Regional Fellowship and Instructorship

Click here to view the Regional Fellowship and Instructorship Regional Division Faculty Bios.

2024-2025 ACGME Fellows

Our accredited fellowship adheres to the ACGME program requirements  for our field (Updated 7/1/2022):

• Fellows are fully-immersed in RAAPM education. Historically, our fellows have far exceeded the required numbers of procedures.
• Non-clinical time is available for our fellows to pursue academic interests.
• There are no in-house night or weekend requirements for our fellows.
• Fellows who are eligible for independent licenses have the opportunity to pursue departmentally-supported internal moonlighting that does NOT interfere with fellowship training.
• We offer financial support for meetings and educational resources.
• Fellows can expect to have 4 weeks of vacation and 4 weeks of elective time.
• Salary details for this PGY-5 position can be found at this link.

RAAPM Rotation Goals

The Main Operating Room (OR) Regional Rotation is a four week rotation that the fellows will rotate through during their fellowship training. During this time, fellows will master the knowledge and skills necessary to evaluate and manage the care of patient undergoing both inpatient and outpatient surgery with a focus on regional anesthesiology and acute pain management techniques.

Fellows will demonstrate an understanding of the specific needs of peri-operative and medicine patients tailoring pain control techniques to facilitate efficiency and safety. Orthopedic, Vascular, General Surgery, and Plastic surgery patients will constitute a large component of the inpatients.

Fellows will provide single shot as well as continuous catheter techniques for patients and will orchestrate care with primary surgical teams and nursing. In addition, the fellows will serve as consultants of non-operative patients and pain management needs and will provide regional and acute pain techniques as indicated.

The expectation is that the experience will culminate in the fellow ultimately being able to manage the anesthetic plan for both surgical and non-surgical patients, and to operate effectively and independently under the supervision of an attending anesthesiologist. Along with weekly Grand Round lectures, you will also have weekly didactic lectures. While doing your fellowship here you will rotate in the following:

• Main Regional OR
• Out-Patient Surgery Center
• Acute Pain Service

Professionalism

• Demonstrate respect, compassion, integrity, reliability, and dependability in their role as an anesthesiologist
• Respond in a timely manner to requests by surgeons and nurses for assistance in patient management issues
• Provide follow up on patients and any complications or patient concerns
• Exhibit the ability to make more independent decisions about patient management
• Demonstrate leadership of daily rounds and the priorities for addressing all care needs over the course of the day
• Serve as mentor to junior residents/students concerning aspects of APS work

Patient Care and Procedural Skills

• Provide routine management of the analgesic needs of patients undergoing surgical procedures and medical patients
• Perform a detailed patient history and physical including neurologic history
• Understand appropriate analgesic choices including regional techniques and multi-modal techniques
• Accurately obtain, interpret and apply information about analgesic options
• Formulate a regional anesthesia plan for both surgical and medical patients
• Formulate a multi-modal analgesic plan for surgical patients and inpatients
• Identify patients who can undergo a regional technique as the primary anesthetic
• Demonstrate competence in performing blocks of the brachial plexus including interscalene, supraclavicular, infraclavicular, axillary and forearm blocks
• Demonstrate competence in performing blocks of the lower extremity including femoral, saphenous, sciatic and ankle blocks
• Demonstrate competence in performing truncal blocks including TAP, erector spinae and paravertebral blocks
• Follow up all techniques including the following of and management of any complications
• Apply current body of literature in the management of surgical and medical patients and their analgesic needs
• Understand orthopedic-specific medical management

Practice-Based Learning

• Demonstrate consultant quality evaluation and treatment planning skills
• After discussion with the APS Attending, perform the epidural placement with less hands-on intervention from the attending
• Utilize a wider range of adjunctive therapies for pain management
• Demonstrate more leadership skills in the daily provision of service
• Obtain consultations for more sophisticated therapy, as deemed necessary
• Follow up on nerve blocks and discuss opportunities for improvement
• Demonstrate proficiency in reading scientific literature and applying choosing analgesic options for patients

Interpersonal Communication

• Obtain information from patients and provide effective communication with patients and their families
• Provide appropriate communication with surgical teams when caring for patients
• Demonstrate ability to coordinate care by communicating with nursing staff in the pre-operative, intra-operative and post-operative care areas
• Obtain informed consent from patients and families
• Manifest consultant level of interaction with patients and staff
• Evidence concern for the effectiveness of information-sharing with patients, families and colleagues

Medical Knowledge

• Create a differential diagnosis for the causation of a patient’s pain and suggest a plan for focusing on ‘the’ working diagnosis for which primary treatment will be targeted
• Establish an awareness of a broader spectrum of therapeutic modalities for pain management, including pain psychology

Systems-Based Practice and Improvement

• Understand your role as patient care advocate
• Become familiar with costs associated with specific interventions
• Emphasize safety and well-being of patients in the hospital setting
• Demonstrate an understanding of continuous nerve catheters, their risks and benefits to patients
• Demonstrate familiarity of best practice regarding regional anesthesia and anti-coagulation
• Describe Local Anesthetic Systemic Toxicity treatment plan and how to utilize available resources to optimize patient safety
• Provide more evidence of self-directed learning
• Evaluate/critique the relevant pain medicine literature
• Demonstrate awareness of options for care in published guideline documents
• Understand the vital role that pain management plays in healthcare, thus the need for effective management of acute pain
• Manifest greater appreciation for the array of services at the UVA Health System that can be brought to bear on the patient’s behalf

Fellows will be expected to achieve competence in pain assessment, formulation, and coordination of a multiple modality treatment plan, integration of pain treatment with primary disease management and palliative care, and interaction with other members of the multidisciplinary pain team. The didactic and clinical curriculum will address the attainment of these competencies and the assessment of fellow performance will be based on the successful achievement of the following ACGME and ABA (The American Board of Anesthesiology) specialty-specific competencies and attributes.

The out-patient Continuity Clinic runs full days (0800 – 1700) four days of the week at the Pain Management Center. On Wednesdays, both start at 12:30 to permit attendance at the Anesthesiology departmental morbidity and mortality and grand rounds conferences which run from 0700 – 0845. These are followed by dedicated pain medicine lectures at the Pain Center from 0930-1130. The IASP (International Association for the Study of Pain) and American Board of Anesthesiology curriculum outlines provide the essential topic structure for the conference presentations.

APS Rotation Goals

• Expand, broaden and strengthen the knowledge and skills gained in the first or second APS rotation
• Highlight advanced patient assessment/evaluation techniques
• Demonstrate improved technical performance in the provision of needle-based care, particularly epidural techniques
• Manifest greater participation in the decisions for daily management of patients as well as the utilization of a wider range of diversified therapeutic modalities
• Take more responsibility for handling patient follow-up actions and acute pain consults
• Evidence more autonomy in patient management
  Strive to integrate more input from literature review into the care of patients
• Demonstrate the ability to teach information related to APS care

Applications are reviewed on a rolling basis and selected candidates will be invited to interview in March/April for both the Fellowship positions and the Clinical Instructor position.  Both types of positions follow the typical academic cycle from July 1 to June 30, though an August start date may be acceptable if approved by the Program Director in advance.

For additional information, please contact the Fellowship Program Director, Dr. Brett Elmore, or the Regional and Acute Pain Medicine Fellowship Coordinator, Lisa Morton, by phone at 434.924-9454, or by email at anesthesiology-regionalfellow@virginia.edu.