The Department of Anesthesiology

Pain Medicine Fellowship

The University of Tennessee Graduate School of Medicine Pain Medicine Fellowship is an ACGME-accredited 12 month (starting and ending in July) training program designed to qualify physicians for specialty certification in pain medicine by the American Board of Anesthesiology.

Hospital Overview

The University of Tennessee Graduate School of Medicine partners with The University of Tennessee Medical Center at Knoxville and serves as a referral center for Eastern Tennessee, Southeastern Kentucky, and Western North Carolina. It is the region’s only Academic Medical Center, “Magnet” recognized hospital, and Level 1 Trauma Center.

The Department of Anesthesiology provides the necessary infrastructure to support the Pain Medicine Fellowship. The Anesthesiology Residency Program is a four-year program with 40 residents. For over five decades the department has adhered to a core training policy that combines progressive clinical responsibility with careful supervision to maintain patient safety and resident support. The department’s pain medicine fellowship faculty includes eight board certified pain medicine physicians. Additional University of Tennessee Graduate School of Medicine faculty participating in the program include physicians from the specialties of physical medicine and rehabilitation, neurology, psychiatry, oncology, palliative care, and radiology. All faculty members have experience in supervising and teaching fellows, residents and medical students.

Key Faculty

The Department of Anesthesiology faculty at the University of Tennessee Graduate School of Medicine in Knoxville includes 8 board-certified pain medicine physicians who serve as key faculty for the fellowship:

Matthew Vance, MD, Fellowship Program Director, Division of Pain Medicine
Jason Buehler, MD, Associate Professor, Division of Pain Medicine, Residency Program Director, Vice Chair of Education 
Mark Murray, MD, Assistant Professor, Division of Pain Medicine
Che Solla, MD, MBA, Assistant Professor, Division of Pain Medicine, Director of Multimodal Acute Pain Service
Jeffrey Staack, MD, Assistant Professor, Division of Pain Medicine
Stephanie Vanterpool, MD, MBA, FASA, Associate Professor, Director of Comprehensive Pain Services

Additional University of Tennessee Graduate School of Medicine faculty who will participate in the program will include:

Steven Rider, MD, Clinical Assistant Professor, Chief, Division of Neurology, Department of Medicine
Paul Miller, MD, Assistant Professor, Division of Psychiatry, Department of Medicine
Jeffrey Hecht, MD, Associate Professor, Chief, Division of Surgical Rehabilitation, Department of Surgery
Hannah Denham, PharmD, Clinical Pharmacist Specialist

Training Focus

The University of Tennessee Graduate School of Medicine's Pain Medicine Fellowship includes board certified pain medicine physicians providing excellent training in outpatient and inpatient pain medicine.

The fellowship program places a strong emphasis on an interdisciplinary approach to identification and treatment of the source of patients' pain.

The Department of Anesthesiology staffs an outpatient pain medicine clinic and a busy inpatient pain service. The pain clinic manages over 19,000 patient visits and over 3,300 interventional pain procedures per year. The wide variety of interventional and non-interventional techniques used to diagnose and treat these patients will provide excellent experience for a pain medicine fellow.

Fellows will spend a total of six months rotating in the pain clinic divided into three two-month “blocks." Fellows will be assigned to work primarily with one faculty member during each week of these two-month rotation blocks. Most of the patients that fellows care for on these rotations will be encountered multiple times for both evaluations and procedures during each rotation block. Faculty members will utilize the multidisciplinary nature of the pain clinic to enforce competencies related to the disciplines of Neurology, Anesthesiology, Physical Medicine and Rehabilitation, and Psychiatry and reinforce those competencies after fellows return from rotations in those specialties.

Curriculum

• University Center for Pain Management (UCPMK.com) - Pain Clinic- Six months
  
  
• Inpatient Multimodal Acute Pain Service- Two months
  
  
• Additional rotations (two weeks to one month):
  Physical Medicine and Rehabilitation
  Neurology
  Psychiatry
  Electives (see below)

Pain Medicine Fellowship Sample Rotation Schedule

Elective rotations: Oncology, Palliative Care, Airway (required for non-anesthesia specialties), Research, Neuroradiology, Regional Anesthesia, Pediatric Neurology/ Headache Clinic.

Vacation: Maximum of five vacation days on any rotation. Twenty vacation days allowed per year.

Learning Activities

Case Conference

A fellow aided by the fellowship director will lead a guided case discussion among the department which includes faculty, fellows, residents, medical students, nurse practitioners and clinical and administrative personnel about controversial ethical topics such as the impact of regulatory measures that may restrict access to opioids for patients with uncontrolled pain.

Inspired by the American Society of Anesthesiologists Syllabus on Ethics, the primary focus is to provide training opportunities that serve to emphasize the physician’s moral obligation to serve as the patient’s protector and advocate. Discussions of moral development and moral character can create a sense of uneasiness among physicians, who may believe that anyone can become a victim of moral finger-pointing, and who think that in ethics there are, or should be, “no right answers.” The inclusion of all of our department members including non-health care providers helps provide a forum where everyone is encouraged to state their opinion and can elicit opinions not as prevalent in physicians and nurses. Experience has proven that case based discussions elicit the most interest and participation from all attendees.

Learning by “real cases” and discussing anecdotal scenarios emphasizes the importance of recognizing and developing an approach to ethical problems for use in everyday practice. For example, a woman with back pain demands “pain pills” and refuses to consider other treatments despite the fellow's strong belief that she is not a good candidate for narcotic therapy. Discussion items may include the following points: Are you required to present any other options besides opioid therapy? Should you “scare” the patient into accepting your opinion? Should she be required to undergo an indicated interventional procedure prior to being considered for narcotic therapy? A medical ethicist, Dr. Annette Mendola (Chief, Division of Clinical Ethics, Department of Medicine), will be present to provide valuable contributions to the discussion.

The conference will incorporate core competencies, including professionalism, patient care, medical knowledge, practice based learning, and communication skills.

Root-Cause Analysis

Every fellow will complete rotations in the anesthesia pain clinic and on the acute pain service. During these rotations each fellow will be required to complete a Quality Improvement project. For example, fellows may identify a problem that impacts patient care and complete a root-cause analysis. The goal will be for the fellow to determine the underlying cause of an identified problem as opposed to merely "treating the obvious symptoms." The fellow's staff mentor will aid the fellow in using the Six Sigma approach of repeatedly asking ‘why’ a problem occurs. By applying this type of methodology, the fellow will learn how to identify system errors and suggest solutions.

The fellow will also identify any evidence-based literature that is relevant. If applicable, they will make recommendations for any clinical or systems based changes that may help prevent the issue from occurring in the future.

The fellow will also identify any ACGME competencies related to the patient care issue. The results of the root-cause analysis will be presented at our Morbidity and Mortality Conference throughout the academic year. Each fellow's mentor will provide faculty support and supervision for the entire process. The M&M Conference promotes scholarly activity and incorporates the six ACGME core competencies. In this conference our goal is to provide a safe environment for fellows to evaluate their care of patients and to promote continued improvement in patient care based on self-evaluation and life-long learning.

Grand Rounds

Each fellow must present an hour-long Grand Rounds presentation about a clinically relevant topic of interest to the entire Anesthesiology Department. After discussion with the fellow's faculty mentor, a topic or interesting clinical case is selected. The resident uses information technology to locate and evaluate scientific studies to incorporate into the presentation. The faculty mentor will assist the fellow by reviewing the results of the literature search and its application to the presentation. To aid in this process, Martha Earl, MSLS, AHIP, of the Preston Medical Library, will introduce our fellows, during orientation, to the various tools available to locate pertinent information for the presentation. The fellow will utilize skills learned in the use of medical knowledge, professionalism, and communication to educate the members of the Department of Anesthesiology (including faculty, residents, nurse anesthetists, student nurse anesthetists and nurse practitioners) during the presentation at our weekly Grand Rounds Conference.

Case Presentation

Fellows will also be expected to identify and submit a case or case series to a national meeting. A faculty mentor will provide support.

Journal Club

The fellow and residents will attend journal club monthly. A fellow or resident will be responsible for choosing a relevant article from a current journal for presentation and discussion. A faculty mentor will provide support.

Faculty Lectures

The fellow will attend weekly faculty lectures that cover assigned reading. Lectures will focus on topics in the ABA content outline for the pain medicine board examination.

Research

Research support for fellows will be provided by the Department of Anesthesiology's Research Division, which includes a research coordinator and dedicated research faculty. Fellows will be provided with office space and computers. The Anesthesia Research Division is located in the hospital and invites active interaction with clinical faculty and fellows in the department. The Department of Anesthesiology will provide an experienced anesthesiologist faculty researcher to serve as a mentor to fellows. The department’s research coordinator will also provide support to fellows. Ongoing departmental research in areas such as neuroscience and data-based outcomes will provide opportunities for fellow research involvement.

The UT Graduate School of Medicine will provide additional research support. The UT Graduate School of Medicine provides a research course for the fellows in the fall consisting of five half-days of instruction. Eric Heidel, PhD, Associate Professor, Division of Biostatistician, is also available to the fellows through the UT Graduate School of Medicine.

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