Role of the pain panagement trainee as a consultant to other specialties
As described previously, the trainee plays a major role as a consultant to other specialties. Primary care physicians and specialties such as neurology, neurosurgery, orthopedics, and oncology provide the majority of requests for consultations. While some of these consultations are done on an inpatient basis, most are outpatients. The administrative personnel of the PMC obtain appropriate referral information and schedule the patient's initial evaluations. Inpatient consults are seen within 24 hours and outpatient consultations are usually seen within one Week.
Outpatients are asked to complete a patient history form, which provides information regarding the pain complaint, medical history, a review of systems, family/social history, treatments received elsewhere, diagnostic studies, medications, allergies, etc. Trainees will assist patients who have difficulty completing the form. This information is usually available in the chart for inpatients. Moreover, the trainee will contact the physician team requesting the consultation to review the questions/reason for consult prior to seeing the inpatient.
The trainee will take a careful history, including, but not limited to, the description of the pain onset, location, intensity, time of occurrence, modifying factors, as well as the functional status and a quality of lifestyle assessment. Other important elements of the medical history, of course, will be included. The trainee will perform a physical exam appropriate for the pain complaint. The above history and physical exam will be documented. The trainee will present this information to the attending physician who will see the patient and confirm important aspects of the history and physical exam findings. If further information is thought to be necessary in the work-up of the patient, the trainee will contact primary care physician, specialist, psychologist, physical therapist, home health aide, etc. The attending physician will help the trainee develop an assessment and therapeutic plan and, together, the trainee and the attending physician will discuss the plan of treatment with the patient. The trainee will provide additional instructions and teaching to the patient to clarify the plan as needed. Evaluations are reviewed with the staff member prior to the dictation of a full note for the chart. The trainee will assist in the communication of the findings, impressions, and plan to the referring physician as follows: in the case of outpatient consultations, the trainee dictates a letter to the physician who requested the consult; and in the case of an inpatient consultation, the plans for treatment are discussed with the physician or physician team member who requested the consult.
Role of the pain management trainee in teaching other residents
The trainees will give brief morning teaching sessions to one another (in the presence of attending staff) related to topics that arise as a result of patients seen in clinic or on rounds.
Each trainee will give one in-depth, comprehensive presentation on the pain management related topic of his/her choice at the Grand Rounds of the Department of Anesthesiology and Pain Medicine at St. Elizabeth's Medical Center.
The trainee will present cases discussed at the monthly multidisciplinary conference when the trainee has seen that patient for an initial evaluation.
Biweekly Journal Clubs and case presentations are organized and conducted by both pain residents and anesthesia residents.
One or two anesthesia residents from the core program at St. Elizabeth's Medical Center will rotate through the Pain Management Center on a monthly basis. Trainees will help orient these residents as their rotation begins and will serve as a resource to them as to the policies and procedures of the Pain Management Center.
Trainees will research and present an assigned core lecture in pain management under the supervision of an attending physician.
- Pain Management Trainees. Formal written evaluations of pain trainee progress will be conducted at six-month intervals. Evaluations may be done more frequently at the direction of the pain program director. A scoring evaluation is completed by appropriate staff every six months and constructive comments are encouraged from the attending staff. The evaluations are reviewed by the pain program director. The pain program director will meet with each resident on at least a bi-yearly basis and review the evaluations. The resident is given a summarized copy of the evaluation and a copy is retained by the department.
- Faculty evaluation by Trainees. Faculty members will be evaluated yearly by the trainees. They will be evaluated in five different areas (availability, personal attributes, case-related teaching ability, didactic teaching, and overall contribution to learning) on a 1 to 5 Likert scale. These evaluations are completely confidential and anonymous. The results are tallied by the departmental manager and a percentile score is developed for each faculty, for each question, as well as a total percentile of the faculty's teaching evaluation. These evaluations are reviewed annually with each faculty member.
- Quality Assurance. The quality assurance process, led by the center's administrator, includes study and documentation of: patient access for cancer patients; use of psychological services within the clinic; patient follow up; wait times for invasive procedures; and other institution-wide CQI studies.
Some of the above quality assurance studies will continue and others will be developed.
The pain management fellowship program will have an ongoing daily process of tracking outcomes. Any procedural problems, standard of care issues, and systemic shortcomings can be identified and dealt with in a prompt and appropriate manner. These quality assurance procedures will be flexible and closely intertwined with the trainees' education and with the Pain Center's practice.