Description:
This is a Chronic Pain medicine rotation of one-month duration during the PGY-2 year and is a clinical base anesthesiology resident rotation. The rotation is at the UK Pain Care Center (Dr. Holtman) on Tuesday-Thursday and at the VA Pain Clinic (Dr. Atallah) on Monday and Friday. The Anesthesiology program director approves and oversees the rotations provided by each service for the Clinical Base Year (CBY) education. The Chronic Pain medicine staff (Dr. Holtman [UK], Dr. Atallah [VA]) is responsible for appropriate faculty teaching, over-site, and resident evaluation for this rotation.

Goals:
At the completion of the Chronic Pain Medicine rotation, the PGY-2 resident will be able to:
• Rapidly obtain a focused medical and pain history
• Perform a focused physical examination
• Make appropriate use of diagnostic studies and tests
• Integrate information to develop a differential diagnosis of painful conditions
• Implement a treatment/consultation plan for patients with painful conditions

Educational Objectives:
(1) Patient Care
• Be able to provide patient care that is compassionate, appropriate, and effective in caring for patients with painful conditions
• Demonstrate ability to efficiently obtain a focused medical/pain history
• Demonstrate ability to efficiently perform a focused physical examination
• Integrate information to develop a differential diagnosis of painful conditions
• Be exposed to and develop experience with neuropathic pain and the mechanisms (e.g. CRPS1/CRPS2, post-herpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia)
• Learn to assess musculoskeletal, spinal and other painful conditions and when to intervene with nerve blocks and other procedures.
(2) Medical Knowledge
• Understand common pain management procedures
• Understand the pharmacology of opioids and other pharmacologic adjuncts in chronic pain practice (e.g. conversion between modes of opioid delivery, metabolites of opioids, withdrawal from opioids, appropriate use of NSAID’s, anticonvulsants, antidepressants)
• Understand the appropriate role of epidural steroids in chronic pain management (low back pain, lumbosacral radiculopathy)
• Will integrate information and with assistance from faculty/senior residents develop an appropriate differential diagnosis and treatment plan
• Become familiar with cancer pain management
• Become familiar with the psychology of chronic pain and the role of psychologists in the chronic pain management team
(3) Practice-Based Learning and Improvement
• Will locate, appraise and assimilate evidence from scientific studies related to the management of chronic pain patients
• Will use information technology to manage information, access on-line medical information and support their own education, and apply this information in decision making
• Will facilitate the learning of students, nurses, and other health care professionals they interact with
(4) Interpersonal and Communication Skills
• Works effectively with other members of the chronic pain care team including attending staff, fellows in pain management, neurology, rehabilitation medicine, oncology, and palliative care
• Will effectively exchange information with patients, their families, and other health professionals
• Writes legible, organized notes which effectively communicate a plan
(5) Professionalism
• Demonstrates sensitivity and responsiveness to patients’ and their families’ cultures, age, gender, and disabilities.
• Demonstrates respect and compassion when talking with patients and their family members
• Wears appropriate attire
• Demonstrates a commitment to ethical practices including confidentiality of patient information, informed consent, and equal treatment
• Attends all educational conferences required by the Chronic Pain Medicine department of residents on the Chronic Pain rotation
(6) Systems-Based Practice
• Utilizes laboratory/diagnostic testing in a cost conscious manner
• Appropriately utilizes consultation with other health care professionals and formulates appropriate question(s) to be posed to consultants
• Facilitates the efficient Team Care approach to chronic pain management

Resident Assessment
Competencies will be assessed by the following methods:
1. Direct observation by faculty and senior residents of intern patient care, medical knowledge, and interpersonal and communication skills.
2. A global rating form will be used at the end of the month to evaluate the intern on the six General Competencies based on direct observation and feedback from faculty, residents, nurses, and other health care providers when appropriate. This evaluation will be provided to the anesthesiology program director in a timely manner for quarterly review of intern performance.
• The faculty or senior resident of record will discuss the end of the month evaluation with the intern.
• Any issues regarding unsatisfactory intern performance will be immediately communicated to the intern and to the anesthesiology program director