Regional Anesthesiology and Acute Pain Medicine Fellowship

About the Program

Regional anesthesia training is a subspecialty focused on the perioperative management of patients receiving neuraxial or peripheral neural blockade for anesthesia or analgesia. This fellowship program will ensure the ongoing development of regional anesthesia as a defined subspecialty. Research activities, educational curricula, and, most importantly, clinical care is emphasized. Fellows will also have the option to extend the fellowship for an additional research year.

The University of Iowa Regional Anesthesia Fellowship program is managed by the Acute Pain and Regional Anesthesia division with Pain Medicine and Ambulatory Anesthesia and, apart from equipping the Fellow with the required technical ability and knowledge to be able and proficient to perform advanced Regional Anesthesia on a consultant level, the program has the basic philosophy of putting Fellows in a position to “trouble-shoot” Regional Anesthesia procedures and programs and to set up Regional Anesthesia programs necessary for Orthopedic Anesthesia. The emphasis is purely on acute pain management, and most regional anesthesia required for general surgery and thoracic surgery is also taught. A Fellow who completes his/her fellowship at the University of Iowa will be able to conduct high-level scientific research, be proficient with advanced Regional Anesthesia and be a consultant and teacher for other anesthesiologists interested in Regional Anesthesia. There is an emphasis on continuous nerve block and the management of acute post-operative pain with regional anesthesia. The teaching for continuous nerve blocks is to place perineural catheters by stimulating not only the needle for placing the catheter with a nerve stimulator, but by stimulating the catheter as well. This technology has been invented and developed by this program director in collaboration with a major equipment manufacturing company.

The majority of the fellowship year will be spent at UIHC on the Acute Pain Service, which has over 6,000 patient encounters per year and on the Regional Anesthesia Service, which performs over 2,400 blocks per year. In addition, fellows will be able to utilize neuraxial techniques in the operating rooms where 25 procedures, on average, are performed each week. Fellows will be exposed to a wide variety of blocks for regional pain and acute pain management including single-shot and peripheral and central neural blocks, continuous catheter techniques, ultrasound and fluoroscopy guidance, as well as other innovative approaches to perioperative pain management. In addition, fellows will also participate in perioperative pain management and regional anesthesia care of pediatric patients. Graduates of the program are expected to become highly skilled in regional and acute pain management from basic to the most challenging interventions.

Additionally, fellows actively participate in the regular On- and Off-Campus RASCI Workshops. For further information please see Regional Anesthesia Study Center of Iowa (RASCI).

The Regional Anesthesia Fellowship program is a one-year non-ACGME accredited program. The fellowship began in July 2004 and accepts two fellows per year.

The Regional Anesthesia Didactic series consists of lectures presented weekly as well as a fellow PBLD session. The educational program is designed to augment the clinical and educational experience.

University of Iowa Graduate Medical Education (GME) policies are located here.

Welcome

The Department of Anesthesia, at University of Iowa Hospitals & Clinics is pleased to offer a Fellowship in Regional Anesthesia and Acute Pain Medicine, and accepts applications from anesthesiologists who desire to focus on this relatively new and rapidly growing subspecialty. Over a 12-month period, two fellows will rotate through a broad range of clinical areas including outpatient, inpatient, and pediatric regional and acute pain management within UI Hospitals & Clinics and Ambulatory Surgery Center.

The Acute Pain and Regional Anesthesia Service at the University of Iowa aims to provide excellence in acute and regional anesthesia for postoperative pain relief, to educate residents and fellows in the management of acute pain, and to further clinical research in the fields of pain management and regional anesthesia.

We consult on the management of patients with postoperative, post-traumatic, or any acute pain condition requiring:

  • Specialized interventions such as epidural analgesia
  • Continuous peripheral nerve blockade
  • Complex pharmacological management, such as opioid tolerant patients

We also offer a full range of interventional procedures, such as blood patches, difficult lumbar punctures, fluoroscopy-guided epidural placement and ultrasound-guided regional blocks. The service is staffed for 24-hour coverage seven days a week. Please take this opportunity to explore the possibilities you will find at the University of Iowa by visiting our departmental website as well as this website for specific curriculum and types of procedures performed.

 

Curriculum

Didactic Lecture Series

The acute pain lectures are presented Thursdays at 4 p.m. The fellows are expected to present between two or three PBLD (Problem Based Learning Discussion) type lectures during the academic year.

Anesthesia Clinical Case Conference

Clinical Case Conference (M and M) and visiting professor presentations are on Tuesday mornings from 0700 - 0745.  Fellows are invited and encouraged to attend these weekly conferences. Pain and Regional interesting cases are presented by Pain Medicine Faculty three to four times per year.

Clinical Education

The clinical program will serve as the cornerstone of the fellowship training in regional anesthesia. In order to achieve the necessary level of expertise, fellows should be familiar with the indications, contraindications, techniques, and complications of the techniques listed below:

Basic Techniques

  • Superficial cervical plexus block
  • Axillary brachial plexus block
  • Intravenous regional anesthesia (Bier block)
  • Intercostobrachial nerve block
  • Saphenous nerve block
  • Ankle block
  • Spinal anesthesia
  • Lumbar epidural anesthesia
  • Combined spinal-epidural anesthesia
  • Femoral nerve block
  • TAP (transverse abdominis plane) block
  • Lateral femoral cutaneous nerve block

Intermediate Techniques

  • Deep cervical plexus block
  • Interscalene block
  • Supraclavicular block
  • Infraclavicular block
  • Sciatic nerve block: posterior approach
  • Popliteal block: all approaches
  • Suprascapular nerve block
  • Thoracic epidural anesthesia

Advanced Techniques

  • Continuous interscalene block
  • Continuous infraclavicular block
  • Continuous supraclavicular block
  • Continuous axillary block
  • Thoracolumbar paravertebral block: single injection or continuous
  • Lumbar plexus/Psoas block: single injection or continuous
  • Combined lumbar plexus/sciatic block: single injection or continuous
  • Continuous femoral nerve block
  • Obturator nerve block
  • Sciatic nerve block: anterior approach and parafemoral technique
  • Continuous sciatic nerve block: all approaches
  • Continuous popliteal block: all approaches

Exposure to regional and acute pain techniques involving pediatric and ambulatory surgery patients is strongly encouraged. Physiologic and pharmacologic consequences of regional and acute pain anesthesia will be stressed. Particular attention should be focused on the potential respiratory and hemodynamic perturbations, which accompany performance of neuraxial and peripheral nerve blocks.

Acute Pain Call

The regional anesthesia fellows are assigned to cover acute pain call on the weekends, beeper call from home.

Weekdays - the regional fellows as well as the residents rotating on the acute pain service rotate acute pain consults. When assigned to acute pain consults, they are expected to stay in-house until the OB resident can take over the beeper call for the evening.

FAQ

How are the applicants chosen for interviews?

Completion of an Anesthesia residency program is a requirement. Applicants are chosen based on their educational background including scores, educational presentations, and research activities as well as their performance in the interview process and based on their references. The successful applicant will have an M.D. or equivalent and will have passed the Anesthesiology specialty exams or in the process of examinations by the American Board of Anesthesiology. Candidates must have completed a core residency program with at least one year of clinical training from an ACGME accredited program.
Interested applicants should submit the following: letter of intent, curriculum vitae, official record(s) of Board scores (NBME, FLEX, USMLE), letter of recommendation from anesthesiology residency program director, and two additional letters of recommendation from faculty members. Final selection will be made by a selection committee upon the recommendation of the director of the fellowship program.

Can you describe a typical clinic day for your fellows?

Typical clinic day starts around 6:30 am completing the regional blocks for the early start surgeries followed by morning acute pain rounds. During the day, the fellows perform regional procedures and attend acute pain consults. In the afternoon they check the OR schedules for regional procedures for the next day. If on call, the fellow would conduct/attend acute pain evening rounds.

Do you have an electronic record?

Yes, since November 2010 the University uses Epic for medical records, including documentation and orders.

Do fellows have an educational fund?

Yes. Fellows are allotted a fund of $2,400 to provide support for specific needs during the course of their training. An additional $600 is awarded to the fellow if they present a research project at a national meeting that is approved by the Director for Acute Pain Medicine.

What are your average duty hours?

The average duty hour week is 56 hours. Duty hours are recorded on Med Hub.

How are fellows performance evaluated?

Faculty evaluates fellows using MedHub monthly. The evaluations are based on the six ACGME core competencies.
The fellows also evaluate the faculty using the Department of Anesthesia Faculty Evaluation System (these evaluations are combined with resident evaluations and presented to the faculty quarterly to ensure confidentiality).

Program Accreditation

The Regional Anesthesiology and Acute Pain Medicine fellowship at the University of Iowa Hospitals & Clinics is a one-year fellowship which was accredited by the Accreditation Council for Graduate Medical Education (ACGME) effective April 17, 2018.

Information specific to program requirements for a regional anesthesiology and acute pain medicine training program may be found at the ACGME’s Anesthesiology Review Committee (RC).

How to Apply

The successful applicant will have an M.D. or equivalent and will have passed the Anesthesiology board exams or in the process of examinations by the American Board of Anesthesiology. Candidates must have completed a core residency program from an ACGME accredited program.

If interested in applying, please complete and send the application and supporting documents (outlined below) to the Fellowship Coordinator and include "Regional Fellow Applicant" in the subject line.

  • CV (curriculum vitae) with photo
  • Official records of Board Scores (USMLE, NBME, FLEX or COMLEX). MUST have passed USMLE Step 1, Step 2, and Step 3.
  • Three (3) Letters of Recommendation – one from your anesthesiology residency program director and two additional letters of recommendation from faculty members.
  • Copy of visa, if applicable
  • Copy of ECFMG certificate (applicants who attended medical school outside the U.S.)

The program director reviews all completed applications and makes the decision on whom to invite for an interview.

Deadline

Applications are now being accepted for one position to start July 1, 2022, and two positions to start July 1, 2023.

Due to the current COVID-19 pandemic, selected candidates will be invited to online interviews.

If you have any additional questions, please contact the fellowship program coordinator.

Fellow Eligibility

Eligibility criteria for applicants:

1.  Graduate from one of the following:

  • United States or Canadian medical school accredited by the Liaison Committee on Medical Education (LCME)
  • United States college of osteopathic medicine accredited by the American Osteopathic Association (AOA)
  • Medical school outside the United States or Canada with:
    • A valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) and have a passing score for Step 1 and Step 2 of the USMLE
    • Be a U.S. citizen, a legal permanent resident, or hold a visa which provides eligibility to work in the U.S. Typical visas are J-1 (requires Steps 1 and 2 of USMLE and ECFMG certification) and H1-B (requires departmental approval, and Steps 1, 2 and 3 of USMLE, and an Iowa medical license)

2.  Meet Iowa Board of Medicine licensure requirements.

3.  All applicants must also meet program eligibility requirements as defined by the ACGME’s respective RRC.

Contact our Fellowship Coordinator if you have any eligibility questions.

The Department of Anesthesia at Roy J. and Lucille A. Carver College of Medicine and UI Health Care shares the University of Iowa’s commitment to equal access and, consistent with its academic mission and standards, strives to achieve excellence through the advancement of diversity, equity, and inclusion. In the Department of Anesthesia, we are mindful of all aspects of human difference and define diversity in the broadest sense to mean inclusion of all persons. This means we do a holistic review of applications, with particular interest in recruiting applicants who have shown grit and resilience in their path to medicine, as well as potential to lead anesthesiology in the future.

Interviews

Preparing for Interview

If you are selected to come to Iowa for an interview, you will receive an email inviting you to interview at Iowa.

You are responsible for making your transportation to Iowa (either by driving or flights), including shuttle.

Nearest airports are:

  • Cedar Rapids (code CID) – approximately 25 min drive
  • Quad Cities/Moline (code MLI) – approximately one hour drive

When making flight arrangements, please fly the evening before your interview and make your departing flight 4 p.m. or later.

Our department will pay for one night stay at the hotel (we will make reservations for you).

Approximately one week prior to your interview, you will receive e-mail with a copy of your itinerary, hotel information, and directions to our office once you arrive at the hospital.

Interview Day – What to Expect

Your day will begin at 8 a.m.

You will be escorted to all appointments; appointments will be with regional and acute pain faculty, acute pain nurse and lunch with the current regional fellows.

Your day will end around 2 p.m.

Our People

Acute Pain and Regional Anesthesia Faculty

Michelle Parra, MD, Clinical Associate Professor; Director, Anesthesia Residency Program

Melinda Seering, MD, Clinical Associate Professor; Medical Director of the Ambulatory Surgery Center

Tejinder Swaran Singh, MD, Clinical Associate Professor; Director of the Pain Medicine Fellowship Program

Regional Anesthesia Faculty

Anil Marian, FRCA, MD, Clinical Associate Professor

David Swanson, MD, Clinical Assistant Professor

Pediatric Pain Service Faculty

Stephen Hays, MD, Clinical Professor

Katherine Keech, MD, Clinical Assistant Professor

Martin Mueller, MD, Clinical Associate Professor

Sarah Titler, MD, Clinical Assistant Professor

Acute Pain, Chronic Pain and Regional Pharmacist

Lee Kral, PharmD, Adjunct Assistant Professor

Current Fellow

Shilpa Chouhan, portrait

Shilpa Chouhan, MBBS
University of Iowa.

Leadership

Cynthia Wong, MD

Department Chairman
Professor of Anesthesia