UCSD DEPARTMENT OF ANESTHESIOLOGY LEARNING OBJECTIVES FOR ADVANCED PAIN MEDICINE ROTATION, UCSD MEDICAL CENTER Competencies Objective Learning Environment Instructional Method Assessment Tool Patient Care: Non- interventional Obtain thorough comprehensive medical history with an emphasis on the condition, as well as physical psychiatric comorbidities Outpatient at UCSD Center for Pain Medicine at UCSD; Didactic,, Faculty, Perform thorough comprehensive physical examination with an attention directed to the chief complaint. Outpatient at UCSD Center for Pain Medicine at UCSD Didactic,, Faculty, Review discuss pertinent radiological electrophysiological studies, including CT MRI scans, EMG nerve conduction studies. Correlate these findings to the results of physical exam Outpatient at UCSD Center for Pain Medicine at UCSD Didactic,, Faculty, Formulate appropriate management plan. Specific goals for improvement of the condition, as well as physical mental states will be discussed with the patients. If possible, the treatment plan will incorporate multidisciplinary approach Outpatient at UCSD Center for Pain Medicine at UCSD Didactic,, Faculty, Participate in follow- up of patients treated with medication, evaluate discuss their effectiveness side effects Outpatient at UCSD Center for Pain Medicine at UCSD Didactic,, Faculty, Acute ; with supervision, assess Hospital
Patient Care: Interventional Medical Knowledge: Pain Assessment manage inpatients with acute Inpatient chronic ; with supervision, assess manage patients with chronic in the inpatient setting. With assistance, Perform minimally invasive percutaneus guided be anatomical lmarks or fluoroscopy, including lumbar epidural, sacroiliac joint, lumbar facet joint, major joint injections major bursa injections With assistance, develop expertise in performing trigger point injection The residents will study demonstrate knowledge understing of anatomy, physiology pharmacology of transmission modulation inpatient wards, Postoperative Anesthesia Unit (PACU), Hospital inpatient consult Hospital based patients followed on a chronic consultation team Pain procedure at UCSD Moores Cancer Center, Pain procedure at VA San Diego Healthcare System (VASDHS) Pain procedure at UCSD Moores Cancer Center, Pain procedure at VASDHS, outpatient at UCSD Center for Pain Medicine at UCSD; Study, didactic Didactic,, skill, skill, Fellow s presentation Research Forum Multi- disciplinary, Faculty, Faculty, faculty, faculty discussion,
The residents will study demonstrate knowledge understing of the general principles of management including neurological exam, musculoskeletal exam, psychological assessment describe the indications for diagnostic imaging studies including X- Rays, MRI, CT The residents will be study be able to describe various psychosocial aspects of, including cultural cross- cultural considerations discuss the etiologies of of spinal origin including radicular, zygapophysial joint disease, discogenic, myofascial, Ambulatory Neurology, Outpatient PM&R treatment center inpatient PM&R, Ambulatory Neurology, Outpatient PM&R treatment center inpatient PM&R psychiatry rounds, Psychiatry case s Pain, Fellow s presentation Research Forum Multi- disciplinary Pain, Fellow s presentation Research Forum Multi- disciplinary Pain, Multi- disciplinary Pain discussion discussion discussion discussion
Medical Knowledge: Treatment of Pain describe neuropathic complex regional syndromes diagnosis treatment options discuss acute pathophysiology treatment options discuss the assessment of in special populations including patients with ongoing substance abuse, elderly patients, pediatric patients, pregnant patients, the physically disabled, the cognitively impaired Describe pharmacology properties use of opioids The residents will study demonstrate knowledge understing of normal pathological neural pathways, musculoskeletal anatomy pathophysiology, cognitive science. The residents will study demonstrate knowledge understing of the pathophysiology of including neural pathways (both central peripheral), acute, chronic, nociceptive, neuropathic states The residents will study demonstrate knowledge understing of the treatment approaches to Acute post-, Ambulatory Neurology, Hospital inpatient ward acute rounds, PACU, Hospital inpatient consult rounds discussion discussion discussion discussion discussion discussion discussion
operative, including: a. Regional Techniques i. neuroaxial ii. peripheral b. Opioids pharmacotherapy i. IV PCA ii. Opioid rotation equianalgesic doses c. Adjuvant drugs i. Muscle relaxants ii. NSAIDs iii. Antidepressants iv. Anticonvulsants inpatient Pain consultation The residents will study demonstrate knowledge understing of Chronic management, including: Patient treatment, complaints of: 1. axial 2. low back 3. thoracic spine 4. cervical spine 5. sacroiliac joint 6. facet joint 7. discogenic 8. radicular pai 9. myofascial 10. in cancer patient palliative care 11. fibromyalgia 12. Persistent headaches a. Migraine b. tension headache c. cluster headache d. paroxysmal hemicranias e. cervicogenic headache f. occipital neuralgia 13. Complex regional syndrome a. Type I b. Type II 14. Pelvic discussion discuss the emotional mental health aspects associated with chronic discussion
The residents will study be able to describe properties use of antipyretic analgesics NSAIDs discussion The residents will study be able to describe properties use of antidepressants, anticonvulsants, local discussion anesthetics, muscle relaxants miscellaneous drugs The residents will study be able to describe psychological psychiatric approaches to treatment, including discussion cognitive- behavioral therapy treatment of psychiatric illness psychiatry rounds, Psychiatry case s describe multidisciplinary approach to medicine discussion psychiatry rounds, Psychiatry case s, UCSD Pain & Palliative Care consult hospital inpatient rounds, discuss the pharmacology, toxicity, side effects of injectable medications, including discussion local anesthetics radiographic contrast agents, steroid preparations. Identify approach to treatment of local anesthetic systemic toxicity. Pain, Operating room, The residents will be taught be able to
Practice- based Learning Improvement discuss indications, procedure technique, possible complications of spinal injections including epidural injections: interlaminar, transforaminal, sympathetic blocks, zygapophysial joint injections The residents will identify their own strengths, deficiencies, limits in knowledge expertise The residents will accordingly seek assimilate new medical information through presentation demonstrated active participation in Quality Improvement Residents will demonstrate commitment to excellence strive to self- improvement acquisition of knowledge Residents will use self- assessments of knowledge, skills attitudes to develop plans for addressing areas for improvement Residents will seek formative on performance incorporate into daily practice Pain, Pain Ambulatory Clinic, Pain, Operating room Pain Quality Improvement, Pain, Pain Pain, Operating room Pain, Operating room, Morbidity Mortality Debriefing after patient assessment,, quality improvement, Pain medicine journal club, medicine research Pain medicine multidisciplinar y rounds Debriefing after, debriefing after patient assessment treatment planning Debriefing after, debriefing after patient assessment treatment discussion Daily debriefing after patient assessment discussion discussion Daily debriefing case based discussion debriefing
Interpersonal Communication Skills Residents will learn to communicate effectively with patients, families, the public, as appropriate, across a broad range of socioeconomic cultural backgrounds Residents will be able to interact effectively professionally with patients, families, physicians, nurses, other members of the healthcare team. Residents will be able to maintain comprehensive, timely, legible medical records Residents will effectively conduct patient interviews, obtain consents for treatment or performed, clearly communicate therapeutic plans, share bad news, explain treatment expectations Residents will learn effective communication techniques during periods of stress in order to decrease patient family anxiety Residents will present an assigned topic at medicine gr rounds or journal club Residents will learn strategies techniques for teaching other trainees, including medical students, the principles of medicine Pain, Pain Pain, Pain, skill, multidisciplinary Pain, Pain, Pain, Pain, Pain, Pain, Pain journal club, multidisciplinary Pain, Pain planning, skill, skill, skill, skill, skill, skill, skill, case based discussion, fellows fellows fellows fellows fellows
Professionalism Residents will practice team approach Residents will demonstrate compassion, integrity, respect for others Residents will learn to work effectively within a multidisciplinary medicine team. Residents will demonstrate respect, compassion, integrity, kindness in relationships with patients, families, colleagues Residents will demonstrate understing of the concepts of patient confidentiality informed consent. Residents will develop the ability to formulate constructive in response to problems encountered in the workplace. Residents will demonstrate behavior demeanor that adheres to ethical principles, respect, compassion integrity Residents will demonstrate sensitivity to patients gender, beliefs, needs, disabilities. Pain, Pain, fellows fellows fellows fellows fellows fellows fellows
fellows Residents will demonstrate commitment to duties towards the patients, the family members all other parties involved in patient care, including the attendings, fellows residents, nursing ancillary staff. fellows Residents will learn communication techniques with patients families of different cultural backgrounds who possibly speak little English. Residents will underst the legal ethical issues involved in patient consent. Residents will demonstrate a commitment to advocating patient care that is appropriate for their individual needs. Residents will adhere to institutional departmental stards policies. Residents will demonstrate ability to appropriately take on, share delegate patient care responsibilities. Residents will demonstrate a commitment to ongoing professional development Residents will learn how to discuss fellows fellows fellows fellows fellows fellows
Systems- based Practice record cases with complications /or poor outcomes. Residents will participate in patient follow- up after evaluate discuss their effectiveness Residents will demonstrate respect, compassion responsiveness to patient s concerns or needs Residents will demonstrate respect for patient privacy autonomy Residents will answer pages promptly Residents will be punctual reliable Residents will demonstrate sensitivity responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, sexual orientation Residents will work effectively in various health care delivery settings Residents will consider cost- benefit analysis cost awareness in patient care Pain consult,, Hospice, discussion discussion, lecture fellows fellows faculty faculty faculty discussion direct case
Residents will advocate for quality patient care optimal patient care systems will participate in identifying system errors implementing potential systems solutions, discussion discussion, lecture discussion based discussion