Revised September 25, 2009
Goals and Objectives
Pain Management Rotation 2009-2010
Rotation Coordinator:
Firooz Mashhood, MD
Physical Medical & Rehabilitation
734 E Sahara Avenue
(702) 477-7764
OVERVIEW
Educational Purpose
Acute and chronic pain represent common reasons for patients to visit their physician. Pain may be
due to a localized process, but may also represent life-threatening primary disorders or indicate
serious internal disorders. Because of their frequency and potential importance, internists should be
able to recognize different pain syndromes and initiate management. They should also be familiar
with different therapeutic modalities utilized for treatment of pain.
The pain management rotation is a 2-4 week experience available to residents at the PGY-1, PGY-2,
and PGY-3 levels. It is designed to introduce the resident to the principles of acute and chronic
pain, and give them opportunity to improve their skills in terms of management. During this
rotation, residents will see new and follow-up patients and will acquire knowledge in evaluating and
managing acute and chronic pain.
Teaching Methods
The rotation will be under the supervision of the attending pain management subspecialist. The
resident will participate in the daily office practice of the attending, evaluating patients together.
The resident will see patients as assigned by the attending in the outpatient clinic. The resident will
obtain the initial data, write a consultation note, and present the patient to the attending physician.
The attending will confirm the findings, teach about the case, and with the resident, craft the final
recommendations.
The attending will teach based on case material. The resident and attending will review and discuss
any required reading. Residents are expected to complete the required readings assigned in addition
to the rotation reading list so that they can participate fully in these didactic sessions.
Mix of Diseases
Patients will be those who afflicted with acute and chronic pain syndromes. The patients seen will
represent a wide variety of pain syndromes, including low back pain, neck pain, arthritis, spinal
cord injuries, work injuries, disk disease, radicular pain, neuropathic pain syndromes, reflex
sympathetic dystrophy, fibromyalgia, and pain associated with malignancy.
Patient Characteristics
The patients are ambulatory outpatients in a pain management clinic, representing a diverse mix of
income level, age, gender, and ethnicity from Las Vegas and the surrounding area.
Types of Clinical Encounters
Patient encounters are in the outpatient setting. Patient encounters occur in the office as initial
consultations or ongoing care of patients with pain syndromes.
Resident Supervision
Residents have constant on-site supervision as well as daily personal supervision in their patient
care.
Procedures and Services
Local anesthesia
Large joint injections
Epidural injections (optional)
Peripheral nerve block (optional)
Trigger point injections (optional)
Cryotherapy (optional)
Didactic Teaching
Attending Teaching
Didactic discussions will be held regarding all consultative activities occurring during the
month. Each resident is required to review common pain management topics.
Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 17th ed., Kasper DL, ed. McGraw Hill
The Washington Manual of Medical Therapeutics, 32nd ed.
Walsh: Palliative Medicine, 1st ed.
Tollison: Handbook of Pain Management
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology, Endocrinology,
Infectious Diseases, Rheumatology as well as General Medical References (Harrison’s
Principles of Internal Medicine, Cecil’s Textbook of Medicine) are available 24 hours a day,
seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of the
University of Nevada - Reno) via their computer in the resident room, Suite 300 of the 2040
W. Charleston Building. Access to this room is available 24 hours a day, seven days a
week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 16th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
The Medical Letter
Training Sites
Medical Rehabilitation & Associates
This venue is a private practice physical medicine and rehabilitation office of a clinical
faculty member.
Competency-based Goals and Objectives
Pain Management Rotation
Learning Venues
1. Clinic
2. Self Study
Evaluation Methods
A. Attending evaluation
B. Objective testing
C. Self evaluation
Competency Patient Care
Demonstrate competency in obtaining
thorough history from patients with a
focus on patients acute and chronic pain
complaints.
Demonstrate competency in physical
exam skills used to evaluate acute and
chronic pain
Demonstrate competency in
musculoskeletal exam.
Describe the indications and use of
physical therapy, pharmacologic agents,
nerve blocks, psychosocial support in the
treatment of chronic pain.
Establish a pain contract with patients and
understand appropriate use of narcotics in
the outpatient primary care setting.
Demonstrate ability to write reasonable
prescription for patients with acute and
chronic pain.
Identify patients who can be treated for
their pain by a primary care physician and
those requiring specialized, referral care.
Understand and perform assessment of
pain and function.
Competency : Medical Knowledge
Describe the different etiologies of
common pain syndromes and identify
these in the outpatient primary care
setting.
Level Specificity
Not applicable –
this elective is
taken once during
residency
Learning
Venues
1
Evaluation
Methods
A, C
Level
1
A, C
NA
1
A, C
NA
1, 2
A, C
NA
1, 2
A, C
NA
1
A, C
NA
1
A, C
1
A, C
Learning
Venues
Evaluation
Methods
1, 2
A, B, C
NA
Level
NA
Describe joint anatomy and location for
injections.
Understand the side effects and
complications of acute and chronic pain
management modalities.
Understand the pharmacology of opiates,
non-narcotic analgesics, and nonsteroidal
anti-inflammatory agents.
Discuss the pharmacology of local
anesthetics, neuromodulatory drugs used
in pain management.
1, 2
A, B, C
NA
1, 2
A, B, C
1,2
A, B, C
1, 2
A, B, C
Competency: Interpersonal and
Communication Skills
Learning
Venues
Evaluation
Methods
Interact in an effective way with
physicians, nurses and medical support
staff.
Demonstrate understanding of patient
preferences in diagnostic evaluation and
management
Maintain accurate medical records.
Serve as a patient advocate.
1
A, C
NA
1
A, C
NA
1
1
A, C
A, C
NA
NA
Competency: Professionalism
Learning
Venues
Evaluation
Methods
Level
Level
Treat team members, primary care1, 2
givers, and patients with respect and
empathy.
Understand, practice and adhere to a code 1, 2
of medical ethics.
A, C
NA
A, C
NA
Competency: Practice-Based Learning Learning
Venues
Review the outcomes of patient care in
1, 2
order to reflect on the approach taken in
the delivery of care.
Utilize established practice guidelines for 1, 2
individual diseases to devise care
strategies.
Evaluation
Methods
A, C
A, C
Level
NA
NA
Identify limitations of one’s medical
1, 2
knowledge in evaluation and
management of patients and use medical
literature (primary and reference) to
address these gaps in medical knowledge.
A, B, C
Competency: Systems-Based Practice
Learning
Venues
Evaluation
Methods
Recognize the importance of the role of
support systems in the health of patients
with acute and chronic pain, including
physical therapy, occupational therapy,
home health workers, and home medical
equipment vendors.
Understand the role of the pain
management consultant
1, 2
A, C
NA
1, 2
A, C
NA
NA
Level
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the standard
ABIM resident evaluation form. All clinical faculty are encouraged to provide face-to-face
feedback with the residents. Residents may receive interim feedback utilizing the ABIM’s
Praise and Early Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty member, at the
completion of the rotation. This evaluation form is included at the end of this document.
These evaluations are then converted to type and shared anonymously with the clinical
faculty. Residents are also encouraged to give on-going feedback during the rotation to
ensure the experience is suiting their educational needs.
The program director also discusses the rotation with the residents to ensure rotation quality
and satisfaction.
Pain Management Rotation Resident Check List
___________ 1.Evaluation reviewed at mid-rotation end of rotation by the supervising
faculty member and resident.
___________ 2. Completed assigned readings and assignments.
___________ 3. Attended all assigned clinical activities (excluding scheduled time
away, required clinics and emergencies).
___________ 4. Completed required presentations, case reports abstracts and/or posters
assigned by the supervising faculty member.
___________ 5. Demonstrated understanding of the basics principles of medical diagnosis and
management relevant to pain management.
___________ 6. Received verbal feedback from attending at end of rotation.
.
Intern/Resident Signature_________________________
Date___________________
Supervising attending__________________________
Date___________________
All items must be completed for rotation credit and checklist returned to the Department of
Medicine by the rotation’s end.