Appendix -- Pain Fellowship (Operational Characteristics Associated with Goals & Objectives)

Clinical Rotations

Tampa General Hospital – Rotation

1. Outpatient clinics
   1. Daily inpatient rounds on acute & chronic pain patients at TGH
   2. Inpatient pain management unit
   3. Hospice of Hillsborough (Wednesday with Dr. Joan Christie)
   4. Neurology Headache Clinic (every Tuesday AM with Dr. Marie Carmen Wilson)
   5. Procedures with Dr. Miguel (All day Thursday at HLM and Friday mornings at TGH)
2. Post operative patients:
   1. All pain management trainees should work as a team to expedite pain consults and pain clinic patients. However, the "on call" pain medicine resident should have seen all acute pain patients by 0830-0900 q day.
   2. OR anesthesia team will contact "on call" pain resident prior to the patient coming to PACU.
   3. Except for the first case of the day, the "on call" pain medicine resident will be responsible for inserting operative epidurals staffed by the Attending Anesthesiologist for the case.
   4. The pain team will evaluate the patient in a timely manner. Under no circumstances will a post-operative patient with an epidural, be kept on the floor/PACU without effective analgesia.
   5. Evaluate and make him/her comfortable as soon as possible by:

i.Appropriate doses of IV Morphine

ii.Epidural route. Always test the catheter that it is epidural, not Intravascular, not intrathecal nor subdural!

iii.'A pearl' - It's more convenient and reliable to order epidural infusions from OR pharmacy than the main pharmacy.

iv. Daily log all inpatients!

3. Inpatient Pain Program Patients:
   1. These patients are admitted on Sundays. Week-end call resident should find out about them by calling 25l-790l on Friday.
   2. Obtain medical records by calling 251-7956 and discuss the management plan with the admitting attending this may be different from on-call attending.
   3. Weekly staffing of these patients is on Tuesday afternoon. Preferably the fellow or CA3 resident will attend this staffing with the multidisciplinary team.

Hospice of Hillsborough Rotation: (This is a unique opportunity to get involved/and learn about terminal care with dignity.)

1. Interdisciplinary Team (IDT) orange is our team.
2. The pain fellow assigned to TGH will rotate through HOH every Wednesday.
3. The fellow will also attend a monthly administrative meeting.
4. > 70% of HOH patients have pain related problems and this is a multidisciplinary/approach to their treatment.

H. Lee Moffitt Cancer Center Rotation

1. Outpatient clinic/procedures
2. Monday cancer and chronic pain clinic with Dr. Miguel
3. Thursday procedure clinic with Dr. Miguel

Florida Pain Clinic Rotation

1. The pain fellow will have an opportunity to rotate through Florida Pain Clinic in Ocala. This is a unique opportunity for the fellow to learn advanced invasive procedures (i.e., spinal cord stimulator, morphine pumps, radio frequency lesioning, mycloscopy, etc.) Florida Pain Clinic director Dr. Pyles has a high volume pain clinic where fellow have an excellent opportunity to learn various hands-on experiences for pain relief procedures. This pain clinic is affiliated with the University. Residential accommodations are available at no additional cost to the fellows.
2. Key learning opportunities for the fellows are:
   1. How to operate/administer a high volume pain clinic.
   2. Hands-on clinical experience for various procedures. This center provides an opportunity to learn community based pain medicine in our Program.

Fellow Responsibilities

1. The Pain fellow assigned to TGH/HLM rotation will make daily rounds prior to 9:00 am along with rotating/on-call resident. His/her role is a 'teaching' fellow to the resident as well as maintaining and continuing patient care, by communicating with the primary attending and the pain attending.
2. The pain fellow will conduct an orientation lecture on the first working day of each month for the new rotating residents.
3. After six months of training the pain fellows are required to prepare a lecture topic for rotating resident/medical students for formal teaching purpose. This teaching session should be documented by the fellow and faculty will be in attendance.
4. Each pain fellow will regularly participate in pain journal club. Presentation and active participation is highly desirable for the purpose of learning to objectively criticize the pain topics presented.
5. During the pain clinic when they are rotating along with the resident they will act as their 'guide' or 'facilitator' in learning.
6. A pain fellow will be assigned to perform more complicated and complex pain management procedures/cases than the rotating residents (CA2 & CA3). They will be given priorities to perform/assist in procedures like spinal cord stimulator, radio frequency lesioning, neurolytic blocks, subarachnoid pump, etc.
7. Pain fellow will collect QA data as necessary from ongoing clinics after attendings consent to be presented to QA meeting. They will participate in administrative meetings of the Department and research committees.
8. Fellows are encouraged to review a subject of their interest to prepare as a formal review article for publication/participation. They may select faculty of their choice as their guides.
9. Each month fellows should put down number of procedures and evaluation/patient contacts and give their grand total at the end of the year.
10. The Fellows will evaluate the program at the end of each rotation and submit their evaluation to Nanci Verrastro in a timely manner.
11. The Fellow assigned to TGH will also participate in Multidisciplinary staffing on Tuesday afternoon whenever Dr. Christie may have inpatients in the pain management unit.
12. The Fellow will make the monthly on call schedule for the resident and fellows.
13. The Fellow will be involved in the selection and arrangement of "Guest Lecturers'.

Work Schedule for the Fellow