- How To Apply
- Benefits / Salary
- Moving to Baltimore
- GME Policies
- Postdoctoral Association
- ACGME Accredited : No
- ABA Certified: No
- Duration of Program: 1 year advanced clinical training (hybrid faculty-fellow position)
- Positions Available: 2-3
- Application enrollment date(s) or deadline: Applications April 1st through September 30th
- Applicant Qualifications (which are required prior to starting program):
- Completion of an ACGME accredited residency anesthesia program
- Eligible to hold:
- Unrestricted Maryland State Medical License
- Maryland State Controlled Dangerous Substances (CDS) registration
- United States DEA Registration Certificate
- Eligible to be credentialed and appointed as full faculty
Overview and Curriculum Goals
The goal of the Acute Pain Medicine and Regional Anesthesia Fellowship is for fellows to develop the skills and knowledge base necessary to perform basic, intermediate, and advanced regional nerve blocks. After completion of the fellowship, graduates will be experts in the management of acute pain in the perioperative and peri-trauma period, will have developed the knowledge and skills necessary to be a valued consultant in the perioperative management of acute and acute-on-chronic pain, and will have developed expertise in the performance of peripheral nerve and central neuraxial blocks.
Clinical Practice Sites
- Johns Hopkins Hospital
- Johns Hopkins Bayview Medical Center
(Advanced clinical rotations at alternate sites are being developed and will be introduced in the near future)
Although the advanced training fellowship program is not ACGME accredited, the goals of the one (1) year advanced training program is organized according to ACGME core competencies.
Fellows are expected to:
- Act responsibly and with integrity with their patients, nurses, residents, fellows, and health care providers.
- Fulfill clinical duties in a timely and appropriate manner.
- Adhere to ethical principles including respect for patient privacy.
- Demonstrate an active interest in learning and participating in the care of patients receiving regional anesthesia.
Interpersonal and Communication Skills
As advanced trainees, fellows will be expected to interact well with and demonstrate cultural sensitivity to patients, nurses, nurse anesthetists, surgeons and attending anesthesiologists. They will refine their skills in educating and preparing patients for the regional nerve blocks or other interventional acute pain procedures. Fellows are expected to:
- Provide effective patient education regarding indications, risks and side effects of procedures.
- Obtain appropriate informed consent from patients, paying special attention to identifying laterality for unilateral procedures.
- Communicate effectively with other members of the team.
- Initiate and appropriately conduct a pre-procedure “timeout.”
- Properly and accurately document in the medical record any procedures performed.
By the end of training, fellows will demonstrate expert knowledge in the following areas:
Medical Management of Acute Pain:
- Local anesthetic pharmacology, toxicity, and appropriate clinical usage in peripheral, neuraxial, and systemic analgesia, and use of adjuvants.
- Appropriate use of opioids (systemic and neuraxial) in treating acute pain states, and implications related to their side-effects.
- Advanced management of acute pain with multimodal analgesics, including understanding the pharmacology of NSAIDs, COX-2 inhibitors, NMDA antagonists, α2-agonists, α2δ-Ca2+ channel blockers (i.e. gabapentinoids).
- Management of patients with chronic pain and chronic opioid use/ abuse.
- Direct the acute pain medicine service with attending supervision.
Interventional Management of Acute Pain:
- Nerve localization techniques, including principles of ultrasound and nerve-stimulation technologies, and other localization methods (i.e. hanging drop, loss of resistance, landmark techniques).
- Methods, rational, and appropriate application of single-shot and continuous catheter techniques.
- Applied functional regional anatomy as relevant to the surgical procedure and/ or block technique employed, including positioning patients for performing blocks.
- Appropriate use of procedural sedation when performing interventional procedures.
- Appropriate patient selection for and choice of interventional nerve blockade.
- Recognition and management of complications related to interventional acute pain management (i.e. hemodynamic compromise, local anesthetic toxicity).
- Upper extremity blockade, including:
- Cervical plexus
- Brachial plexus (Interscalene, Supraclavicular, Infraclavicular
- Distal extremity nerve block
- Truncal blocks, including:
- Transversus Abdominus Plane
- Lumbar and thoracic epidural anesthesia/ analgesia
- Lower extremity blockade, including:
- Lumbar Plexus
- Saphenous/ adductor canal
- Sciatic (proximal and distal approaches)
- The art and science of spinal anesthesia and associated side effects.
- Appropriate postop management of peripheral nerve and epidural catheters to achieve effective pain control.
Practice-based Learning and Improvement
During training, fellows will further develop an understanding of and apply critical analysis of the relevant primary source literature relevant to the various acute pain phamacotherapeutic modalities, including regional nerve blockade techniques. Fellows will also moderate and lead a monthly Journal Club on topics relevant to the specialty.
By the end of the advanced training fellowship, graduating fellows will be expected to independently:
- Assess patients’ appropriateness for placement of peripheral or neuraxial nerve blocks.
- Setup and properly position patients for peripheral nerve blocks
- Select appropriate procedural sedation based on patient and/ or procedure factors
- Select the appropriate nerve localization technique using nerve stimulation vs. ultrasound vs. landmarks
- Select alternative approaches to perioperative pain control in non-traditional patient populations (i.e. chronic pain, anatomical variants, infected patients, low weight patients, etc.)
- Manage block failures (single-injection and/ or continuous catheter techniques)
- Perform and complete peripheral nerve and neuraxial procedures
- Medically manage surgical patients’ acute pain in the perioperative period (pre-, intra-, and post-op)
- Provide expert patient care recommendations as a consultant in Acute Pain Medicine to requesting medical and surgical specialists
- Counsel patients on appropriate modalities of pain management in the acute setting
The fellow will develop an awareness of and responsiveness to the needs of the large health care system as it relates to the acute pain patient receiving regional anesthesia, both as a primary anesthetic and for postoperative analgesia. He/ she will also understand the rationale for and participate in hospital initiatives to improve quality and efficiency in the operating room as it pertains to acute pain medicine and regional anesthetic techniques.
- Work effectively as a member of and with the patient care team.
- Understand basic principles of safety in administering regional nerve blocks.
- Identify areas for quality improvement in the administration of acute pain and regional anesthesia.
- Understand the documentation of regional nerve block and acute interventional pain procedures.
The fellow will receive electronic evaluations (E-value) by the Division of Regional Anesthesia and Acute Pain Management, in addition to verbal feedback during his/ her clinical performance. Fellows will maintain a procedure log that will be evaluated quarterly or more frequently, as needed, by the fellowship program director for the number and type of nerve blocks or other regional anesthetic techniques to ensure they are obtaining adequate experience.
Educational Resources/ Reading Material:
The following reference texts are among the top sources of specialty texts:
- The Military Advanced Regional Anesthesia and Analgesia Handbook
- Acute Pain Management by Sinatra et al.
- Essentials of Regional Anesthesia by Kaye et al.
- Textbook of Regional Anesthesia and Acute Pain Management by Hadzic
- Acute Pain Management: A Practical Guide, 3rd ed by MacIntyre & Schug
- Ultrasound-Guided Regional Anesthesia and Pain Medicine 3rd ed by Bigeleisen (4th ed. to be released in 2014)
- Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade by Hebl
- Marie Hanna, MD
Associate Professor, Division Chief – Regional Anesthesia and Acute Pain Management
- Jason C. Brookman, MD
Assistant Professor, Fellowship Program Director
- J.P. Ouanes, MD
Assistant Professor, Director of Regional Anesthesia, Johns Hopkins Bayview Medical Center
- Christopher Wu, MD, Professor
- Scott Mittman, MD, PhD, Assistant Professor
- Vineesh Mathur, MD, Assistant Professor
- E. David Bravos, MD, Assistant Professor
- Asha Manohar, MD, Assistant Professor
- Rashmi Prasad, MD, Assistant Professor
- Ronen Shechter, MD, Assistant Professor
- Mohammad El-Rahim, MD, Assistant Professor
- Michael Purvin, MD, Instructor
- Sean Owens, D.O., Instructor
Acute Pain Medicine and Regional Anesthesia Fellowship Program
Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions
Sheik Zayed Tower 8120L
1800 Orleans Street
Baltimore, MD 21287
Tekeia Ringgold, Interim Program Coordinator