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The 48 weeks of the Pediatric Pain Medicine Fellowship program are equally divided between the pediatric and adult institutions in several clinical blocks.
Fellows rotate through the following subspecialty rotations in the pediatric environment at Cincinnati Children’s Hospital Medical Center: Child Psychiatry, Child Neurology, Physical Medicine and Rehabilitation, and with the Pediatric Palliative and Comfort Care Team. Training in the area of pediatric pain management consists of rotation with the Surgical / Perioperative Pain Service, Medical Pain Service, and the outpatient Pain Management Clinic (rotation details below).
This includes pediatric patients admitted to our inpatient Functional Independence Restoration Program, one of the few in the country.
The rotations at the University of Cincinnati Medical Center focus on training in the area of adult pain medicine. The inpatient rotation consists of caring for patients with acute postsurgical pain, chronic non-malignant pain, and malignant pain. Fellows also rotate with some of the outpatient clinics, such as the UC Health Pain Management Center and the cancer pain clinic. In addition, we offer a one-week rotation in Neuroradiology to further master knowledge and the skill of interpretation of imaging studies (rotation details below).
Fellows are allotted 20 business days for personal time off (includes vacation, conferences, meetings, interview days, etc.), and 8 Cincinnati Children's holidays (unless covering call duties, for which time compensation is provided).
The Perioperative / Surgical Pain Service (APS) rotation focuses on acute pediatric postoperative pain management. Fellows further master technical skills acquired previously in residency tailored to pediatric patients. This includes ultrasound guided peripheral nerve blocks and neuroaxial techniques, pain assessment, utilization of multimodal pain management, side-effect and complication management, and use of adjuncts and non-pharmacologic means of pain control in various age groups and developmental levels. Fellows are expected to participate and lead rounds, communicate with patients, families, referring services, and support staff (nurses, nurse practitioners).
The Medical Pain Service (MPS) is a pediatric chronic pain service that includes several clinical responsibilities assigned throughout the week. Fellows spend a total of 15 weeks throughout the year rotating on this service. The MPS consists of two major clinical areas: the outpatient Pain Management Clinic and the inpatient consultation service.
The main goal of the MPS rotation is to prepare fellows for the future role of a consultant in the area of chronic pediatric pain medicine. Several facets of this role will be addressed during this rotation and further cultivated throughout the training:
1. In a position of a multidisciplinary team leader in an outpatient setting, fellows learn about the role of the various team members and their contribution to the treatment.
2. As a member of a multidisciplinary team (inpatient and outpatient), fellows are taught the proper communication with team members, team leaders, patients and their families.
3. Treatment for chronic pediatric patients admitted for inpatient rehabilitation through the Functional Independence Restoration Program. While the physical medicine and rehabilitation team are the admitting service, the medical pain team and its fellow serve as a co-admitting service and work very closely together to design treatment goals. Fellows learn to select appropriate patients, implement interventional techniques, optimize analgesia and manage complications and side-effects to facilitate rehabilitation.
4. Fellows learn to serve as a consultant during multidisciplinary clinics such as epidermolysis bullosa (EB).
Fellows attend outpatient continuity clinic 2-3 days a week while rotating on the Medical Pain Service. The continuity clinic teaches the principles of management of chronic pediatric pain conditions in an outpatient multidisciplinary setting. Fellows spend approximately 40 days throughout the year working alongside faculty with progressively increasing levels of autonomy. Fellows become skilled in assessment, physical examination, medication management, and interventional procedures when pertinent to the pediatric patients with chronic painful conditions. Fellows are involved in care coordination, communication with team members, and an educational program to meet the rotation objectives.
The goal of a two-week rotation with the Physical Medicine & Rehabilitation (PM&R) team is to obtain a comprehensive musculoskeletal and neuromuscular history and physical examination with emphasis on both structure and function. Fellows gain an understanding of the natural history of various musculoskeletal pain disorders and are able to appropriately integrate therapeutic modalities and surgical intervention in the treatment algorithm.
The goal of a three-week rotation with Palliative and Comfort Care (PACT) is to familiarize pain fellows with patients who have complex medical and social histories with special attention to cultural, personal, spiritual and familial values as they relate to pain perception. Underlying terminal or advanced chronic illness affects the length and quality of life and determines the choice of treatment modalities. Untreated pain may impair treatment progression and its success, and quality of life. Fellows develop an understanding of and the ability to implement the principles and techniques of the pharmacologic and non-pharmacologic therapies. The rotation places significant emphasis on communication with the families, members of the treatment teams, and medical and non-medical personnel involved in the care.
Psychiatric comorbidities frequently coexist in pediatric and young adult patients with acute and chronic pain. Presence of a psychiatric illness may impair successful treatment and also affect choices of treatment modalities. The rotation with the psychiatry liaison and consult service serves to familiarize pain fellows with comprehensive psychiatric history with special attention to psychiatric and pain co-morbidities. Fellows develop an understanding of the principles and techniques of the pharmacologic and psychosocial therapies with special attention to supportive and cognitive behavioral therapies.
Fellows spend a portion of 21 weeks of the fellowship year caring for adult patients at UH who require regional and neuraxial anesthesia and pain management for acute, chronic, and cancer related pain. Fellows work under the supervision of a faculty member who specializes in regional anesthesia and pain management and the activities are supported by a registered nurse. During this rotation fellows round daily on patients that require pain management such as, thoracic epidurals, indwelling regional anesthesia catheters, and consults.
Various radiologic imaging techniques have become essential elements in patient evaluations. Consulting services may request not only medical treatment, but also to offer interventional pain management options. It is of prime importance that a pain medicine specialist has basic knowledge of neurological disorders, the ability to evaluate the radiological findings and their relevance to clinical presentation, and make qualified management decisions. The goal of rotation with the Neuroradiology service is to familiarize fellows with basic neuro-imaging and identification of significant findings.
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