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The Pain Medicine Fellowship curriculum is listed below.
Mayo Clinic Rochester Pain Clinic (7-10 months)
Pain medicine trainees always work under the direct supervision of the pain medicine program director and pain clinic faculty. Trainees participate in the evaluation and treatment of patients with a wide variety of pain problems including cancer pain, spine pain, sympathetically mediated pain, head and facial pain, neuropathic pain, visceral pain, and myofascial pain. Most patients are seen as direct referrals from other Mayo Clinic physicians or from physicians at Mayo-affiliated facilities. Trainees are expected to completely evaluate their patients and present their findings and treatment plans to pain medicine faculty.
Typical treatment plans may involve behavioral modification/psychological testing and treatment, interventional pain procedures, medications and physical modalities. Fluoroscopically-guided interventional pain procedures are performed either at the Gonda Outpatient Procedure Center or in an operating room at Rochester Methodist Hospital.
Services not physically located in the Pain Clinic (such as diagnostic radiology and the autonomic nervous system laboratory) are readily available on the Mayo Campus.
Trainees implement treatment plans and follow their patients under the direct supervision of faculty.
Pain medicine trainees also have the following rotations available:
Hospital-Based Pain Services – Saint Marys and Rochester Methodist hospitals (4 weeks)
Trainees learn how to evaluate postoperative pain patients, manage complications, and, most importantly, how to organize and safely manage a hospital-based pain service. All hospital-based pain service activities are directly supervised by pain medicine faculty.
Pain Rehabilitation Unit (3 weeks)
Trainees learn to identify patients who may benefit from a behavioral rehabilitation approach to chronic pain. They are also exposed to various psychometric testing procedures, rehabilitative approaches to therapy, and gain experience in identifying and treating patients with substance abuse and dependence issues. Trainees work under the supervision of the medical director of the Pain Rehabilitation Unit during this rotation.
Spine Center (1-2 weeks)
Trainees improve musculoskeletal examination skills, improve skills in interpreting radiographs, CT, MRI and other imaging studies of the spine, and learn to order and interpret nerve conduction/electromyographic studies. The spine center is a multidisciplinary facility. Trainees work under the direct supervision of spine center faculty that includes neurologists, orthopedic surgeons, neurosurgeons, physiatrists and others.
Hand Clinic (1 week)
Trainees are exposed to the evaluation and treatment of common hand problems. They review the basic anatomy and innervation of the hand and upper extremity to facilitate understanding of upper extremity neural blockade. They also learn to identify hand problems that may respond to surgery. Trainees are directly supervised by faculty hand surgeons during this rotation.
Hospice/Palliative Care (1 week)
Trainees learn basic concepts of hospice care including eligibility and certification; cancer pain and symptom management in terminal patients; and ethical issues related to death and dying. Information about palliative sedation, depression and anxiety are taught during this rotation. Trainees are supervised by faculty specialists in palliative care during this training.
Pain Clinic-Mayo Clinic in Florida (4-8 weeks elective)
Trainees gain exposure to additional pain faculty and are exposed to a somewhat different case mix during this rotation. All activities are directly supervised by pain medicine faculty .
Pain Clinic-Mayo Clinic in Arizona (4-8 weeks elective)
Trainees gain exposure to additional pain faculty and are exposed to a somewhat different case mix during this rotation. All activities are directly supervised by pain medicine faculty.
Regional Anesthesia (1-4 weeks elective)
Trainees gain additional experience with regional anesthesia techniques useful in the care of pain patients during this rotation. This includes instruction about the indications, contraindications, complications and techniques of various nerve blocks. All activities are directly supervised by anesthesiology faculty.
Anatomy Dissection Laboratory
An anatomy course is organized specifically for pain medicine trainees and conducted on an annual basis. Fellows are asked to dissect anatomical areas of interest that are relevant to pain medicine training and practice. Pain medicine trainees and faculty subsequently meet in the Anatomy Laboratory to review the dissection with the assistance of Dr. W. Pawlina (anatomy faculty). Anatomy dissection conferences are conducted during the spring quarter each year. Eight of these conferences were conducted between April 9 and June 28, 2001.
Neuroscience Course
Pain medicine trainees with interests in basic neuroscience are encouraged to participate in the Mayo Graduate School Neuroscience Course. This course includes more than forty conferences per year. Presentations are made by basic science and clinical faculty with interests and expertise in this field.
Mayo Graduate School of Medicine and Mayo Graduate School also conduct courses in the conduct of human and basic scientific research. Interested pain medicine trainees have the opportunity to participate in these courses on an elective basis.
Program flexibility
Given the vast number of subspecialties available on campus, fellows have considerable flexibility in choosing their electives. All electives require written objectives, an appointed supervisor and evaluation forms.
The Pain Medicine Fellowship curriculum is subject to changing requirements of the ACGME. Further details on the educational curriculum items can be seen at: http://home.theaba.org/materials/PMContentOutline.pdf
Research Training
Your research opportunities at Mayo Clinic are outstanding. During the course of this fellowship, you will design and complete a research project under close mentorship from one of our clinician-researchers. Opportunities for both clinical studies and laboratory-based projects exist.
Teaching Opportunities
Fellows have the opportunity to teach Mayo medical students; visiting students from other medical schools; surgery, pediatric and internal medicine residents; and other anesthesia residents through operating room instruction and formal didactic lectures.
Call Frequency
Mayo follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME) regarding call frequency. Call schedules vary by individual rotation, but call is approximately one weekend per month. The call duties are in compliance with ACGME requirements in that it allows a day after call with no direct patient care responsibilities and at least one weekend-day off per week.
Evaluation
To ensure acquisition of adequate knowledge and development of appropriate technical skills, your performance is monitored carefully during the course of training. Formal evaluation by supervising faculty members occurs quarterly, and each trainee is assigned a faculty adviser for the purpose of providing feedback. Fellows receive a written clinical competence evaluation by the Chair of the Clinical Competence Committee twice each year. These evaluations are forwarded to the American Board of Anesthesiology (ABA), which grants credit for training.
In addition, trainees regularly evaluate rotations and faculty to ensure education needs are met and to provide feedback to the faculty to guide their efforts to improve the program.
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