Duration: 12-months, 13 four-week long rotations

Clinical: 

The fellow will spend the majority of time on the acute pain service in the perioperative area at UC Davis Medical Center.  Our service performs approximately 3,500 ultrasound guided nerve blocks and epidurals annually.  The fellow will obtain substantial experience performing advanced truncal blocks and catheter placements including quadratus lumborum blocks, erector spinae plane blocks, pectoralis plane blocks, and serratus anterior plane blocks.  We routinely place these catheters for open abdominal surgeries, thoracotomies, renal transplants and mastectomies.  UC Davis Medical Center has a busy orthopedic surgery service and the fellow will become an expert in optimizing perioperative pain control for patients undergoing complex orthopedic joint replacements and orthopedic trauma surgery. Due to the plethora of blocks and the small size of the fellowship, the fellow will master a broad range of basic and advanced blocks and catheter placement as well as have the ability to be involved in resident education.   

The APS maintains an inpatient acute pain medicine census averaging 10-15 patients daily with epidurals or peripheral nerve block catheters that the team rounds on to provide guidance to the primary team on pain management recommendations.  The fellow will learn to become a leader of the acute pain medicine service and will coordinate the care of surgical patients with other departments and team members.  The fellow will be on call for rounding of inpatient acute pain medicine patients once every 4 weekends while on the acute pain medicine service with a resident and attending. 

Our hospital system has a busy outpatient Same Day Surgery Center with four operating rooms and many orthopedic procedures.  Once every 2 weeks, our fellow will be in the OR in an orthopedic surgery operating room (total joint arthroplasty, foot/ankle, shoulder arthroplasty, orthopedic sports), and will obtain experience with challenging neuraxial procedures, and will perform the perioperative regional anesthetic nerve catheters as well.  This provides a valuable opportunity to maintain OR skills during a regional anesthesia fellow year.    

The fellow will also spend time in the newly opened Children’s Surgery Center to learn regional anesthesia techniques in the pediatric surgery population.  In addition, the fellow will spend two 2-week blocks evaluating the diagnosis and treatment of inpatient chronic pain patients with the inpatient pain pharmacy service and the chronic pain service.  The fellow will be able to participate in multidisciplinary rounds with pain pharmacy, chronic pain, and palliative care services to learn management of inpatient chronic pain patients.

Our APS focuses on innovative ways to provide pain relief and care for our patients.  Point of care ultrasound (POCUS) is an area of focus that is highlighted by the American Society of Regional Anesthesia.  We have APS faculty members certified in POCUS that will teach the fellow the basics of POCUS including transthoracic echo (TTE), gastric ultrasound, lung ultrasound, and the FAST exam.  This is a valuable skill to learn and the fellow will become proficient in both performing POCUS and teaching others this skill set.

Leadership and communication skills will be emphasized in this fellowship.  Fellows will coordinate care with our surgical colleagues, operating and perioperative nursing staff and other anesthesiologists to ensure safe and efficient care for patients.  By the conclusion of the fellowship, the fellow will be both an expert at performing regional anesthesia procedures and an effective educator.  The fellow will be proficient in developing and managing a regional anesthesia and acute pain medicine service in both private practice and academic settings.

Education:

In addition to daily clinical teaching, the fellow will have weekly protected didactic time by our acute pain medicine service faculty with a structured lecture / simulation / ultrasound workshop schedule.  Structured acute pain medicine journal clubs will be scheduled throughout the year to discuss the recent high impact journal articles and new regional techniques and controversies in a group setting.  

Teaching:

The fellow will not only become an expert at performing US guided nerve blocks but will also learn the skills it takes to teach others including medical students, residents, and other physicians.  The fellow will have an opportunity to be an instructor at a CME program / ultrasound workshop and will also assist and supervise residents on the APS.

Scholarly Activity:

The RAAPM fellow is encouraged and expected to participate in scholarly activity and quality improvement as part of our fellowship.  The fellow will receive dedicated non-clinical time to work on scholarly projects including case reports and abstracts that may qualify for presentation at ASA and ASRA annual meetings.  Faculty members have several ongoing current scholarly projects that the fellow can become involved in or the fellow may choose to design their own project as part of the fellowship training. The fellow will have CME funds to use to present at and attend the Spring Regional Anesthesia ASRA meeting.

ABA board certification:

We have several faculty members that are ABA oral board examiners who are available to assist with oral boards preparation.  Our faculty will also have mock OSCE simulation sessions in preparation for the new OSCE component of the ABA advanced exam.