• Rotations

    The fellow will rotate through subspecialty rotations in the pediatric environment at the Cincinnati Children’s Hospital – Child Psychiatry, Child Neurology, Physical Medicine and Rehabilitation and Palliative and Comfort Team (PACT). The training in the area of pain management will consist of rotation with Surgical/Perioperative Pain Service (aka acute pain service), Medical Pain Service (inpatient consultation service for patients with acute or chronic nonsurgical pain,  inpatient  pediatric chronic pain rehabilitation program, one of few in the country, and the Outpatient Continuity Clinic).

    The UC Health Rotations

    The rotations at UC Health will focus on training in the area of adult pain medicine. The inpatient rotation will consist of caring for patients with acute (postsurgical) pain, chronic non-malignant pain and malignant pain. There will be an outpatient continuity clinic and outpatient cancer pain clinic as well. We offer a week rotation in Neuroradiology to further master knowledge and skill of interpretation of imaging studies.

    Rotation Specifics

    The 48 weeks of Pediatric Pain Medicine Fellowship will be equally divided between the pediatric and adult institutions in several clinical blocks. The fellow will have 20 business days for personal time off (incl. vacation, meeting, interview days), and 8 Cincinnati Children's holidays off (unless covering call duties, for which the time compensation is provided).

  • Cincinnati Children's Rotations

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    Perioperative/surgical pain service is a rotation with focus on acute pediatric postoperative pain management. The fellow will further master technical skills acquired previously in residency tailored to pediatric patients, including ultrasound guided peripheral nerve blocks and neuroaxial techniques, , including pain assessment, utilization of multimodal pain management, side effect and complication management, use of adjuncts and non-pharmacologic means of pain control in various age groups and developmental levels. The fellow will be expected to participate and to lead the rounds, communicate with patients, families, referring services and support staff (nurses, nurse practitioners).

    Medical Pain Service is a pediatric chronic pain service that includes several clinical responsibilities assigned throughout the week. The fellow will spend total of 15 weeks a year rotating on this service. There are 2 major clinical areas falling under the Medical Pain Service – Outpatient Continuity Clinic (see below) and inpatient consultation service. The main goal of the medical pain service rotation is to prepare the fellow 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, the fellow will be educated 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), the fellow will be taught the proper communication with team members and team leaders, patients and their families. 3. For chronic pediatric patients admitted for inpatient rehabilitation, while the physical medicine and rehabilitation team will be the admitting service, the medical pain team and its fellow will serve as a co-admitting service, working very closely with the PM&R team designing treatment goals. The fellow will learn to select appropriate patients, implement interventional techniques, optimize analgesia and manage complications and side effects to facilitate rehabilitation. 4. The fellow will learn to serve as a consultant during multidisciplinary clinics – such as epidermolysis bullosa (EB).

    Outpatient Continuity Clinic takes place 2-3 days a week (2 days/week at minimum) while fellow is rotating through Medical Pain Service. The continuity clinic teaches the principles of management of chronic pediatric pain conditions in an outpatient multidisciplinary setting. The fellow will spend approximately 40 days per year working with faculty with progressively increasing level of autonomy. The fellow will become skilled in assessment, physical examination, medication management and interventional procedures if indicated as pertinent to the pediatric patients with chronic painful conditions. The fellow will be involved in care coordination, communication with team members and an educational program to meet the rotation objectives.

    One of the primary clinical responsibilities of a practicing pain medicine specialist is to serve as a consultant for patients with pain and co-existing neurologic problems. The goal for child neurology rotation is to have a true hand on experience with most common pediatric neurological problems such as pediatric headaches. The fellow will attend the Headache Center, observing multidisciplinary evaluations of new and existing pediatric patients with headaches. The fellow will also become familiar with basic neuro-imaging of the brain, cervical, thoracic and lumbar spine and develop understanding of the indications and interpretation of electro-diagnostic studies.

    The goal of a two-week rotation with the Physical Medicine & Rehabilitation team is obtain a comprehensive musculoskeletal and neuromuscular history and physical examination with emphasis on both structure and function. Fellows will gain an understanding of the natural history of various musculoskeletal pain disorders and be able to appropriately integrate therapeutic modalities and surgical intervention in the treatment algorithm.

    The goal of a 3 week PACT rotation is to familiarize pain fellows with patients with complex medical and social history with special attention to cultural, personal, spiritual and familial values as they relate to pain perception. Underlying terminal or advanced chronic illness affect the length and quality of life and determine choice of treatment modalities. Untreated pain may impair treatment progression and its success, and quality of life. The fellow will develop an understanding of and ability to implement the principles and techniques of the pharmacologic and non-pharmacologic therapies. The rotation will place significant emphasis on communication with the families, members of the treatment teams, 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 will serve to familiarize pain fellows with comprehensive psychiatric history with special attention to psychiatric and pain co-morbidities. The fellow shall develop understanding of the principles and techniques of the pharmacologic and psychosocial therapies, with special attention to supportive and cognitive behavioral therapies.

    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.

  • Rotations at University Hospital (21 weeks/year)

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    During outpatient pain clinic days, in conjunction with pain faculty, the fellow will be responsible for the management of adult patients with chronic non-cancer and cancer pain, while working at the University Hospital (TUH) clinic as well at the University of Cincinnati Health Pain Management Center (UCHPM center). The setup provides experience with a tertiary care pain clinic model as well as a private practice pain clinic model. During the time spent at TUH pain clinic, the fellow will have the primary responsibility for the patient, providing continuity of care. The educational program will consist of both didactic and clinical components. Fellows are expected to learn the principles and practical management of chronic cancer and non-cancer pain. In addition to comprehensive multidisciplinary care of the patient, fellows will also learn and perform basic and advanced interventional procedures.
    Focus of the limited rotation in the interventional pain management is on the diagnosis, therapeutic plan formulation and treatment of adults with chronic painful conditions suitable for procedure in an outpatient office based setting. The offered spectrum of interventional therapies includes diagnostic and therapeutic nerve blocks, facet blocks, radio-frequency ablation, and cryotherapy. Training in advanced spinal procedures, along with implantable device trials and implants are NOT requirements for graduation from this fellowship, nor affect ABA Pain Medicine certification eligibility. The training will embrace all aspects of comprehensive multidisciplinary care which - apart from conservative/medical and/or interventional management - will include assessment of the need for physical restorative and rehabilitative services, pain psychologists, psychiatrists, neurologists, spine surgeons, etc.

    The fellow will spend a portion of 21 weeks of the fellowship year caring for adult patients who require regional and neuraxial anesthesia, and pain management for acute, chronic and cancer related pain at University Hospital. The fellow will work under the supervision of a faculty member who specializes in regional anesthesia and pain management, and the activities will be supported by a registered nurse. During this rotation, the fellow will round daily on patients that require pain management (thoracic epidurals, indwelling regional anesthesia catheters and any consults).