ANEU-4004 - Anesthesiology - Pain Clinic

ANEU-4004 - Anesthesiology - Pain Clinic

Elective Type: clinical
Anesthesiology - Pain Clinic
Course Number
Prerequisites: Successful completion of Year 2 
      Additional Requirements:
Responsible Faculty Director:
Courtney Williams, MD
Other Faculty:
Gulshan Doulatram MD; Jeff Baker PhD; Michael Cook MD; Govindaraj Ranganathan MD; Denise Wilkes MD;
Location to Report on First Day
UTMB Neurology & Pain Management, 2660 Gulf Frwy. South, Town Center Shopping Center, Exit 20 between Hobby Lobby and Sports Authority, 832-505-2450 at 7:00am.
Periods Offered
3-7, 9-12
excluding holiday period 8
Maximum Enrollment

Enhance knowledge of pain and pain management.

1. To develop and learn skills in the basic principles of chronic and acute pain management and learn to evaluate, consult and manage pain syndromes, both chronic and acute.
2. To learn the indications , limitations, and complications of neural blockade in pain management and begin to develop procedure skills to perform neural blockade.
3. To learn indications, limitations, and contraindications for the use of non-opiod, opioid and adjunctive pharmacologic and non-pharmacologic therapy, including psychologic and support therapy, in management of pain syndromes, both chronic and acute.

Description of course activities
The student will be assigned for 3 weeks directly to the faculty members covering the Pain Clinic each day and will work in partnership with the anesthesiology resident(s) and/or fellow. For 1 week the student is assigned to the faculty member covering Regional Anesthesia Acute Pain at John Sealy Hospital (3rd week). Night and weekend call is not required. When multi-disciplinary pain conferences are scheduled, students participate in the presentation of a case or protocol. Special projects are encouraged but must be arranged well in advance.

Type of students who would benefit from the course
Students interested in psychiatry or rehabilitation medicine may benefit from this early exposure to chronic pain management. Students pursuing surgery, anesthesiology, and oncology may also benefit from their exposure to both acute and chronic pain problems. Students with a strong interest in neurosciences may also find the rotation enlightening. Primary care physicians may especially benefit from the ability to deal with patients with pain; a difficult and poorly understood patient population.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 8:00am 4:00pm
  Tuesday 8:00am 4:00pm
  Wednesday 8:00am 4:00pm
  Thursday 8:00am 4:00pm
  Friday 8:00am 4:00pm
   Average number of patients seen per week: 15  
   Call Schedule:   no call duties  

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?
    Students are observed daily on inpatient rounds and during patient assessments in the outpatient clinic.
  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?
    The student may be asked to present on a pain related topic during the rotation. Content will be at the discretion of the student or the topic may be assigned by faculty. The audience will include faculty, resident(s) and fellow.
  B. Frequency / Duration of Presentation(s)?
    One presentation per month, for 30 - 45 minutes.
  C. Format - What guidelines are set for the student's presentation?
    Oral presentation with the use of aids such as written materials, computerized equipment, slides, etc..
  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)?
    Student will write H+P''s in the clinic under the direction of the supervising faculty.
  B. Format - What guidelines are set for the student's written work?
    UTMB guidelines on patient records are followed.
  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.?
    Content selection made in discussion between student and faculty.
  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)?
    The student is encouraged to attend departmental conferences and any pain related didactic sessions. The student may present on a pain related topic of interest to the student. Participation on rounds and/or patient discussions is encouraged.

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.
    1. Directed select reading from literature and appropriate textbooks (supervised).
2. One-on-one direct supervision by physician (preceptor) resident(s) and/or fellow and faculty daily.
3. "Hands on" management and participation in patient care with physician (preceptor) resident(s) and/or fellow and faculty supervision.

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.