by the candidate after an offer, an institutional license is available in lieu of a Texas license. For more information about our application process, click here.

Summary of Benefits

The salary for the 2012-2013 school year is $50,436.00.

Authorized absences:

  • 15 days vacation leave each year
  • 5 days sick leave each year
  • 5 days professional (meeting) leave (academic good standing)

Medical and Dental Insurance

Medical Insurance is provided for graduate trainees and their dependents. Insurance is provided through the University and includes major medical and special hospital allowances, which provide additional coverage for maternity and out-patient care.

Dental insurance is also available for graduate trainees and their eligible dependents. For more information about salary and other benefits click here.

Other Benefits

Lab coats, laundry service, malpractice insurance, disability insurance, and life insurance are provided for graduate trainees.

Stipends

The stipends for fellows at the Texas Tech University Health Sciences Center are consistent with other medical centers in the Southwest area and may undergo adjustments each year. Stipends are currently $500 per year and may be used for books or meeting travel.

Program Director

Miles Day, MD, DABA, FIPP, DABIPP, DABPM, Associate Professor, Pain Management Fellowship Director, Department of Anesthesiology, Texas Tech University Health Sciences Center.

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