ANEU-4024 - Regional Anesthesia & Acute Pain

ANEU-4024 - Regional Anesthesia & Acute Pain

Elective Title: Regional Anesthesia & Acute Pain
Course Number: ANEU-4024
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Richesh Guragain, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Kathryn Gwinn Other Faculty:
Location to Report on First Day:
OR Front Desk

1. To orient medical student to inpatient pain and peri-operative pain management using multimodal techniques to include regional anesthesia.
2. To help understand the basic anatomy of pain sensation and how to manage it using procedures in the peri-operative setting.
3. To introduce students to regional anesthesia as an alternative to general anesthesia as a form of anesthetic for surgical procedures.
4. To give student additional exposure into future career choices beyond core electives.

By the end of the rotation elective, medical student should:
1. Understand the basic anatomy and innervation for upper extremity, lower extremity, abdomen and chest wall.
2. List the common local anesthesia medications used during regional anesthesia blocks.
3. Understand the mechanism of action of common pain medications used to manage peri-operative pain in the inpatient setting

Description of course activities
Students will arrive at 6:30am daily to participate in first case procedures of the day if any. Participation involves joining the residents to get medications ready and procedure supplies. Learning from faculty teaching and watching the procedures been performed. The student will participate in acute pain daily rounds, no pre-rounding required, with the acute pain resident and faculty where patients are managed with medications to include oral and intravenous options. The student will present a powerpoint presentation to the team on an assigned topic in regional anesthesia and acute pain in their second week of the rotation. Students will participate in our teams monthly discussion on a recently published topic in the acute pain journal. The student will receive a regional anesthesia textbook to go through during the rotation as a learning resource that will be returned upon completion of the rotation. The student will be expected to complete a paper checklist that will be given to you for block procedures participated in during your rotation. This will allow the team to ensure a well-rounded opportunity to see various regional anesthesia procedures. The student will be expected to complete a checklist of the number of acute pain consults seen with the team to ensure an opportunity to participate in how the patients pain medications are titrated, both with escalation and de-escalation.

Type of students who would benefit from the course
Any 3rd or 4th year medical student who has completed an OR Anesthesia Course rotation.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6:30 3:00
Tuesday 6:30 3:00
Wednesday 6:30 3:00
Thursday 6:30 3:00
Friday 6:30 3:00

 Average number of patients seen per week: 15-20
 Call Schedule: N/A

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty & Residence on Service
  B. Frequency / Duration of Presentation(s)?
    Once during the rotation
  C. Format - What guidelines are set for the student's presentation?
    PowerPoint presentation on Acute Pain Subject 6
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
    Daily progress notes, consults & H&P's, faculty & resident's recommendations, if any.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    student selected based on approval by mentor
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Participate in monthly journal if it falls during a rotation or present an assigned topic to team during the elective rotation

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Faculty, Resident and Self Evaluation

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.