pain medicine fellowship program

Introduction and Welcome from the Program Director, Leena Mathew, MD

Thank you for your interest in the Pain Medicine Fellowship Program at Columbia University Medical Center/New York Presbyterian Hospital. Our Fellowship program is an integral part of the Department of Anesthesiology and is fully accredited by the ACGME.  Graduates of our program are eligible to continue their examination progress towards subspecialty certification in Pain Medicine. The fundamental goal of the Pain Medicine Fellowship program is to train pain clinicians and investigators for the future, through mentored experience in providing comprehensive, team-based, patient-centered care.  Over the course of this one year, highly selective, multidisciplinary program, we provide opportunity to develop increasing autonomy towards the achievement of demonstrated competence in the treatment of acute, chronic and cancer pain in adult and pediatric patients. The program is complemented by a comprehensive multidisciplinary didactic curriculum, and opportunities for basic and clinical research. 

The Fellowship experience at Columbia University Medical Center

Experiential learning is attained through meaningful and responsible patient care under faculty supervision. Informal daily interactions with rotating residents, medical students, faculty and interprofessional team members occur in an academic environment that uniquely blends community and hospital-based medicine, preparing a fellow for future practice in any setting. Patients are seen in the inpatient and ambulatory setting using an individualized, multidisciplinary approach with interventions focused on functional restoration and analgesia. The vast patient diversity affords exposure to a wide variety of pain problems that allow the fellow to develop the competencies and skills they need to respond to the dynamic health care needs of patients across cultural and socioeconomic boundaries and integrate pain treatment with primary disease management.

The core faculty members are dedicated to providing multidisciplinary, compassionate, respectful, patient-centered care using stylistically distinct approaches to therapeutics while staying bound by ethical, evidence and value-based guidelines. The comprehensive training allows the fellow to broaden the perspectives available to them to develop awareness needed to identify and adopt practice styles that are consistent with their future career plans

Pain Medicine Fellowship Educational Activities

A comprehensive lecture series is in place to provide the didactic foundation for the fellowship and complements the extensive clinical experience. Fellows who graduate from the Columbia Pain Medicine Fellowship program are able to document a procedural and clinical experience that far exceeds ACGME requirements and prepares them for independent practice. Through direct observation and feedback from faculty and interprofessional team members, the fellows are able to self-reflect and evaluate their personal clinical effectiveness to constantly improve their own skills.  This experience, in association with research/scholarly activities, helps to develop all aspects of the expert consultant.  Formal feedback on their competency development, aided by a self-reflective learning portfolio process, helps the fellow in establishing and monitoring individualized learning plans. The fellows are expected to take the Pain Medicine In-Training Exam in latter half of the fellowship year, as another measure of their acquisition of medical knowledge regarding Pain Medicine in anticipation of the actual subspecialty certification examination.

I. Rotations and Clinical Experience

The fellowship clinical experience comes through rotations divided into repeating cycles, consisting of four weeks in an outpatient office-based practice, four weeks in the Interventional Suite and four weeks of chronic inpatient care interspersed with one-two week multidisciplinary experiences throughout the year. The multidisciplinary experiences include Psychiatry, Electrophysiology, Palliative Care, Pediatric Pain, Neuro-radiology and Neurology.  Fellows who come from backgrounds other than Anesthesiology are trained in the core concepts of Anesthesiology through a thoughtfully structured four week rotation to develop basic competency and understanding of emergency airway management, neuraxial techniques and to develop a basic familiarity with use of local anesthetics, intravenous analgesics and sedation techniques. All fellows are sent for national cadaveric courses in order to enhance their understanding of the more advanced implantation techniques.   Additional elective time may be arranged as well depending on the background and interests of the fellow.

In addition to clinical rotations, fellows are required to engage in an academic project in clinical or basic science for the year with faculty mentorship culminating in a presentation at the Academic Evening held each year by the Department of Anesthesiology, and/or other professional meetings. Participation in state and national meetings is highly encouraged and meeting time and financial support is provided.

In order to insure patient safety and provide the highest quality patient care, the Pain Medicine fellows hold daily sit down rounds to review patients on the in-patient Pain Service from 7:30-8:00 AM with rotating residents, medical students, and Faculty. This forum assures effective and efficient care transitions between providers, and provides a valuable learning experience.  In order to further develop their own teaching skills, the fellows use this venue to sequentially focus on the key words in pain which are pertinent to rotating residents.

The Center for Pain Medicine 

Fellows obtain their clinical experience in interventional procedures and treatment modalities as detailed below at The Center for Pain Medicine in the Department of Anesthesiology.  The state of the art Interventional Suite is equipped with a C ­Arm,  Ultrasound,  RF generator and a cryoablation unit.  Advanced invasive interventional procedures including implantable techniques are performed in the Operating Rooms in New York Presbyterian Hospital-Columbia Medical Center.

Interventional Techniques:

Cervical Procedures

  • Cervical Epidural Steroid Injections
  • Cervical medial branch nerve blockade
  • Radiofrequency ablation of the medial branch nerve
  • Cervical selective nerve root blocks
  • Cervical Discography
  • Stellate ganglion blockade
  • Ultrasound guided brachial plexus blockade for acute, chronic and cancer pain management

Thoracic Procedures

  • Epidural steroid injection
  • Intercostal nerve blockade
  • Ultrasound guided paravertebral blockade and catheter placement
  • Radiofrequency and cryoablation

Lumbar Procedures

  • Epidural steroid injections
  • Selective nerve root blocks
  • Medial branch blockade and Intraarticular facet injections
  • Radiofrequency ablation of medial branches
  • Discography
  • Intradiscal procedures
  • MILD ­ Decompression for spinal stenosis
  • Sacroiliac joint blocks
  • Piroformis injection
  • Vertebral augmentation procedures
  • Lumbar sympathetic nerve blocks

Abdominal and Pelvic Procedures

  • TAP blocks for acute, chronic and cancer pain with ultrasound guidance
  • Celiac plexus and splanchnic nerve blockade
  • Hypogastric plexus block
  • Pudendal nerve block
  • Ganglion of Impar block
  • Neurolysis
  • Peripheral nerve blockade and radiofrequency ablation

Intrathecal Pumps

  • Intrathecal and epidural trials
  • Intrathecal pump placement for cancer pain management

Neuro-modulation Techniques:

  • Spinal cord stimulator trial and implantation
  • Occipital nerve stimulators

Nerve blocks:
In addition to diagnostic peripheral nerve blocks and perineural catheter placement for infusion therapy for pain management, radiofrequency and cryoablation techniques are also employed in the following areas:

  • Occipital
  • Supraorbital, infraorbital and supratrochlear
  • Mandibular
  • Trigeminal
  • Suprascapular
  • Femoral
  • Sciatic
  • Popliteal
  • Saphenous
  • Genitofemoral
  • Ilioinguinal
  • Iliohypogastric
  • Brachial and lumbar plexus

Musculoskeletal Blocks

  • Ultrasound and fluoroscopy guided joint injections
  • Bursa injections with ultrasound and fluoroscopy guidance
  • Trigger point injections

Others

  • Epidural blood patch
  • Botox for migraines and musculoskeletal pain syndromes

In addition to interventional techniques, the following treatment modalities are also offered at The Center for Pain Medicine:
Behavioral modalities

  • Psychotherapy
  • Cognitive behavioral therapy
  • Biofeedback

Medical Management

  • Non steroidal anti-inflammatory agents
  • Steroids
  • Opioids
  • Antidepressants
  • Anticonvulsants
  • Antiarrythmics
  • NMDA antagonists
  • Calcium channel blockers
  • Topical agents
  • Muscle relaxants
  • Bisphosphonates

Others:

  • Acupuncture
  • TENS trials

II. Didactic Curriculum

The comprehensive didactic curriculum at the core of the Pain Medicine Fellowship program is based on the ACGME requirements for training in Pain Medicine, as well as the Content outline for the Pain Medicine subspecialty Certification exam, the International Society for the Study of Pain, and evolving trends in Pain Medicine

Core Fellowship Didactic Lecture Series: Wednesday 8: 00 ­ 9:00 AM

Provided by Pain Medicine Core faculty as well as Multidisciplinary Faculty and guest speakers from Addiction Medicine, Neurology, Physical Medicine and Rehabilitation, Critical Care Medicine and Neurosurgery.  Additional topics in Patient Safety/Quality Improvement methodologies, Epidemiology, basic science research and statistics are included in the core lecture series, as well as areas of Faculty clinical and academic interest.

Journal Club:  1st Thursday  8:00 - 9:00 a.m.

Critical evaluation of the medical literature, understanding evidence based approach and current advances in the field of basic and clinical pain research is a key component of the fellowship. Fellows are encouraged to choose meaningful articles with faculty for discussion at journal club and spearhead discussions. Additionally residents rotating to Pain Medicine are also expected to participate and engage fully in journal club presentations.

Case Conference: 4th Thursday 8:00- 9:00 AM

This multidisciplinary conference includes all Pain Medicine faculty/staff, trainees and invited faculty/staff from other departments. Selected cases are presented and discussed. In addition to being an educational forum, this conference serves to improve patient care through the open discussion of treatment successes and failures. As such, this conference is an integral part of the Quality Improvement/Patient Safety process.

Behavioral Psychology Series: 2nd Wednesday 8:00- 9:00 a.m.

This lecture series provides a structured curriculum to enable fellows to concentrate on psychopathology as well as behavioral interventions targeting patients with acute, chronic and cancer pain.

Spine Conference: 1st Tuesday 5:00 – 6:00 PM

Pain Fellows participate in the Interdisciplinary Spine conference conducted with Neurosurgery and Physical and Rehabilitation Medicine.

Pain and Addiction Conference:  3rd Thursday 5pm

This conference is provided by Addiction Psychiatry faculty using the format of formal lectures as well as case based discussion.

Pain Medicine Board Review:

This specialized format held during the last month of fellowship, reviews all topics and questions relevant to the examination for subspecialty certification in Pain Medicine.

Department of Anesthesiology  Grand Rounds: Thursdays, 7:00 - 8:00 a.m.

Pain Fellows are expected to attend and participate in Grand Rounds offered by the Department of Anesthesiology.  Grand Rounds covers topic areas pertinent to evolving areas of Anesthesiology, Critical Care and Pain Medicine. During the course of the year, in collaboration with Pain Medicine Faculty, the Pain Medicine fellows provide at least one presentation pertaining to Pain Medicine.

Department of Anesthesiology Research Seminars

Pain Medicine fellows have the opportunity and are encouraged to attend Department of Anesthesiology Research Seminars that are held on a monthly basis. 

Fellow Participation in the Education of other Learners

Our fellows are afforded the opportunity to further their own skills to prepare them to be future consultants and role models who are proficient teachers who demonstrate quality improvement and patient safety in the context of their everyday practice.

The Pain Faculty and Fellows play an active role in medical   student education. The fellows prepare and present an introduction to pain management lecture to the Columbia University medical students as part of their Anesthesia experience in their MCY (Major Clinical Year).  In addition, the Department sponsors a four week Multidisciplinary Pain Medicine elective for senior medical students. During the rotation the medical student is encouraged to be an integral part of the team with the Pain Fellows and rotating residents. The fellows have the opportunity to work with the Faculty in providing exposure to all aspects of clinical pain medicine.

The fellows also have the opportunity to collaborate with the Pain Faculty in the education of Anesthesia residents. Fellows participate as a team member as the residents are exposed to the entire spectrum of pain syndromes. While residents gain clinical experience in a graduated fashion through rotations in acute pain, office based outpatient pain management, inpatient pain and the interventional suite, fellows enhance their own teaching, mentoring and feedback skills.

 

Core Pain Faculty

David Bandola, MD
Assistant Professor of Anesthesiology
Fellowship, Pain Medicine, Columbia University, NY
Board Certified in Anesthesiology and Pain Medicine

Anthony (Robin) Brown, M.B.Ch.B., F.F.A. (S.A.)
Professor of Anesthesiology and Vice Chair
Director, Orthopedic and Regional Anesthesia
Board Certified in Anesthesiology

Anis Dizdarevic, MD
Assistant Professor of Anesthesiology
Fellowship: Pain Medicine, Brigham & Women's Hospital, Harvard Medical School
Board Certified in Anesthesiology and Pain Medicine

Robert Maniker, MD
Assistant Professor of Anesthesiology
Director, Acute Perioperative Interventional Pain Program
Fellowship: Interventional Pain Medicine, Brigham and Women's Hospital, Harvard University
Board Certified in Anesthesiology and Pain Medicine

Leena Mathew, MD
Associate Professor of Anesthesiology
Fellowship Program Director, Pain Medicine
Fellowship: Pain Medicine, Columbia University, NY
Board Certified in Anesthesiology and Pain Medicine

William S. Schechter, MD, MS, FAAP
Clinical Professor of Anesthesiology & Pediatrics
Chief, Division of Pediatric Pain Medicine, Symptom Management and Palliative Care Director, the Pediatric Pain Medicine Program and Advanced Care Team
Board Certified in Pain Medicine, Critical Care Medicine, Pediatrics and Anesthesiology

Nomita Sonty, PhD
Associate Professor in Medical Psychology (in Anesthesiology & Psychiatry
Fellowship: Pain Management & Behavioral Medicine, St. Louis University Health Sciences Center

Michael L. Weinberger, MD
Associate Professor of Anesthesiology
Director, Pain Medicine Center and Division Director, Pain Medicine
Fellowship: Pain Medicine, Memorial Sloan-Kettering Cancer Center
Board Certified in Internal Medicine, Anesthesiology, Pain Medicine

 

FAQ’s

Who can apply?

Residents who are completing an-ACGME accredited residency are eligible to apply for a fellowship in Pain Medicine.

What are the salary and benefits for the Pain Medicine Fellows?

All fellows receive a competitive salary and benefits from New York Presbyterian Hospital (NYPH), our ACGME Institutional Sponsor. Please refer to the NYPH Graduate Medical Education Website for more specific information.

What additional support is provided by the Department of Anesthesiology?
The Department provides an educational allowance for all fellows of $1600, which can be used to attend a pre-approved professional meeting, or to purchase additional books or an iPad. All pain fellows are given the following Pain Medicine texts at the outset of their fellowship:

  • Interventional Radiology of the Spine, McGraw
  • Image-Guided Spine Intervention, Fenton and Czervionke
  • Essentials of Pain Medicine, Benzon, et. Al
  • Basic Surgical Techniques, Kirk
  • Atlas of Implantable Therapies for Pain Management

How do I apply?
The Pain Medicine Fellowship participates in the National Resident Matching Process. Applications are accepted starting January 1, 2014- July 31, 2014, in anticipation of the NRMP Match opening in June 2014.  Additional information on the application process and NRMP Match can be found below.

Fellowship Application Checklist
Fellowship Application

National Resident Matching Program (NRMP)

For further information, regarding applying to the Pain Medicine Fellowship please email or contact:

Jennifer Anglin
Coordinator, Pain Medicine Fellowship Program
622 West 168th Street (PH 5-Stem)
New York, NY 10032
Phone: 212-305-3226
E-mail: ja2875@cumc.columbia.edu

Or the PD, Dr. Leena Mathew - lm370@cumc.columbia.edu


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Columbia University Medical Center Department of Anesthesiology