The University of Pain Management

Transcription

1 UC Davis Divisin f Pain Medicine Pain Fellwship Educatinal Gals and Objectives Understand the nature f pain and its treatment. Understand the mind bdy spectrum f pain and suffering. Understand cmmn barriers t treating pain. Understand the majr drug grups used t manage the different classes f pain. Understand the interventinal therapies used t treat different types f pain. Understand the full range f resuscitatin skills required fr safe prcedural practice. Understand the nn-pharmaclgical and nn-injectin appraches t pain management. Understand the special needs f the terminally ill patient wh is suffering. Understand the legal and regulatry issues that impact pain management. The missin f the UC Davis Pain Medicine Fellwship is t fully prepare future pain specialists fr the demands f practice in Pain Medicine. The fcus is in brad-based multidisciplinary knwledge and skills fr managing pain and suffering in all patients and mst patient settings. Our Fellwship is designed t help Fellws meet these gals, as well as t acquire the necessary skills t substantially cntribute t and advance the field. The UC Davis Pain Fellwship is cmmitted t excellence in clinical care, research, educatin, and advcacy fr thse in pain. The faculty is dedicated t training and educating the future leaders in Pain Medicine s that they can utilize the mst cmprehensive and innvative appraches t the evaluatin and management f acute, cancer-related, and chrnic nn-cancer pain. Teaching is a cre activity within the Fellwship as reflected in ur faculty maintaining ne f the mst didactically intensive Pain Fellwships in the US, ffering 9 frmal didactic sessins per week (30-60 minutes per sessin). Because the UC Davis Pain Fellwship has a lng histry f multidisciplinary leadership and has accepted bth Anesthesilgist and nn-anesthesilgist trainees, ur prgram is accustmed t prviding the cre educatinal elements frm the multiple medical disciplines essential t the practice f Pain Medicine and has lng been well-psitined t meet the newly adpted ACGME Pain Medicine requirements. Our Faculty ffers a remarkably brad representatin f the multiple disciplines within state-f-the-art pain and symptm management. These include Anesthesilgy (Drs. Cpenhaver, Furukawa, Kreis, Sheth, N. Singh), Internal Medicine (Drs. Fishman, MacMillan, McCarrn), Psychiatry (Drs. Fishman, McCarrn and Mskwitz), Physical Medicine and Rehabilitatin (Dr. Mahajan), Neurlgy (Drs. Grin and Lenaerts), Addictin Medicine (Dr. Kreis), Hspice & Palliative Medicine (Drs. Fishman and MacMillan), Acupuncture (Ian Kebner), Radilgy (Dr. Dublin), Public Health (Dr. Mskwitz), Psychlgy (TBA), Pharmaclgy (Dr. Hltsman), Law and Biethics (Dr. Rich), Physical Therapy (Tim McGnigle and Michael Mre), and Mindfulness Based Stress Reductin (Dennis Warren). The clinical prgram integrates utpatient and inpatient settings, ffering a brad array f diagnstic and therapeutic UC Davis Pain Fellwship Educatin Gals & Objectives Page 2

2 appraches, including pharmaclgical, surgical, psychlgical, rehabilitative, and alternative mdalities. The gal f imprving quality f life is infused thrughut the Fellwship s culture and is expressed thrugh clinical care, teaching, research, and advcacy. In additin t faculty teaching the Fellws and ther trainees, the Fellws are actively invlved in this prcess as well. Fellws supervise Residents and medical students rtating n the Pain service and are asked t take n the rle f junir faculty fr these trainees. Our Fellws are taught that a cmprehensive apprach t patient care wrks best in achieving tangible results. Therefre, they learn hw t ptimize patient utcmes fr bth physical and emtinal wellbeing by understanding hw t integrate pharmaclgical, interventinal, psychlgical, and alternative mdalities. Learning Objectives Cre Cmpetencies At the cmpletin f the rtatin we require Fellws t btain cmpetencies in the 6 areas belw t the level expected f a Fellw at his/her current stage f training: A: Patient Care that is cmpassinate, apprpriate, and effective fr the treatment f health prblems and the prmtin f health. B: Medical Knwledge abut established and evlving bimedical, clinical, and cgnate (e.g. epidemilgical and scial-behaviral) sciences and the applicatin f this knwledge t patient care. C: Practice-Based Learning and Imprvement that invlves investigatin and evaluatin f their wn patient care, appraisal and assimilatin f scientific evidence, and imprvements in patient care. D: Interpersnal and Cmmunicatin Skills that result in effective infrmatin exchange and teaming with patients, their families, and ther health prfessinals. E: Prfessinalism, as manifested thrugh a cmmitment t carrying ut prfessinal respnsibilities, adherence t ethical principles, and sensitivity t a diverse patient ppulatin. F: Systems-Based Practice, as manifested by actins that demnstrate an awareness f and respnsiveness t the larger cntext and system f health care and the ability t effectively call n system resurces t prvide care that is f ptimal value. MILESTONES: the abve cmpetencies are up t date as f August 2013 hwever the ACGME is transitining t the use f milestnes t assess trainee prgress. This may r may nt replace the cmpetencies as listed abve. UC Davis Pain Fellwship Educatin Gals & Objectives Page 3

3 Patient Care Patient care that is cmpassinate, apprpriate, and effective fr the treatment f health prblems and the prmtin f health. Quality and Safety The verall cre aims f patient care t imprve the quality and safety f patient care as defined by the Institute f Medicine (Crssing the Quality Chasm, 2001) are as fllws: Patient care must be: Safe: Timely: Effective: Efficient: Equitable: Patient- Centered: Aviding injuries t patients frm the care that is intended t help them. Reducing waits and smetimes harmful delays fr bth thse wh receive and thse wh give care. Prviding services based n scientific knwledge t all wh culd benefit, and refraining frm prviding services t thse nt likely t benefit. Aviding waste, including waste f equipment, supplies, ideas, and energy. Prviding care that des nt vary in quality because f persnal characteristics such as gender, ethnicity, gegraphic lcatin, and sciecnmic status. Prviding care that is respectful f and respnsive t individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisins. Clinical Management Fellws are expected t understand relevant principles, apply knwledge in practice, and t demnstrate abilities in the clinical management f patients with acute and chrnic pain. These include the fllwing: Pain Assessment and Measurement Assess pain and utcme f pain treatment using histry, clinical examinatin and pain measurement tls. Recgnize the limitatins f pain measurement techniques, particularly in certain patient ppulatins/situatins (e.g. children, thse in whm a language barrier exists between the patient and health-care prvider and thse with cgnitive impairment). Acute and Chrnic Pain Have an understanding f: Anatmy, physilgy and pharmaclgy f pain transmissin and mdulatin. Neur-endcrine and metablic respnses t surgery and ther acute and chrnic stressrs and impact f analgesic techniques. Cnsequences f prly cntrlled pain. Current evidence fr and against pre-emptive analgesia and clinical implicatins. Current evidence fr the effect f analgesic technique n mrbidity and mrtality. Imprtance f aggressive multimdal pstperative rehabilitatin. UC Davis Pain Fellwship Educatin Gals & Objectives Page 4

4 Relatinship between acute and chrnic pain, including factrs invlved in prgressin frm ne t the ther and ptential interventins t prevent such prgressin. Have an understanding f the mre cmmn pain syndrmes: Spinal pain. Myfascial pain. Neurpathic pain. Headache and rfacial pain. Rheumatlgic aspects f pain. Cmplex reginal pain syndrmes. Visceral pain. Urgenital pain. Cancer pain, including palliative and hspice care. Chse the mst apprpriate technique f acute and chrnic pain management: Pharmaclgical techniques (piid and nn-piid) via a variety f rutes. Reginal techniques including central neuraxial, plexus and peripheral nerve blckade. Nn-pharmaclgical techniques (physical therapy, psychlgical therapy, and cmplementary and alternative therapies). Frmulate a pain management plan based upn: Integratin f medical knwledge with clinical data. Priritizatin f pain management gals and medical issues apprpriate fr the level f care. Patient preference, physical and mental status, and available expertise and technlgy. Special requirements in specific patient grups (e.g., the elderly, children, pregnant and pstpartum patients; bstructive sleep apnea, cncurrent hepatic r renal disease; nn-english speaking; cgnitive impairment). Special requirements in patients with piid-tlerance and/r a substance abuse disrder, including an understanding f guidelines and regimens fr analgesic drug use (equianalgesic dsing fr piids; tlerance, dependence, and pseudaddictin). Special requirements under specific clinical situatins (e.g., spinal crd injuries, burns, acute and chrnic spine pain, musculskeletal pain, acute medical pain, acute and chrnic cancer pain and patients in the Intensive Care). Include in a pain management plan: Apprpriate evaluatin f the patient's pain. Infrmed cnsent, including disclsure f risk and apprpriate dcumentatin. Patient educatin abut the selected treatment plan and alternatives. Recgnize cmmn presentatins f acute musculskeletal pain (e.g., rib fracture, acute back pain), ther nn-surgical acute pain syndrmes (migraine, renal clic), and cancer pain syndrmes. Identify when t seek advice frm, r refer t, anther specialist. Cancer Pain and Palliative Care Undertake assessment f pain in patients with cancer based upn: Understanding f the multiple ptential etilgies f pain assciated with cancer. UC Davis Pain Fellwship Educatin Gals & Objectives Page 5

5 Differentiatin between smatic, visceral, and neurpathic pain. Evaluatin f psychlgical, scial, cultural and spiritual issues. Undertake treatment f cancer-related pain syndrmes based n therapies available (including chemtherapy, raditherapy, surgery, invasive and nn-invasive analgesic techniques, physical therapy and psychlgical therapy). Understand guidelines and regimens fr analgesic drug use including equianalgesic dsing fr piids; dependence, tlerance, pseud-addictin, and addictin and their management in the patient with cancer. Understand clinical apprach t the multi-dimensinal treatments that cmprise palliative care, and understand the strategies t integrate pain management int this multi- dimensinal treatment mdel. Identify when t seek advice frm, r refer t, anther specialist. Neurpathic Pain Understand diagnstic criteria, clinical features and management f specific neurpathic pain syndrmes including: Central pain (e.g., pain after strke, thalamic pain, spinal crd injury pain, deafferentatin pain, phantm limb pain). Neuralgias (e.g., trigeminal neuralgia, pstherpetic neuralgia, ccipital neuralgia, iliinguinal neuralgia, meralagia paresthetica). Painful peripheral neurpathy (e.g., metablic, txic, ischemic). Pain after nerve injury (e.g., neurma). Pst-surgical pain syndrmes (e.g., pst-thractmy, pst-cabg pain, pstmastectmy, pst-amputatin pain, phantm pain). Cmplex reginal pain syndrme types I and 2 (including the differentiatin f sympathetically-maintained frm sympathetically-independent pain). Identify when t seek advice frm, r refer t, anther specialist. Pain in Children Recgnize and understand the ways in which acute and chrnic pain in children differ frm pain in adults, including: The effect f develpmental stage n assessment and management f pain in children. The selectin f pain assessment tls fr children f different develpmental stages. Principles f managing acute, prcedural and chrnic pain in children. Pain in the Elderly Understand pain management in the elderly, taking int accunt: The epidemilgy f pain syndrmes in the elderly. Physilgical changes assciated with ageing and effects f these n pain and pain management (including changes in pharmackinetics, pharmacdynamics, and pain bilgy). Effects f cncurrent disease, and psychlgical, scial and cgnitive changes n assessment and management f pain. Risks assciated with plypharmacy in the elderly. Use f Diagnstic Studies Understand the indicatins fr rdering varius diagnstic studies and t develp treatment plans based n the results. UC Davis Pain Fellwship Educatin Gals & Objectives Page 6

6 X-rays. CT. MRI. Ultrasund. Electr-diagnstic studies (EMG/NCS). EKGs Clinical Skills Fellws will prvide, r assist with, apprpriate pain management in bth inpatient and utpatient settings. Fellws must dcument invlvement with a minimum f: 50 different patients fr whm they had primary respnsibility, fllwed ver at least tw mnths. 15 new inpatients with chrnic pain. 50 new inpatients with acute pain. 25 patients wh underg interventinal prcedures. 20 cancer patients. 10 palliative care patients. Clinical evaluatin Fellws will demnstrate skills in the clinical evaluatin f patients with acute and chrnic pain by: Obtaining a specific pain histry Onset, lcatin, nature, duratin, intensity, aggravating and relieving factrs. Physical, psychlgical and scial cnsequences f the patient's pain. Current and past pain treatments and utcme. Other relevant histry (past patterns f drug use r misuse, family histry, medical and surgical histry). Pain beliefs. Treatment expectatins. Interpreting relevant investigatins. Frmulating a management plan and evaluating utcme. Anesthesilgy skills Demnstrate cmpetency in btaining intravenus access in a minimum f 15 patients. Demnstrate cmpetency in basic airway management, including a minimum f mask ventilatin in 15 patients and endtracheal intubatin in 15 patients. Obtain and maintain certificatin in basic life supprt and advanced cardiac life supprt. Demnstrate cmpetency in the management f sedatin, including direct administratin f sedatin t a minimum f 15 patients. Demnstrate cmpetency in the administratin f neuraxial analgesia, including placement f a minimum f 15 thracic r lumbar epidural injectins using an interlaminar technique. UC Davis Pain Fellwship Educatin Gals & Objectives Page 7

7 Physical Medicine and Rehabilitatin skills Understand hw t perfrm a cmprehensive musculskeletal and apprpriate neurmuscular histry and examinatin with emphasis n bth structure and functin as it applies t diagnsing acute and chrnic pain prblems and develping rehabilitatin prgrams fr them. Understand hw t assess static and dynamic flexibility, strength, crdinatin and agility fr peripheral jint, spinal, and sft tissue pain cnditins. Understand the natural histry f varius musculskeletal pain disrders and hw t apprpriately integrate therapeutic mdalities and surgical interventin in the treatment algrithm. Be able t perfrm a cmprehensive musculskeletal and neurmuscular exam n a minimum f 15 patients. Be able t demnstrate prficiency in the clinical evaluatin and rehabilitatin plan develpment f a minimum f 5 patients. Understand the indicatrs and interpretatin f electr-diagnstic studies. Understand the cncepts f functinal disability assessment. Understand the cncepts f functinal and vcatinal rehabilitatin. Psychiatry skills Understand hw t perfrm a cmplete psychiatric histry with special attentin t psychiatric and pain c-mrbidities. Be able t a cmplete mental status examinatin under the supervisin f a faculty bserver n a minimum f 15 patients. Understand the impact f frequent psychiatric and pain c-mrbidities, which include substance related, md, anxiety, smatfrm, factitius, and persnality disrders. Understand the effects f pain medicatins n mental status. Understand the principles and techniques f psychscial therapies, with special attentin t supprtive and cgnitive behaviral therapies, sufficient t explain t a patient and make a referral when indicated. Neurlgy skills Understand hw t elicit a directed neurlgical histry, perfrm a detailed neurlgical examinatin t include at least mental status, cranial nerves, mtr, sensry, reflex, cerebellum examinatins, and gait in 15 patients. Faculty shall verify this experience in a minimum f 5 bserved patient examinatins. Understand hw t interpret basic neur-imaging and identify significant findings, t include at least MRI and CT f the spine and brain n a minimum f 15 CT and/r MRI studies drawn frm the examples within the fllwing areas: brain, cervical, thracic, and lumbar spine. Understand the indicatrs and interpretatin f electr-diagnstic studies. Technical skills Fellws are required t btain cmpetency and prficiency in: Obtaining infrmed cnsent frm the patient, including discussing and answering any patient questins related t the risk and benefits assciated with bth the prcedure and the medicatins utilized fr the prcedure. Setting up the prcedure suite with the apprpriate medicatins, needles, and ther equipment needed fr perfrming the intended prcedure. UC Davis Pain Fellwship Educatin Gals & Objectives Page 8

8 Being able t perfrm prcedures in patients wh d and d nt require sedatin. Being able t manipulate C-arm flurscpe t allw him/her t safely advance a needle t its intended target while at the same time being cgnizant f radiatin safety t the patient, self, nurse, medical assistant, and ther persnnel in attendance. The anatmy, technique, indicatins, cntraindicatins, cmplicatins and management f cmplicatins f varius interventinal prcedures. Central neuraxial injectins: Epidural injectins. Translaminar/interlaminar. Transframinal. Caudal. Facet jint prcedures: Intra-articular facet jint injectin. Medial branch nerve blck. Radifrequency ablatin f medial branch nerve. Peripheral nerve blcks. Peripheral jint injectins. Sft tissue injectins. Sympathetic ganglin blckade: Stellate ganglin blckade. Celiac plexus blckade. Lumbar sympathetic blckade. Superir hypgastric blckade. Impar ganglin blckade. Fellws need t understand the anatmy, technique, indicatins, cntraindicatins, cmplicatins and management f (but nt necessarily be able t perfrm): Intradiscal prcedures. Spinal crd stimulatr implantatin. Intrathecal pump implantatin r refill. Reginal techniques (including knwledge f anatmy, technique, indicatins, cntraindicatins, cmplicatins and their management) including: Peripheral and plexus blcks f the upper and lwer limb. Cranial nerve blcks. Medical Knwledge Medical knwledge abut established and evlving bimedical, clinical, and cgnate (e.g. epidemilgical and scial-behaviral) sciences and the applicatin f this knwledge t patient care. Basic sciences Fellws are required t review the relevant subjects in the basic sciences and t apply basic science principles t clinical practice. Basic science subjects relevant t pain management include the fllwing: UC Davis Pain Fellwship Educatin Gals & Objectives Page 9

9 Neurbilgy f Pain Overview f nciceptive pathways, neurtransmitters, wind-up and ther phenmena. Multi dimensinal aspects f pain; rle f physilgical, psychlgical and envirnmental factrs. Cncepts f incident and backgrund pain, the cncept f the bipsychscial mdel f illness. Pharmaclgy f Analgesic Agents This includes pharmackinetic and pharmacdynamic principles, drug interactins, side effects, and txicities. Knwledge f the pharmaclgy f: Opiids. Lcal anesthetics. Acetaminphen. Nn-steridal anti-inflammatry drugs (NSAIDs). Crticsterids. Antidepressants (TCAs, SNRIs and SSRIs). Anticnvulsants. Benzdiazepines. Alpha-2 agnists. NMDA-receptr antagnists. Experimental agents fr analgesia. Knwledge f different rutes f analgesic drug delivery: Oral. Sublingual. Buccal. Intramuscular. Intranasal. Rectal. Subcutaneus (including cntinuus infusin). Intravenus (including cntinuus infusin). Patient-cntrlled analgesia (PCA) via different rutes (i.e., intravenus, subcutaneus, and epidural). Anti-emetics. Agents used t treat hyptensin assciated with neuraxial blckade. Anti-migraine agents. Tpical agents (e.g., NSAIDs, capsaicin). Transdermal agents (e.g., lidcaine patch). Neurlytic agents. Neuraxial Other rutes: e.g., tpical; transdermal; intracerebrventricular; intraarticular; incisinal. Factrs gverning chice f rute. Side effects relevant t particular rute. Principles f additive and synergistic effects when agents are cmbined. Interventinal Therapies Understand hw t interpret relevant investigatins (including x-rays, CT scans, MRIs and electr-diagnstic studies) and apply the findings when determining which interventin is apprpriate. Knwledge f which interventins are apprpriate fr individual patients. Understand the indicatins, risks, and cmplicatins f prcedures. Understand if surgical appraches are apprpriate, including referral t the apprpriate surgical specialty. Principles f Pain Medicine Histry, Philsphy and Mediclegal Aspects Cncepts f pain and suffering. UC Davis Pain Fellwship Educatin Gals & Objectives Page 10

10 Relevance f the subjective nature f pain reprt t pain assessment. Relevant ethical principles including prfessinal respnsibility (prfessinal pwer, vulnerable grups), autnmy and dignity, natinal and reginal legislative and ethical issues regarding death, particularly with respect t euthanasia. Natinal and reginal issues relevant t the prescriptin f cntrlled substances. Infrmed cnsent with fcus n issues relevant t the patient with pain. Cnfidentiality principles, including relevant natinal and reginal legislatin. Principles f evidence-based medicine as they apply t the assessment f pain interventins. Epidemilgical aspects f persistent pain, including scial cst. Psychlgical, Scial and Cultural Issues The imprtance f psychlgical (emtinal and cgnitive), scial, and ther factrs in the presentatin and management f pain with emphasis n: Factrs invlved in the wide variatin in individual respnse t tissue injury. The relatinship between depressin and persistent pain. The rle f anxiety and/r depressin in acute pain. Differentiatin f active and passive cping strategies. Assessment f suicidality. The rle f illness behavir. Factrs that cntribute t impairment and disability. The rle f natinal and reginal cmpensatin and ther third party issues in the presentatin f pain and respnse t treatment. The influence f the health care prvider n the respnse t pain treatment. The imprtance f an interdisciplinary apprach t pain assessment and treatment including the ptential rle f ther members f the pain team (particularly psychiatrist, clinical psychlgist, physical therapist, nursing staff, ccupatinal therapist, scial wrker). The placeb effect and its implicatins fr treatment f pain. General Tpics, Research, and Ethics Epidemilgy f pain. Gender issues in pain. Placeb respnse. Multidisciplinary pain medicine. Organizatin and management f a pain center. Cntinuing Quality Imprvement, Utilizatin Review and Prgram Evaluatin. Patient and prvider safety. Designing, reprting, and interpreting clinical trials f treatment fr pain. Ethical standards in pain management and research. Animal mdels f pain and ethics f animal experimentatin. Substance Abuse Cncepts f tlerance, physical dependence, addictin and pseud-addictin. Iatrgenicity in tlerance and dependence. Cmmn licit and illicit drugs f abuse. UC Davis Pain Fellwship Educatin Gals & Objectives Page 3

11 The imprtance f a multidisciplinary apprach t pain management in patients with a histry f substance abuse (including mnitring, drug therapy, rehabilitatin). Principles f detectin, initial interventin and nging treatment f substance abuse in dctrs (including awareness f services available fr treatment f the impaired dctr). Practice Based Learning and Imprvement Practice based learning that invlves investigatin and evaluatin f their wn patient care, appraisal and assimilatin f scientific evidence, and imprvements in patient care. Educatinal Skills Fellws are expected t build n the educatinal skills and develp the fllwing: A review f their persnal learning plan. Identificatin f the factrs that lead t deviatin frm their riginal learning plan. A learning plan in which basic science teaching is linked t clinical practice. The Fellw shuld acquire the fllwing cre skills: Maintain an independent learning prgram. Develp a study plan fr the rest f the training perid. Review study plans and crrect fr deviatins: e.g., develp crrective actin plan t address deficiencies in knwledge r experience. Reflect n previus learning experiences with the aid f the Self Learning Prgram. Link basic science teaching with clinical practice. Study effectively. Participate in small-grup learning and educatinal activities. Be aware f decisin-making prcesses. Manage time effectively fr study, wrk, and hme/leisure. Give and receive feedback. Develp insight int persnal limitatins. Use the Internet as a clinical resurce. Cnduct and appraising literature searches. Appraise jurnal articles including the applicatin f statistics. Apply evidence-based medicine t direct clinical care. Develp presentatin skills in bth infrmal presentatins f patients t the Attending and in a mre frmal presentatin given during Grand Runds. Interpersnal and Cmmunicatin Skills Interpersnal and cmmunicatin skills that result in effective infrmatin exchange and teaming with patients, their families, and ther health prfessinals. Fellws are expected t develp interpersnal and cmmunicatin skills relevant t the team apprach t pain management in the fllwing areas: Demnstrate cmmunicatin skills in dealing with patients in pain, including: UC Davis Pain Fellwship Educatin Gals & Objectives Page 4

12 Dealing with issues f grief and lss. Undertaking cnflict management (e.g., in dealing with difficult patients, in dealing with ther staff). Apprpriate use f (nn-medical) language in cmmunicating with patients and their families, including with specific patient grups such as children. Demnstrate cmmunicatin skills with ther health prfessinals by Presenting results f patient assessment at multidisciplinary meetings where apprpriate. Undertaking cnsultatin (verbal and/r written) with ther medical and paramedical specialists, as indicated by the clinical situatin. Cmpleting daily prgress ntes in a timely manner. Cmmunicate effectively with clleagues, patients and thers. Establish effective relatinships with patients, families, clleagues and ther healthcare wrkers. Develp an empathetic apprach t patients that is apprpriate and respectful fr their age, develpmental, scial and ther factrs. Cmmunicate effectively with language translatrs fr patients wh have limited r n English language skills. Cmmunicates effectively ver the telephne with patients, family members and clleagues. Develp facilitatin skills, such as tutring in small-grup learning and cnducting smallgrup meetings. Understand and cmply with institutinal and federal regulatins pertaining t patient cnfidentiality; i.e., HIPAA regulatins. Use the internet, EMR and ther infrmatinal databases effectively t cmmunicate with clleagues and patients regarding clinical and within the HIPAA regulatins respecting patient cnfidentiality. Manage patient care, institutinal and persnal issues effectively with patience, calm, gd humr and insight. Wrk as a member f a team, but t assume respnsibilities and/r delegate duties as a team leader when necessary. Reslve cnflicts and issues using sund ethical reasning. Demnstrate exemplary practice as a member f a multidisciplinary team, by exercising flexible leadership, cnsultatin and apprpriate delegatin. Shw respect fr the expertise and cncerns f ther team members. Demnstrate insight int ne's wn limitatins, abilities and areas f expertise. Demnstrate respect fr thers, including a respnsibility t wrk as a team and t practice cnflict reslutin. Value human diversity. Respect the views f thers. Prfessinalism Prfessinalism, as manifested thrugh a cmmitment t carrying ut prfessinal respnsibilities, adherence t ethical principles, and sensitivity t a diverse patient ppulatin. UC Davis Pain Fellwship Educatin Gals & Objectives Page 5

13 Attitudes and Behavirs Fellws are expected t develp the attitudes and behavirs that are bligatry in specialist medical practice. Cre attitudes and behavirs that Fellws must cultivate during the whle perid f training include the fllwing. Specialist Practice T attain the attributes f a specialist as a: Medical expert Cmmunicatr Cllabratr Manager Health advcate Schlar and teacher Prfessinal T practice gd cmmunicatin with clleagues, patients and thers. T shw respect fr nurses and ther health care prfessinals invlved in the care f the patient. T cnduct pain runds in an efficient manner and make sure all the required dcumentatin is fully cmpleted. T dress in a way that shws respect fr their patients and ther health care prfessinals. T answer all pages in a timely manner. T wrk as a member f a team, but t assume respnsibilities and/r delegate duties as a team leader when necessary. T cmmit t, and believe in, a culture f safety and ethical, high quality care. T accept that medical knwledge and skills are nt the nly requirements f specialist practice. T be aware f medic-legal bligatins relating t medical practice. T have insight int ne's wn limitatins, abilities and areas f expertise. T cmmit t lifelng cntinuing prfessinal develpment. Prfessinalism and Ethics T cmmit t, and believe in the ethical and prfessinal principles f: Altruism: the best care fr the patient must be the principal driving frce f practice. Patient autnmy: patients' ability t determine their treatment. Beneficence: the principle f "ding gd" t patients. Nn-malfeasance: the principle f nt ding harm t patients. Fidelity: faithfulness t ne's duties and bligatins. This principle underlies excellence in patient care, cnfidentiality, telling the truth, a cmmitment t cntinuing prfessinal develpment and lifelng learning, and nt neglecting patient care. Scial justice: the right f all patients t be fairly treated. Utility: the principle f ding the mst gd fr the greatest number f peple. Duty t neself in terms f persnal health care, and maintenance f cmpetence t practice. Accuntability: a physician is respnsible fr his/her actins. Hnr and integrity in all cnduct, including the generatin and use f resurces. UC Davis Pain Fellwship Educatin Gals & Objectives Page 6

14 Respect fr thers, including a respnsibility t wrk as a team and t practice cnflict reslutin. Apprpriate respnse t clinical errr. Patient Cnsideratins T cmmit t, and believe in, the rights f patients with respect t: Autnmy. Cnfidentiality f the dctr-patient relatinship. Apprpriate, excellent clinical care, including pre-perative assessment. Infrmed cnsent including issues related t the pregnant minr. Cmprehensin f the risks f anesthesia techniques. Apprpriate care irrespective f race, culture, gender, and sci-ecnmic status. Research Cnsideratins T value rigrus educatinal and scientific prcesses. T distinguish between practices with a sund scientific basis and thse that require further bjective assessment. T cmmit t the ethical principles f research, especially the prtectin f human subjects and accurate reprting f data. Systems-Based Practice Systems-based practice, as manifested by actins that demnstrate an awareness f and respnsiveness t the larger cntext and system f health care and the ability t effectively call n system resurces t prvide care that is f ptimal value. Inpatient Hspital Envirnment The rle f the Pain Management specialist in pstperative, acute, nn-cancer, and cancer pain management and inpatient pain services. Principles f managing an inpatient pain service and ambulatry surgery. Plicies and prcedures with respect t referral t ther hspital services. Infrmed cnsent relative t pain management. Regulatins relating t restricted drugs as per natinal r state guidelines. Principles f ccupatinal health and safety such as lifting and psitining patients, infectin cntrl and sharps plicies. Clinic Envirnment Clinic scheduling and resurce allcatin fr patients referred t the clinic. Principles f management f a specialty pain referral service. Patient triage and emergency scheduling f pain cnsultatins. Planning and physical layut f the clinic; e.g., cnsultatin rms, prcedure and recvery rms. Lighting, safety, and infectin and pllutin cntrl in prcedure rms. UC Davis Pain Fellwship Educatin Gals & Objectives Page 7

15 Services and equipment in prcedure and recvery rms specific fr patient s underging invasive pain prcedures. Principles f staffing the clinic and prcedure rms. Infrmed cnsent relative t invasive pain prcedures. Regulatins relating t restricted drugs as per natinal r state guidelines. Principles f ccupatinal health and safety such as lifting and psitining patients, infectin cntrl and sharps plicies. Prfessinal Practice Plicies, recmmendatins and guidelines in prfessinal practice as cntained in prfessinal dcuments frm the clleges and bards respnsible fr pain medicine services. Understand the rganizatin f a multidisciplinary utpatient pain clinic and an inpatient pain service, including the rle f such services in educatin (f patients and staff), cllabratin, dcumentatin and administratin, and the rle f prtcls and audit. Assessment Fellw perfrmance n rtatin: Fellws will be assessed n their clinical perfrmance using the standard Rtatin Assessment Frm residing n evalue. Review clinical experiences n rtatin: The rtatin supervisr will review the clinical experience btained by the fellw by examining the reprt frm evalue summarizing the fellw s case lg. Cre Clinical Cmpetency: Assessed in the areas utlined in the Rtatin Objectives f training and cmmensurate with the teaching missin f the UCDHS. Our fellws are required t btain cre cmpetencies in the six areas belw t the level expected f a new practitiner. This is current as f August 2013 hwever the Our prgrams define specific knwledge, skills and attitudes required, and prvide educatinal experiences fr fellws t demnstrate: Patient Care cmpassinate, apprpriate and effective fr treatment f health prblems and prmtin f health Medical Knwledge f established and evlving bimedical, clinical and cgnate sciences, and applying these t patient care. Practice-Based Learning and Imprvement invlving investigatin and evaluatin f their wn patient care, appraisal and assimilatin f scientific evidence, and imprvements in patient care Interpersnal and Cmmunicatin Skills that result in effective infrmatin exchange and teaming with patients, their families, and ther health prfessinals. Prfessinalism, as manifested by a cmmitment t carrying ut prfessinal respnsibilities, adherence t ethical principles, and sensitivity t a diverse patient ppulatin Systems-Based Practice, as manifested by actins demnstrating an awareness f and respnsiveness t the larger cntext and system f health care, and the ability t effectively utilize system resurces t prvide ptimal patient care Assessment f academic perfrmance: Currently, there is n ITE cnducted by the American Bard f Anesthesilgy fr Pain fellws. Therefre, ur faculty have develped a written examinatin which is administered at the half-way pint and end f the fellwship t dcument adequate medical knwledge cmmensurate with the fellw s level f training. UC Davis Pain Fellwship Educatin Gals & Objectives Page 8