Didactic Teaching Program

Didactics take place Monday through Thursday (unless otherwise specified) at 7:15 am before the start of daily clinical responsibilities. Our didactic schedule follows a "Theme of the Month" scheme. Examples of some themes are Basic science related to pain, Low back pain, Neck Pain, Cancer pain and palliative care, pediatric pain, pharmacology in pain etc. 
Make up presentations can utilize Friday morning optional time. The different components of our didactic program are outlined below.

Pain Clinic Monthly QA/QI Meeting

This meeting takes place on the 2nd Monday every month in the evening after the Pain Clinic Huddle.

Clinical conferences (every 1st, 3rd, 5th Monday morning)

Fellows/residents/faculty will decide on an interesting case from clinic or case reports for discussion. Materials to read and questions to be discussed on the topic are sent out by the presenter at least one week prior to the scheduled conference. 

QA/QI meetings (every 2nd and 4th Monday of even months)

This will be in the format of presentation and discussion.
Fellows/residents/faculty/nursing staff can place a case or scenario which require possible quality improvement in pain clinic and should present that in conference. 

Morbidity and mortality conference (every 2nd Monday of even months)

In the format of presentation and discussion addressing complications and near miss events. A PowerPoint presentation must be made for each morbidity and mortality conference and submitted to the fellowship coordinator. 

Fellows’ hours for resident teaching (every Tuesday morning)

This session is formal teaching of the residents / interns / outside rotators by the pain medicine fellows. A PowerPoint presentation is made for each topic and at a minimum these topics are covered by the pain medicine fellows.

1. Pain rotation orientation and introduction to pain
2. Acute and perioperative pain
3. Pharmacology in chronic pain
4. Introduction to interventional chronic pain
5. Multi-disciplinary pain management
6. Management of cancer pain
7. Interventional pain in chronic and cancer pain

Pain reading club (every 1st, 3rd, 5th Wednesday morning)  

Reading club materials are chosen by the fellows guided by the theme of the month and are distributed by the administrative fellow approximately 10 days prior to the scheduled reading club. Questions to be discussed are sent at least 5 days prior to the scheduled reading club. 

Pain conference (every 2nd and 4th Wednesday morning)

This typically involves presentations by faculty from within or outside our department for lectures based on the theme of the month.  

Pain fellow presentation (every 1st Thursday morning)

Each fellow is responsible for choosing a topic to present to the department twice during the year. Fellow should demonstrate understanding and assimilation of the topic and prepare a PowerPoint presentation.
The PowerPoint presentation should be submitted to Program Coordinator. 

Pain journal club (every 2nd and 4th Thursday morning)

Journal club materials are chosen by the fellows based on the theme of the month and are distributed by the administrative fellow 1 week prior to the journal club.  

Pain seminars (every 3rd and 5th Thursday morning)

Presentation format. This time can be used for outside speakers based on the theme of the month 

Attendance

Fellows are expected to attend all of the didactics when not engaged in patient care, ill, on vacation, post-call, PICU, on an away rotation, or attending an approved meeting. While conference attendance is required, a fellow is not required to attend conference/lecture if doing so would cause a duty hour violation. The fellowship coordinator tracks attendance at educational activities. Fellows are expected to attend 90% of the didactic lectures and Clinical Case Conferences. If a conference/lecture is missed in order to avoid a duty hour violation or the fellow cannot attend due to clinical obligations, the fellow should notify the fellowship coordinator and the fellow will be officially excused from that educational activity. All fellows must scan the badge reader to get credit for attendance

The Pain Management Clinic at The University of Iowa serves patients with chronic pain from both cancer and non-cancer related diagnoses. Multimodal treatment protocols are instituted, utilizing both interventional and non-interventional techniques. 

Interventional procedures include:

• Discography
• Intercostal nerve blocks
• Intra-articular facet blocks
• Intrathecal drug delivery
• IV regional blockade
• Medial branch facet blocks
• Neurolytic blocks
• Permanent implantation of dorsal column stimulator
• Radiofrequency blockade
• Sacroiliac joint injections
• Selective nerve root blocks
• Targeted peripheral nerve catheterization
• Translaminar epidural steroid injections
• Trigger point injections
• Spinal cord stimulation
• Sympathetic ganglion blockade including: Stellate, celiac, lumbar, hypogastric
• Vertebroplasty

The Pain Management Clinic includes six examination/procedure rooms, one consult room, two fluoroscopy suites, 3-bay recovery area, and administrative offices for faculty and staff. The Clinic is located at Iowa River Landing, 105 E. 9th St., in Coralville.

The procedures offered during the fellowship year ensure fellows will be able to practice competently and independently in the field of pain medicine.

Palliative Care

The fellows rotate/train with Dr. Broderick and colleagues for two consecutive weeks. During this rotation the fellows work with patients in the palliative care setting. The fellows are given the opportunity to understand the strategies to integrate pain management into this multi-dimensional treatment model during this rotation.

Neurosurgery

The fellows rotate three afternoons per week for four consecutive weeks (or longer if ACGME requirements are not met within the first eight weeks). The fellows will train with one or more neurosurgery faculty to diagnose, evaluate and treat neurological syndromes associated with pain. The fellows become familiar with basic neuro-imaging, including MRI and CT of the spine and brain, and understand the indications and interpretation of these studies.

Physical Medicine and Rehabilitation (PM&R)/Electromyograph (EMG)

The fellows rotate one day per week for eight consecutive weeks (or longer if ACGME requirements are not met within the first eight weeks). The fellows will train with a member of the EMG faculty to become familiar with diagnostic testing.

Acute Pain Service

The Acute Pain Service actively manages acute postoperative and cancer pain in the inpatient setting. The service commonly utilizes thoracic and lumbar epidural catheters as well as peripheral nerve catheters. The fellows rotate on the Acute Pain Service for two consecutive weeks. 

Anesthesia (for non-anesthesia trained residents)

The fellow works closely with anesthesiology faculty, who are accredited with the ACGME Anesthesia Residency program, for one to two consecutive weeks. May take longer if ACGME requirements for airway management and others are not met within the first two weeks.

Program Accreditation

The pain medicine fellowship at University of Iowa Hospitals & Clinics is accredited by the Accreditation Council for Graduate Medical Education. Our last ACGME site visit was in March 2011 and our accreditation status is continued accreditation. The program is approved for 4 total fellow positions.

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

Board Certification

The ABA-American Board of Anesthesiology-certifies physicians in pain medicine by administering the Pain Medicine examination. Our fellowship program expects fellows to become certified in Pain Medicine.

Pain medicine is the medical discipline concerned with the diagnosis and treatment of the entire range of painful disorders. Because of the vast scope of the field, pain medicine is a multidisciplinary subspecialty. The expertise of several disciplines is brought together in an effort to provide the maximum benefit to each patient. Although the care of patients is heavily influenced by the primary specialty of physicians who subspecialize in pain medicine, each member of the pain treatment team understands the anatomical and physiological basis of pain perception, the psychological factors that modify the pain experience, and the basic principles of pain medicine.

Subspecialty certification is detailed in the ABA's BOI (Booklet of Information).

Read University of Iowa Graduate Medical Education (GME) policies | Download Pain Medicine Fellowship program information

FAQ

How are the applicants chosen for interviews?

Applications are reviewed by a group of faculty. Based on the strength of the candidate and their application materials, an interview is offered.

Can you describe a typical clinic day for your fellows?

The fellows begin their day just before 8 a.m. and the first patients are arriving at 8 a.m. The fellows see approximately 6-10 patients per day depending upon the complexity of patients. Approximately 40% of patients undergo a procedure. The clinic closes at 5 p.m.

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. Additional funds may be awarded to the fellow if he/she presents a research project at a national meeting which is approved by the Director of Pain Medicine.

What are your average duty hours?

The average duty hour week is 53 hours. Duty hours are recorded on Med Hub.

Can you give me an overview of your clinical activities?

Clinical activities begin with evaluation of patients for all types of pain. In addition to undergoing pain clinic evaluation, patients may be referred for physical therapy or pain psychology. Our clinic has a PharmD with expertise in pain management that is available for medical consultation with patients and providers. The patients also undergo procedures. These may be fluoroscopic, ultrasound guided or without imaging.

How is the fellow’s performance evaluated?

Faculty evaluate fellows using MedHub monthly and the director meets monthly with each fellow to review these evaluations and develop strategies if indicated. The evaluations are based on the six ACGME core competencies.
Nursing staff evaluate the fellows quarterly. These evaluations are also reviewed with the fellow during their monthly meeting with the director.
Fellows are asked to review the program twice during the academic year (at 6 months and end of training). The fellows also evaluate the faculty using the Department of Anesthesia intranet (these evaluations are combined with residents’ evaluations and presented to the faculty quarterly to ensure confidentiality).
Fellows are also asked to review each rotation at their conclusions. These evaluations are reviewed by the education committee and allow the division to improve rotations based on these evaluations.

Are there opportunities for research?

Fellows participate in new and ongoing clinical research that leads to presentation of an abstract and eventual publication in the peer-reviewed literature. Opportunities in basic science research and translational medicine may be pursued after the one-year clinical fellowship. Additional opportunities for training in either basic science or clinical research in pain medicine are provided by The University of Iowa Pain Research Program. This NIH-supported multidisciplinary research training program is open to both PhDs and MDs who have completed residency training in any specialty. It is primarily designed to prepare individuals for an independent academic career as physician scientists. Get additional information about anesthesia education at University of Iowa.

Do fellows educate other trainees?

Education skills are an important part of developing a successful pain practice. This may take the form of educating other physicians, in-servicing nurses or speaking to workman’s compensation nursing care coordinators. In order to prepare you for this, you will be involved in the education of residents and medical students during their pain rotation. You will also participate in journal clubs and morbidity and mortality presentations.