New Application: Pain Medicine

New Application: Pain Medicine

Review Committee for Anesthesiology, Neurology, or
Physical Medicine and Rehabilitation

ACGME

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Institutions - Participating Sites

1.Indicate which of the foursponsoring specialty ACGME-accredited residency programs with responsibility for the multidisciplinary pain medicine program are in place at the SponsoringInstitution and/or its affiliates. These specialties are:Anesthesiology, Child Neurology/Neurology, or Physical Medicine andRehabilitation:[PR I.B.3.]

ACGME-Accredited Residency Program / Yesor No / Program Name / Number
Anesthesiology / ☐ YES ☐ NO / Name/Number /
Child neurology/neurology / ☐ YES ☐ NO / Name/Number /
Physical medicine and rehabilitation / ☐ YES ☐ NO / Name/Number /

a)Explain how each of the participating programs indicated above will contribute to the program.

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2.Is there an institutional policy governing the educational resources committed to multidisciplinary pain medicine that ensures cooperation of all involved disciplines?[PR I.B.4.] ☐YES ☐NO

(A copy of the policy should be available for review by the site visitor).

3.Provide a list of multidisciplinary pain medicine committee members by specialty. How frequently does the committee meet?[PR I.B.4.]

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Program Personnel and Resources

Non-Physician Personnel

What additional technical and clerical personnel will be available to support the fellowship?[PR II.C.]

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Resources

1.Is there a pain center located within a hospital/medical office complex, designed specifically for the management of pain patients?[PR II.D.1.] ☐YES ☐NO

2.Describe the monitoring and life support equipment available where invasive pain management procedures are performed.[PR II.D.1.]

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3.Describe facilities that will be provided for: [PR II.D.1.]:

a)Conferences

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b)Research

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Support Services

Are the following support services available to the program for fellow education and patient care?

Appropriate radiologic imaging facilities[PR II.D.2.a)]...... ☐YES☐NO

Psychiatric/psychological services, including behavioral modification[PR II.D.2.b)]...... ☐YES☐NO

Physical and/or occupational therapy[PR II.D.2.c)]...... ☐YES☐NO

Social services[PR II.D.2.d)]...... ☐YES☐NO

Appropriate electrodiagnostic facilities[PR II.D.2.e)]...... ☐YES☐NO

Patient Population (Clinical Resources)

1.Indicate the number of patients available for fellows’ clinical educational experience in each category for the last 12 months.[PR II.D.3.-II.D.3.e)]

TYPE / # of Patients
1. Chronic pain (benign) / # /
Inpatient / # /
Outpatient / # /
2. Cancer pain / # /
3. Acute pain / # /
Inpatient / # /
Outpatient / # /
4. Palliative / # /
5. Pediatric / # /
Under 2 years of age
2-18 years of age / # /
# /
6. Interventional procedures / # /

Educational Program

Patient Care

Anesthesiology

Indicate the settings and activities in which fellowswill demonstrate competence in the following. Also indicate the method(s) used to assess competence.

Competency Area / Settings/Activities / Assessment Method(s)
Obtaining intravenous access in a minimum of 15 patients
[PR IV.A.5.a).(2).(a).(i)-(i).(a)] / Click here to enter text. / Click here to enter text. /
Basic airway management
[PR IV.A.5.a).(2).(a).(ii)] / Click here to enter text. / Click here to enter text. /
A minimum of mask ventilation in 15 patients
[PR IV.A.5.a).(2).(a).(ii).(a)] / Click here to enter text. / Click here to enter text. /
Endotracheal intubation on 15 patients
[PR IV.A.5.a).(2).(a).(iii)-(iii).(a)] / Click here to enter text. / Click here to enter text. /
Basic life support and advanced cardiac life support
[PR IV.A.5.a).(2).(a).(iv)] / Click here to enter text. / Click here to enter text. /
Management of sedation, including direct administration of sedation to a minimum of 15 patients
[PR IV.A.5.a).(2).(a).(v)-(v).(a)] / Click here to enter text. / Click here to enter text. /
Administration of neuraxial analgesia, including placement of a minimum of 15 thoracic or lumbar epidural injections using an inter laminar technique
[PR IV.A.5.a).(2).(a).(vi)-(vi).(a)] / Click here to enter text. / Click here to enter text. /

Neurology

Indicate the settings and activities in which fellowswill demonstrate competence in the following. Also indicate the method(s) used to assess competence.

Competency Area / Settings/Activities / Assessment Method(s)
Eliciting a directed neurological history
[PR IV.A.5.a).(1).(a).(i)] / Click here to enter text. / Click here to enter text. /
Performing a detailed neurological examination to include at least mental status, cranial nerves, motor, sensory, reflex, cerebellum examinations, and gait in fifteen patients
[PR IV.A.5.a).(1).(a).(ii)] / Click here to enter text. / Click here to enter text. /
Identifying significant findings of basic neuro-imaging
[PR IV.A.5.a).(1).(a).(iii)] / Click here to enter text. / Click here to enter text. /
Neuro-imaging studies in the following areas: brain, cervical, thoracic, and lumbar spine
[PR IV.A.5.a).(1).(a).(iii).(b)] / Click here to enter text. / Click here to enter text. /

a)Will faculty members verify fellow experience in detailed neurological examinations in a minimum of five observed patient examinations? [PR IV.A.5.a).(1).(a).(ii).(a)] ☐YES ☐NO

b)Will neuro-imaging studies include at least magnetic resonance imaging (MRI) and computerized tomography (CT) of the spine and brain on a minimum of 15 CT and/or MRI studies? [PR IV.A.5.a).(1).(a).(iii).(a)] ☐YES ☐NO

Physical Medicine and Rehabilitation

Indicate the settings and activities in which fellowswill demonstrate competence in the following. Also indicate the method(s) used to assess competence.

Competency Area / Settings/Activities / Assessment Method(s)
Performing 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
[PR IV.A.5.a).(1).(b).(i)] / Click here to enter text. / Click here to enter text. /
Significant hands-on experience in the musculoskeletal and neuromuscular assessment of 15 patients
[PR IV.A.5.a).(1).(b).(i).(a)] / Click here to enter text. / Click here to enter text. /
Developing rehabilitation programs to include assessments of static and dynamic flexibility, strength, coordination, and agility for peripheral joint, spinal, and soft tissue pain conditions
[PR IV.A.5.a).(1).(b).(ii)] / Click here to enter text. / Click here to enter text. /
Clinical evaluation and rehabilitation plan development of a minimum of five patients [PR IV.A.5.a).(1).(b).(ii).(a)] / Click here to enter text. / Click here to enter text. /
Integrating therapeutic modalities and surgical intervention in the treatment algorithm
[PR IV.A.5.a).(1).(b).(iii)] / Click here to enter text. / Click here to enter text. /

Psychiatry

Indicate the settings and activities in which fellowswill demonstrate competence in the following. Also indicate the method(s) used to assess competence.

Competency Area / Settings/Activities / Assessment Method(s)
Carrying out a complete psychiatric history with special attention to psychiatric and pain comorbidities
[PR IV.A.5.a).(1).(c).(i)] / Click here to enter text. / Click here to enter text. /
Conducting a complete mental status examination on a minimum of 15 patients
[PR IV.A.5.a).(1).(c).(ii)-(ii).(a)] / Click here to enter text. / Click here to enter text. /
Explaining psychosocial therapy to a patient and making a referral when indicated
[PR IV.A.5.a).(1).(c).(iii)] / Click here to enter text. / Click here to enter text. /

a)Will each fellow demonstrate, to a faculty observer, the ability to conduct a complete mental status examination on five patients?[PR IV.A.5.a).(1).(c).(ii).(b)] ☐YES ☐NO

Medical Knowledge

Indicate the activities (lectures, conferences, journal clubs, clinical teaching rounds, etc.) in which fellowswill demonstrate knowledge of the following areas. Also indicate the method(s) that will be used to assess knowledge in each area.

Area of Knowledge / Settings/Activities / Assessment Method(s)
Assessment of pain [PR IV.A.5.b).(1)]
Anatomy, physiology and pharmacology of pain transmission and modulation natural history of various musculoskeletal pain disorders
[PR IV.A.5.b).(1).(a)] / Click here to enter text. / Click here to enter text. /
Natural history of various musculoskeletal pain disorders
[PR IV.A.5.b).(1).(b)] / Click here to enter text. / Click here to enter text. /
General principles of pain evaluation and management, including neurological exam, musculoskeletal exam, psychological assessment
[PR IV.A.5.b).(1).(c)] / Click here to enter text. / Click here to enter text. /
Indicators and interpretation of electro-diagnostic studies: x-rays; MRI; CT; and clinical nerve function studies
[PR IV.A.5.b).(1).(d)] / Click here to enter text. / Click here to enter text. /
Pain measurement in humans, both experimental and clinical
[PR IV.A.5.b).(1).(e)] / Click here to enter text. / Click here to enter text. /
Psychosocial aspects of pain, including cultural and cross-cultural considerations
[PR IV.A.5.b).(1).(f)] / Click here to enter text. / Click here to enter text. /
Taxonomy of pain syndromes
[PR IV.A.5.b).(1).(g)] / Click here to enter text. / Click here to enter text. /
Pain of spinal origin, including radicular pain, zygapophysial joint disease, and discogenic pain
[PR IV.A.5.b).(1).(h)] / Click here to enter text. / Click here to enter text. /
Myofascial pain
[PR IV.A.5.b).(1).(i)] / Click here to enter text. / Click here to enter text. /
Neuropathic pain
[PR IV.A.5.b).(1).(j)] / Click here to enter text. / Click here to enter text. /
Headache and orofacial pain
[PR IV.A.5.b).(1).(k)] / Click here to enter text. / Click here to enter text. /
Rheumatological aspects of pain
[PR IV.A.5.b).(1).(l)] / Click here to enter text. / Click here to enter text. /
Complex regional pain syndromes
[PR IV.A.5.b).(1).(m)] / Click here to enter text. / Click here to enter text. /
Visceral pain
[PR IV.A.5.b).(1).(n)] / Click here to enter text. / Click here to enter text. /
Urogenital pain
[PR IV.A.5.b).(1).(o)] / Click here to enter text. / Click here to enter text. /
Cancer pain, including hospice and palliative are
[PR IV.A.5.b).(1).(p)] / Click here to enter text. / Click here to enter text. /
Acute pain
[PR IV.A.5.b).(1).(q)] / Click here to enter text. / Click here to enter text. /
Frequent psychiatric and pain co-morbidities, including substance-related mood, anxiety, somatoform, factitious, and personality disorders
[PR IV.A.5.b).(1).(r)] / Click here to enter text. / Click here to enter text. /
The effects of pain medications on mental status
[PR IV.A.5.b).(1).(s)] / Click here to enter text. / Click here to enter text. /
Assessment of pain in special populations, including patients with ongoing substance abuse, the elderly, pediatric patients, pregnant women, the physically disabled, and the cognitively impaired
[PR IV.A.5.b).(1).(t)] / Click here to enter text. / Click here to enter text. /
Functional and disability assessment
[PR IV.A.5.b).(1).(u)] / Click here to enter text. / Click here to enter text. /
Treatment of pain [PR IV.A.5.b).(2)]
Drug Treatment I: opioids
[PR IV.A.5.b).(2).(a)] / Click here to enter text. / Click here to enter text. /
Drug Treatment II: antipyretic analgesics
[PR IV.A.5.b).(2).(b)] / Click here to enter text. / Click here to enter text. /
Drug Treatment III: antidepressants; anticonvulsants; and miscellaneous drugs
[PR IV.A.5.b).(2).(c)] / Click here to enter text. / Click here to enter text. /
Psychological and psychiatric approaches to treatment, including cognitive-behavioral therapy, psychosocial therapies, and treatment of psychiatric illness
[PR IV.A.5.b).(2).(d)] / Click here to enter text. / Click here to enter text. /
Prescription drug detoxification concepts
[PR IV.A.5.b).(2).(e)] / Click here to enter text. / Click here to enter text. /
Functional and vocational rehabilitation
[PR IV.A.5.b).(2).(f)] / Click here to enter text. / Click here to enter text. /
Surgical approaches
[PR IV.A.5.b).(2).(g)] / Click here to enter text. / Click here to enter text. /
Complementary and alternative treatments in pain management
[PR IV.A.5.b).(2).(h)] / Click here to enter text. / Click here to enter text. /
Treatments that comprise multidisciplinary cancer pain care
[PR IV.A.5.b).(2).(i)] / Click here to enter text. / Click here to enter text. /
Strategies to integrate pain management into the treatment model
[PR IV.A.5.b).(2).(j)] / Click here to enter text. / Click here to enter text. /
Hospice and multidimensional treatments that comprise palliative care
[PR IV.A.5.b).(2).(k)] / Click here to enter text. / Click here to enter text. /
Treatment of pain in pediatric patients
[PR IV.A.5.b).(2).(l)] / Click here to enter text. / Click here to enter text. /
General topics, research, and ethics, including: [PR IV.A.5.b).(3)]
Epidemiology of pain
[PR IV.A.5.b).(3).(a)] / Click here to enter text. / Click here to enter text. /
Gender issues in pain
[PR IV.A.5.b).(3).(b)] / Click here to enter text. / Click here to enter text. /
Placebo response
[PR IV.A.5.b).(3).(c)] / Click here to enter text. / Click here to enter text. /
Multidisciplinary pain medicine
[PR IV.A.5.b).(3).(d)] / Click here to enter text. / Click here to enter text. /
Organization and management of a pain center
[PR IV.A.5.b).(3).(e)] / Click here to enter text. / Click here to enter text. /
Continuing quality improvement, utilization review, and program evaluation
[PR IV.A.5.b).(3).(f)] / Click here to enter text. / Click here to enter text. /
Patient and provider safety
[PR IV.A.5.b).(3).(g)] / Click here to enter text. / Click here to enter text. /
Designing, reporting, and interpreting clinical trials of treatment for pain
[PR IV.A.5.b).(3).(h)] / Click here to enter text. / Click here to enter text. /
Ethical standards in pain management and research
[PR IV.A.5.b).(3).(i)] / Click here to enter text. / Click here to enter text. /
Animal models of pain, ethics of animal experimentation
[PR IV.A.5.b).(3).(j)] / Click here to enter text. / Click here to enter text. /
Interventional pain treatment, including: [PR IV.A.5.b).(4)]
Selection criteria for a broad range of interventions, and an understanding of the risks and potential advantages of these interventions
[PR IV.A.5.a).(4).(a)] / Click here to enter text. / Click here to enter text. /
Airway management skills
[PR IV.A.5.a).(4).(b)] / Click here to enter text. / Click here to enter text. /
Sedation/analgesia
[PR IV.A.5.a).(4).(c)] / Click here to enter text. / Click here to enter text. /
Fluoroscopic imaging and radiation safety
[PR IV.A.5.a).(4).(d)] / Click here to enter text. / Click here to enter text. /
Pharmacology of local anesthetics and other injectable medications, to include radiographic contrast agents and steroid preparations
[PR IV.A.5.a).(4).(e)] / Click here to enter text. / Click here to enter text. /
Treatment of local anesthetic systemic toxicity
[PR IV.A.5.a).(4).(e).(i)] / Click here to enter text. / Click here to enter text. /
Trigger point injections
[PR IV.A.5.a).(4).(f)] / Click here to enter text. / Click here to enter text. /
Peripheral and cranial nerve blocks and ablation
[PR IV.A.5.a).(4).(g)] / Click here to enter text. / Click here to enter text. /
Spinal injections, to include epidural injections: interlaminar, transforaminal, nerve root sheath injections, and zygapophysial joint injections
[PR IV.A.5.a).(4).(h)] / Click here to enter text. / Click here to enter text. /
Discography and intradiscal/percutaneous disc treatments
[PR IV.A.5.a).(4).(i)] / Click here to enter text. / Click here to enter text. /
Joint and bursal injections, to include sacroiliac, hip, knee, and shoulder joint injections
[PR IV.A.5.a).(4).(j)] / Click here to enter text. / Click here to enter text. /
Sympathetic ganglion blocks
[PR IV.A.5.a).(4).(k)] / Click here to enter text. / Click here to enter text. /
Epidural and intrathecal medication management
[PR IV.A.5.a).(4).(l)] / Click here to enter text. / Click here to enter text. /
Spinal cord stimulation
[PR IV.A.5.a).(4).(m)] / Click here to enter text. / Click here to enter text. /
Intrathecal drug administration systems
[PR IV.A.5.a).(4).(n)] / Click here to enter text. / Click here to enter text. /

Practice-based Learning and Improvement

Briefly describe one learning activity in which fellowswill demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. [PR IV.A.5.c)] (Limit response to 400 words)

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Briefly describe one planned learning activity in which fellowswill engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; and identify and perform appropriate learning activities to achieve self-identified goals (life-long learning). [PR IV.A.5.c).(1)-(3)] (Limit response to 400 words)

Pain Medicine07/2018

Briefly describe one planned quality improvement activity or project that will allow fellows to demonstrate the ability to analyze, improve, and change practice or patient care. Describe planning, implementation, evaluation, and provisions of faculty member support and supervision that will guide this process. [PR IV.A.5.c).(4)] (Limit response to 400 words)

Pain Medicine07/2018

Briefly describe how fellows will receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is used to evaluate these skills, have it available for review by the site visitor.) [PR IV.A.5.c).(5)] (Limit response to 400 words)

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Briefly describe one example of a learning activity in which fellows engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients' health problems. [PR IV.A.5.c).(6)-(7)] (Limit response to 400 words)

The description should include:

Locating information
Using information technology
Appraising information
Assimilating evidence information (from scientific studies)
Applying information to patient care
Conducting a comprehensive literature search

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Briefly describe how fellows will participate in the education of patients, families, students, residents, and other health professionals. [PR IV.A.5.c).(8)] (Limit response to 400 words)

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Interpersonal and Communication Skills

Briefly describe one learning activity in which fellowswill develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health-related agencies. [PR IV.A.5.d).(1)-(2)] (Limit response to 400 words)

Pain Medicine07/2018