Anesthesia Pain Management - AIMMC

PREREQUISITES:  Only available to M4s must have completed the M3 core clerkship

PURPOSE: To provide medical students a perspective of acute and chronic pain resulting from surgical and non-surgical conditions, severe traumas, burns, etc.  The students will spend most of there time under the direct supervision of an attending Anesthesiologist of resident physician of Anesthesia during their clerkship.  In addition, students will attend teaching sessions along with anesthesia residents which will allow the students to develop a core knowledge base that will be reinforced through the anesthesia experiences in order to cultivate those skills and attitudes that are indicative of outstanding physicians regardless of the specialty that the medical student may choose in the future.

COMPETENCIES: The following objectives are expected from the clerks to acquire at the very least a “beginner stage” upon completion of this clerkship.

A-Patient Care:

At the end of the rotation the student should be able to:
1. Understand the physical, emotional and ethical consequences of the under-treatment of pain.
2. Assess acute and chronic pain in the surgical and non-surgical patient.
3. Recognize the different categories and types of pain.
4. Evaluate the psychological components of the patient’s pain.
5. Recognize social and family issues that may affect the patient’s perception of pain.
6. Provide patient care that is compassionate, appropriate, and effective for the treatment of pain.
7. Counsel and educate patients and their families.
8. Develop a therapeutic plan with the assistance of the attending anesthesiologist and/or resident physician.
9. Observe and partake in the therapeutic plan with the primary care physician, the patient and patient’s family.
10. Become proficient in the use of pharmacological and no-pharmacological modalities for the treatment of acute and chronic pain.
11. Describe advantages, disadvantages, side effects and complications of pharmacological and non-pharmacological modalities (PCA, neuroaxial analgesia, systemic opioids, NSAIDS, etc.) for acute and chronic pain.
12. Recognize and explain the differences between acute and chronic pain.
13. Define the “work-up” for a chronic pain patient.
14. Discuss the principles and list the indications of diagnostic testing and procedures.
15. Describe why and how pain becomes chronic.
16. Be familiar with most pain conditions.

Psychomotor ability:
At the end of the rotation the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Evaluate the pain patient, document pertinent information, assess the severity of the patient’s condition, and establish a diagnosis and therapeutic plan.
2. Assemble complete histories and physical examinations.
3. Coordinate evaluation, treatment, and care of patients.
4. Document all the pertinent events in patient charts.
5. Communicate with the referring physician.
6. Demonstrate acceptable technical skills.
7. Perform competently all medical and invasive procedures considered essential for the practice of Pain Management (PCA, continuous epidural analgesia, continuous nerve blocks, management of analgesics and adjuvants)

Attitude:
Clerks are expected to:
1. Display safety consciousness.
2. Demonstrate sympathy and understanding for the patient’s condition
3. Recognize the suffering associated with pain.
4. Listen attentively to the patient and their family.
5. Show concern for the welfare of the patient
6. Have a relationship with the patient that is always ethical.
7. Elicit relevant information and communicates effectively.
8. Display judgment in knowing when to call for help.
9. Work with health care professionals, including those from other disciplines, to provide patient-focused care.
10. Provide health care services aimed at preventing health problems.

B-Medical Knowledge:

Cognitive ability:
At the end of the clerkship the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Perform a complete history and physical that includes a thorough neurological examination
2. Effectively assess the patient’s pain complaint.
3. Determine the category and types of pain complain.
4. Based on the patient’s symptomatology, explain the pathophysiology of the complaint, consider a differential diagnosis, and formulate an acceptable therapeutic plan of action
5. Discuss the pharmacology, indications and contraindications of analgesics and adjuvants.
6. Manage non-malignant and malignant pain.
7. Be familiar with the WHO therapeutic ladder.
8. Know the invasive modalities available, their indications, contradictions, and complications.
9. Be proficient in the use of fluoroscopy.
10. Be able to interpret MRI, CT, and plain X-Ray films.
11. Recognize points of reference in fluoroscopy.
12. Interpret and correlate therapeutic response.

Psychomotor Ability:

At the end of the clerkship the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Gather essential and accurate information about their patients.
2. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
3. Perform competently all medical and invasive procedures considered essential for the practice of Pain Management.
4. Recognize, assess and treat complications resulting from treatment

Affective ability:
At the end of the clerkship, the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Appreciate the concept of an anesthesiologist as a consultant for preoperative setting.
2. Demonstrate analytic thinking when formulating and discussing the Pain Management Care.
3. Know and apply the basic and clinical supportive sciences which are appropriate to surgical patients.
4. Demonstrate an investigative and analytic thinking approach to clinical situations.

C-Practice-Base Learning and Improvement:

Cognitive ability:
At the end of the clerkship, the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Describe the principles of pain self-assessment and quality improvement.
2. Express a basic understanding of the multifactorial nature of medical errors including personal biases and perceptions.
3. Analyze her/his Pain Management experience using appropriate methodology to improve her/his patient care.
4. Adequately assimilate and apply new scientific knowledge into her/his patient care.
5. Adequately adjust and react to a changing clinical situation in the Pain Center.
6. Facilitate the learning of medical students/residents and/or others in the Pain Management team.
7. Understand the dynamic and multi-disciplinary nature of the Pain patients complains.
8. Express and understanding of personal limitations and capabilities
9. Analyze practice experience and perform practice-based improvement activities using a systematic methodology.
10. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems.
11. Apply knowledge of stud designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
12. Use information technology to manage information, access on-line medical information; and support their own education.

Psychomotor ability:
At the end of the clerkship the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Identify areas for improvement of patient care.
2. Establish plan for improving patient care.
3. Follow up to ensure desired improvement.
4. Facilitate the learning of medical students and/or others in the health care team.
5. Adequately adjust and react to a changing clinical situation.
6. Adequately assimilates and applies new scientific knowledge into her/his patient care.
7. Analyze her/his Pain Management clinical experience using appropriate methodology to improve patients’ care.

Affective ability:

At the end of the clerkship, the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Display a willingness to acknowledge error or mistakes.
2. Accept criticisms with the understanding that the mutual goal is to improve patient care and personal performance.
3. Be acceptant of, and willing to consider new ideas and approaches to clinical problems.
4. Be accepting of the opinion and input of all members of the patient care team.

D-Interpersonal and Communication Skills

Cognitive:
At the end of the clerkship, the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Effectively and appropriately communicate so to counsel and educate patients and family.
2. Interact adequately/appropriately with the rest of the health care team to provide patient-focused care.
3. Understand of the multidisciplinary nature of the patients’ complains as it applies to the development of a therapeutic patient relationship.
4. Discuss methods and skills required to ensure effective communication with patient and family
5. Describe the pertinent facts that must be conveyed when referring the patient to another care provider.
6. Display knowledge of common barriers to effective communication
7. Detail the daily Pain Management Unit routine for Pain Management personnel.
8. Create and sustain a therapeutic and ethically sound relationship with patients

At the end of the clerkship, the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Conduct effective patient preoperative interviews and displaying empathy and compassion.
2. Effectively communicate preoperative evaluation and patient data to attending staff.
3. Demonstrate ability to communicate pertinent patient data prior to intraoperative turnover of patient care.
4. Work with others as a member or a leader of a team.
5. Listen and elicit relevant information and communicate effectively.
6. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
7. Work effectively with others as a member or leader of a health care team or other professional group.

Affective ability:
At the end of the clerkship, the medical student, under limited assistance from the staff anesthesiologist, should be able to:
1. Interact adequately with the rest of the health care team to provide patient-focused care.
2. Practice cooperation in-group activities and participate in discussions.
3. Be a volunteer to help
4. Display sound judgment, maintaining patient confidentiality, in all communications of patient information
5. Appreciate the importance of complete communication with all members of the patient care team.
6. Identify common barriers to effective communication in both themselves and others and establish tools to facilitate effective communication.
7. Have an ethical and therapeutic minded relationship with patients
8. Work with others as an effective team member or leader.

ADMINISTRATION:


Duration of Elective:
  4 weeks
Night Call: No
Weekends: No
# of Students Accepted:  Min 1  Max  1
Housestaff Used as Faculty:
Lectures/Conferences/Faculty Contact:  Maunak Rana, M.D. Coordinator: Adiana Vonderhaar  Email: adriana.vonderhaar@advocatehealth.com   Telephone:  773-296-5616  Fax:  773-296-5088
Laboratory: No
Independent Study: No
Outpatient: 50
Inpatient:  0
Total Hours / Week: 50 / 4

Approved: 5/15/13