Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine - Fellowships
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Pain Fellowship Clinical Rotations

The Mass General Center for Pain Medicine Fellowship Program is structured through core rotations as follows:

Outpatient pain clinic - 7 months
Inpatient pain service - 2 months total taken in one-week and two-week blocks.
Pediatric pain service (inpatient and outpatient) at Children's Hospital Boston - 1 month
Elective - 1 month

Embedded within the core rotations are key clinical experiences as follows:

  • Neurology
  • Psychiatry/psychology
  • Operating room interventional
  • Critical event management training (a one-day course held at the Center for Medical Simulation)

The precise amount of time spent in these rotations is somewhat variable; each fellow must achieve a prescribed clinical experience in neurology and psychiatry/psychology. The precise amount of time in those rotations is dependent upon patient load during each scheduled exposure. Similarly, although each fellow is scheduled for two months as OR interventional fellow, during the second half of the fellowship, the fellow involved in each OR procedure is flexible. This allows each fellow to have a similar clinical experience in this area.

Below are more detailed descriptions of each rotation.

a. Outpatient Pain Clinic - MGH

This rotation forms the core of the fellow's experience. In the outpatient clinic fellows evaluate patients with a wide variety of chronic pain complaints. There are three fundamental types of patient visits: new evaluations, follow-up evaluations, and office-based procedures. Patients in the outpatient clinic have a pain attending of record who is involved with that patient's care at each visit. Every attempt is made to provide continuity of care for the fellows.

Fellows ensure that patients are seen in a timely fashion and that the workload and educational opportunities are apportioned fairly. All evaluations and procedures are conducted under the direct supervision of an attending pain physician. For initial evaluations and follow-up visits fellows typically conduct a history and physical, and generate a treatment plan. Fellows then present to the attending for discussion of any pertinent findings and the treatment plan. The attending and fellow then return to the patient for further evaluation under the guidance of the attending and finally discuss the assessment and plan with the patient.

Procedures are scheduled with time provided for fellows to conduct a focused evaluation prior to initiation of the procedure. Attendings typically discuss the technical aspects of the procedure with fellows prior to the initiation of procedures. Attendings are present throughout the entire procedure (though they may not be present during the pre-procedure re-evaluation). While in the pain clinic fellows will periodically be scheduled to see patients with an attending neurologist (Anne Louise Oaklander, MD, PhD) and an attending clinical psychologist (Ronald Kulich, PhD). These clinical experiences are designed to provide further exposure to the care of the chronic pain patient in those focused areas - e.g., neurology and psychiatry/psychology.

b. Inpatient Chronic Pain Service - MGH

The Mass General Pain Service operates an inpatient consultation service for both acute and chronic pain issues in both adult and pediatric patient populations. The majority of acute pain consultations involves perioperative pain issues but may also relate to trauma and the management of post-dural puncture headaches. The service is also consulted on a wide variety of chronic- and cancer-pain problems. Management of patients on the inpatient service is both medical and procedural.

The inpatient service is fellow-run with attending supervision. The pain fellow assigned to the inpatient service is expected each day to see all patients with acute, chronic and cancer pain complaints. Pain attendings evaluate patients with fellows at the initial consultation. The fellow decides when pain-attending involvement is required for follow-up care. Fellows are fully supervised during any procedures performed while rotating on the inpatient service.

c. Advanced Interventional Pain Management Rotation - MGH

At all times there is a pain fellow assigned as the "interventional fellow." This assignment is not obligatory, though all fellows have elected to be involved. The interventional fellow is responsible for all patients who are scheduled to have O.R. procedures conducted by pain service attendings (e.g., implantation of spinal cord stimulators and intrathecal pumps). In such cases, the fellow is responsible for the perioperative care of the patient and will conduct the implantation under the supervision of the pain attending.

While on this rotation fellows may choose to be involved with physicians outside of the pain service who are involved in interventional pain management. Fellows typically work with Joshua Hirsch, MD, an interventional radiologist who performs vertebroplasty. Fellows may also work with Emad Eskandar, MD, PhD, a neurosurgeon who performs a variety of pain-related neurosurgical procedures.

d. Pediatric Pain Medicine - Children's Hospital Boston

Fellows rotate for one month at The Children's Hospital Boston (CHB) in Boston, MA. This rotation provides an in-depth exposure to management of acute and chronic pain in the pediatric population. The inpatient pain clinic at CHB is multidisciplinary and fellow supervision occurs much as it does in our outpatient clinic. Of note, all new patient visits at CHB outpatient clinic involve evaluation by a pain physician, a psychologist, and a physical therapist. As part of the evaluation process, all three groups discuss the patient and generate a treatment plan. The Children's Hospital performs a large number of operations, thus providing our fellows with a significant exposure to perioperative pain management in children. While at CHB, fellows are exposed to medical (e.g., pharmacological), interventional, and psychological pain management.

e. Physical Medicine & Rehabilitation - Spaulding Rehabilitation Hospital

The Spaulding Rehabilitation Hospital is a 196 bed rehabilitation hospital with over 60 physicians on staff and 6 specialized inpatient programs in rehabilitation. There are 4,000 inpatient admissions annually, and 140,000 outpatient visits annually. The Spaulding Rehabilitation Hospital rotation allows our fellows to gain further experience with musculoskeletal examination/physical medicine and rehabilitation, as well as alternative therapies, such as biofeedback.

f. Palliative Care - MGH, Dept. of Internal Medicine

During your rotation with Palliative Care, you will have the opportunity to care for patients with serious and life-threatening illnesses. You will serve as part of the palliative care team made up of attending physicians, advanced practice nurses, a social worker and chaplain. You will round with the team daily, follow your hospitalized patients throughout their stay, and perform new consultations under the supervision of your attending. The rotation provides exposure to palliative care in the acute, inpatient setting and also in the clinic.

g. Elective

Fellows are provided the opportunity to pursue a one-month clinical experience of their choosing. The elective must be directly related to pain medicine and must be approved by the program director. The function of the elective is to allow each fellow to focus on their particular interests. Fellows have chosen to spend the month rotating with the palliative care service, working with interventional radiology, increasing exposure to regional anesthesia, etc. Outside electives require pre-approval from the American Board of Anesthesiology.

Office Information

Department of Anesthesia,
Critical Care and Pain Medicine
Gray-Bigelow 444
55 Fruit Street
Boston, MA 02114

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