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Woodrow A, Teramoto M, Thapliyal M, Christiansen S. Procedural education for cancer-related pain in Pain Medicine fellowships: a national program survey. Reg Anesth Pain Med 2024; 49:440-447. [PMID: 37652574 PMCID: PMC11187366 DOI: 10.1136/rapm-2023-104630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Cancer-related pain is ubiquitous. Targeted procedural interventions may be an important and underutilized method for improving cancer-related pain and quality of life. The goal of this study was to determine the baseline educational experience and perceived post-graduation comfort of Pain Medicine fellows in performing procedures that can be used for cancer-related pain. METHODS Using Qualtrics, a 16-question survey was distributed to graduating fellows at accredited Pain Medicine Fellowship programs in the USA in June 2022. The fellows' experience and comfort level performing eight procedures was analyzed using summary descriptive statistics and contingency table analysis with statistical significance determined by Pearson's χ2 test. RESULTS Survey respondents represented 30% of fellows among 44% of Pain Medicine programs during the 2021-2022 academic year. The majority of respondents reported no experience performing 7 of the 8 procedures for cancer-related pain (56.1%-90.6%). Graduating fellows reported overall comfort performing sympathetic neurolysis (65.7%), spinal cord stimulator trials (85.7%) and implantations (66.0%), but not intrathecal pump trials (36.9%) and implantations (31.3%), peripheral nerve stimulator implantations (41.7%), vertebral augmentations (31.3%), and vertebral body radiofrequency ablations (16.7%). CONCLUSIONS Experience performing 10 or more of the surveyed procedures, personal interest in treating cancer-related pain, and attendance of cancer-related pain lectures were found to significantly increase comfortability in performing cancer-related pain procedures post graduation, whereas cadaver-based learning did not. This study highlights the need for more robust procedural education for cancer-related pain and identifies procedural experience in non-cancer patients and lectures on cancer-related pain as ways to bridge this educational gap.
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Affiliation(s)
- Alex Woodrow
- Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Masaru Teramoto
- Physical Medicine and Rehabilitation, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Mrinal Thapliyal
- Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Sandy Christiansen
- Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Ali S, Hurdle MF, Ghazi SM, Gupta S. Boosting Confidence: Enhancing Spinal Cord Stimulator Needle and Lead Placement Through Simulation Training. Cureus 2024; 16:e55550. [PMID: 38576678 PMCID: PMC10993637 DOI: 10.7759/cureus.55550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Background This pilot study aims to examine the effectiveness of a spinal cord stimulator (SCS) simulator training system in improving the confidence of pain fellows in SCS placement. Methodology Five Ukrainian physicians (neurologists, neurosurgeons, and an anesthesiologist) completed a 10-item survey regarding their confidence in various aspects of SCS placement and their opinions on how effective SCS models were for educational purposes. After placing SCS leads using the SCS simulator, the physicians took the same survey again. The Mann-Whitney U test was used to determine if there was a significant difference in total scores pre and post-simulator training. The software PAST (PAleontological STatistics) was used for statistical analysis. Results Overall, five participants had a 38% statistically significant increase in survey scores before and after the intervention (mean: 4.2 vs. 6.2, p = 0.0055). With regards to each item of the survey, participants had a significantly increased confidence in driving leads (2.6 vs. 5.2, p = 0.008) and in overall technical skills for the SCS procedure after the training (2.8 vs. 5.2, p = 0.0188). Although the other eight survey items were not statistically significant (p > 0.05), participants had a 28% increase in confidence when inserting epidural needles, a 20% increase in interpreting simulated X-rays, a 32% increase in navigating challenging anatomical variations, a 12% increase in identifying key anatomical landmarks, a 20% increase in ensuring the correct placement of the lead, or a 53% increase in preparedness for performing an SCS procedure in a real clinical setting. The participant's perspective on how valuable the stimulator training was for enhancing procedural skills increased by 38% and how well the simulator replicated real-life SCS procedure increased by 52%, although both were statistically insignificant (p > 0.05). Conclusions This pilot study shows that the utilization of simulated neuromodulation training is a viable means of augmenting neuromodulation education by increasing physician's confidence in aspects of the SCS placement procedure. The extent to which simulator training improves procedural skills in a real-life SCS placement needs to be investigated further.
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Affiliation(s)
- Shan Ali
- Neurology, Mayo Clinic, Jacksonville, USA
| | | | | | - Sahil Gupta
- Pain Medicine, Mayo Clinic, Jacksonville, USA
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Mahmoud A, Aman MM, Trumbo JL, Paracha U, Langell A, Petersen E. Education and Experience in Intrathecal Drug Delivery Systems (IDDS) During Pain Medicine Fellowships. J Pain Res 2023; 16:4367-4377. [PMID: 38162405 PMCID: PMC10757777 DOI: 10.2147/jpr.s428851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/18/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) exposure and clinical adoption remains low despite multiple well-designed trials that demonstrate safety, efficacy, reliability, and cost-saving benefits. This study aims to understand the possible contributing factors starting with Pain Medicine fellowship training. Materials and Methods An internet-based, anonymous pilot survey was distributed to pain medicine fellows enrolled in an Accreditation Council for Graduate Medical Education (ACGME) accredited pain medicine training program during the 2021-2022 academic year. Fellowship programs were identified using published online ACGME accreditation data. The survey was distributed via email to fellowship program directors and coordinators and was made available through pain medicine societies. Results Seventy-one of four hundred and twenty-three pain medicine fellows (17% response rate) completed the survey. Nine percent of respondents evidence-informed opinion coincided with the most recent Polyanalgesic Consensus Conference (PACC) guidelines recommendations for IDDS treatment indications. Fifty-one percent of respondents felt there was an unmet need for IDDS training. About one-third of respondents felt that lack of curriculum, faculty, and cases were barriers to IDDS use, respectively. Thirty-one percent of fellows reported sufficient training for IDDS in their fellowship programs. The majority (70%) of respondents somewhat or strongly support direct training by IDDS manufacturers. Conclusion A wide variability exists surrounding IDDS training during ACGME accredited pain medicine fellowship. Insufficient case exposure and lack of a standardized curriculum may play a role in future therapy adoption. The results from this study call for a more standardized training approach with an emphasis on adequate clinical exposure, utilization of peer reviewed educational curriculum and supplemental material to aid pain medicine fellows' education.
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Affiliation(s)
- Ammar Mahmoud
- Department of Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | - Mansoor M Aman
- Department of Pain Medicine, Advocate Aurora Health, Oshkosh, WI, USA
| | - Jennifer L Trumbo
- Clinical Research Center, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | - Umera Paracha
- Department of Neurology, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | - Ashley Langell
- Department of Pain Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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White WW, Jung MJ. Three-Dimensional Virtual Reality Spinal Cord Stimulator Training Improves Trainee Procedural Confidence and Performance. Neuromodulation 2023; 26:1381-1386. [PMID: 35570148 DOI: 10.1016/j.neurom.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study evaluates the use of a three-dimensional virtual reality spinal cord stimulator (SCS) training system to enhance trainee confidence and technical proficiency with interlaminar epidural access and SCS placement. MATERIALS AND METHODS A total of 14 trainees comprising pain fellows and residents were recruited. Experience and confidence levels were established through pre- and postsurveys. Each trainee performed two sessions placing SCS leads using the training device. In between attempts, a standardized teaching session was performed with the simulator. Performance during each attempt was assessed through objective measures such as needle angle and an evaluation rubric Pain Procedure Rating System (PaPRS). Statistical analysis was performed through paired sample t-test to evaluate a single group between separate trials, whereas unpaired t-test was used to assess the difference between the two groups at baseline or within a single trial. RESULTS Participants had statistically significant improvements in their ability to safely access the epidural space (57.1% improving to 100%, p < 0.01) and to effectively drive percutaneous leads to the target level (7.1% improving to 71.4%, p < 0.001). The mean confidence levels improved by 71.4% for interlaminar epidural access (p < 0.001) and 306% for SCS placement (p < 0.001). The mean procedural efficiency (total procedure time) improved by 43.2% (p < 0.001). The PaPRS total score increased by an average of 73.3% (p < 0.001). CONCLUSIONS Virtually simulated neuromodulation training is a viable and effective method of augmenting neuromodulation education. Such didactics are options vital for neuromodulation training, given variable exposure during residency and fellowship.
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Affiliation(s)
- William W White
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of California, Davis, University of California Davis Medical Center, Sacramento, CA, USA.
| | - Michael J Jung
- Department of Anesthesiology and Pain Medicine, University of California, Davis, University of California Davis Medical Center, Sacramento, CA, USA
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Pritzlaff SG, Goree JH, Hagedorn JM, Lee DW, Chapman KB, Christiansen S, Dudas A, Escobar A, Gilligan CJ, Guirguis M, Gulati A, Jameson J, Mallard CJ, Murphy MZ, Patel KV, Patel RG, Sheth SJ, Vanterpool S, Singh V, Smith G, Strand NH, Vu CM, Suvar T, Chakravarthy K, Kapural L, Leong MS, Lubenow TR, Abd-Elsayed A, Pope JE, Sayed D, Deer TR. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation: A Proposal for Standardization in Fellowship and Training Programs. J Pain Res 2023; 16:3101-3117. [PMID: 37727682 PMCID: PMC10505612 DOI: 10.2147/jpr.s424589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
The need to be competent in neuromodulation is and should be a prerequisite prior to completing a fellowship in interventional pain medicine. Unfortunately, many programs lack acceptable candidates for these advanced therapies, and fellows may not receive adequate exposure to neuromodulation procedures. The American Society of Pain and Neuroscience (ASPN) desires to create a consensus of experts to set a minimum standard of competence for neurostimulation procedures, including spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), and peripheral nerve stimulation (PNS). The executive board of ASPN accepted nominations for colleagues with excellence in the subject matter of neuromodulation and physician education. This diverse group used peer-reviewed literature and, based on grading of evidence and expert opinion, developed critical consensus guides for training that all accredited fellowship programs should adopt. For each consensus point, transparency and recusal were used to eliminate bias, and an author was nominated for evidence grading oversight and bias control. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation sets a standard for neuromodulation training in pain fellowship training programs. The consensus panel has determined several recommendations to improve care in the United States for patients undergoing neuromodulation. As neuromodulation training in the United States has evolved dramatically, these therapies have become ubiquitous in pain medicine. Unfortunately, fellowship programs and the Accreditation Council for Graduate Medical Education (ACGME) pain program requirements have not progressed training to match the demands of modern advancements. PEAK sets a new standard for fellowship training and presents thirteen practice areas vital for physician competence in neuromodulation.
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Affiliation(s)
- Scott G Pritzlaff
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA
| | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Mayo Clinic, Rochester, MN, USA
| | - David W Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | | | - Sandy Christiansen
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Andrew Dudas
- Mays & Schnapp Neurospine and Pain, Memphis, TN, USA
| | | | - Christopher J Gilligan
- Division of Pain Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA
| | - Maged Guirguis
- Division of Pain Management, Ochsner Health, New Orleans, LA, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Kiran V Patel
- Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | | | - Samir J Sheth
- Interventional Pain Management, Sutter Health, Roseville, CA, USA
| | | | - Vinita Singh
- Department of Anesthesiology, Emory University, Atlanta, GA, USA
| | - Gregory Smith
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Natalie H Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | - Chau M Vu
- Evolve Restorative Center, Santa Rosa, CA, USA
| | - Tolga Suvar
- Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Michael S Leong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Timothy R Lubenow
- Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Dawood Sayed
- Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas, Kansas City, KS, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Durbhakula S, Toy S, Acosta CA, Barman RA, Kelner AF, Issa MA, Broachwala MY, Marascalchi BJ, Navalgund YA, Pak DJ, Petersen EA, Mehta ND, Moeschler SM, Kohan LR. Needs-based novel digital curriculum for the neuromodulation training deficit: Pain Rounds. Reg Anesth Pain Med 2023; 48:414-419. [PMID: 37055185 PMCID: PMC10359535 DOI: 10.1136/rapm-2023-104480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
This study reports the needs-based development, effectiveness and feasibility of a novel, comprehensive spinal cord stimulation (SCS) digital curriculum designed for pain medicine trainees. The curriculum aims to address the documented systematic variability in SCS education and empower physicians with SCS expertise, which has been linked to utilization patterns and patient outcomes. Following a needs assessment, the authors developed a three-part SCS e-learning video curriculum with baseline and postcourse knowledge tests. Best practices were used for educational video production and test-question development. The study period was from 1 February 2020 to 31 December 2020. A total of 202 US-based pain fellows across two cohorts (early-fellowship and late-fellowship) completed the baseline knowledge assessment, while 122, 96 and 88 participants completed all available post-tests for Part I (Fundamentals), Part II (Cadaver Lab) and Part III (Decision Making, The Literature and Critical Applications), respectively. Both cohorts significantly increased knowledge scores from baseline to immediate post-test in all curriculum parts (p<0.001). The early-fellowship cohort experienced a higher rate of knowledge gain for Parts I and II (p=0.045 and p=0.027, respectively). On average, participants viewed 6.4 out of 9.6 hours (67%) of video content. Self-reported prior SCS experience had low to moderate positive correlations with Part I and Part III pretest scores (r=0.25, p=0.006; r=0.37, p<0.001, respectively). Initial evidence suggests that Pain Rounds provides an innovative and effective solution to the SCS curriculum deficit. A future controlled study should examine this digital curriculum's long-term impact on SCS practice and treatment outcomes.
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Affiliation(s)
- Shravani Durbhakula
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Serkan Toy
- Departments of Basic Science Education and Health Systems & Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Carlos A Acosta
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ross A Barman
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Mustafa Y Broachwala
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bryan J Marascalchi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Daniel J Pak
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Neel D Mehta
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Susan M Moeschler
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lynn R Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
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Chow C, Rosenquist R. Trends in spinal cord stimulation utilization: change, growth and implications for the future. Reg Anesth Pain Med 2023; 48:296-301. [PMID: 37080580 DOI: 10.1136/rapm-2023-104346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
Chronic pain impacts more than 100 million Americans and has a significant impact on the economy and quality of life. Spinal cord stimulation (SCS) has demonstrated efficacy in managing a growing number of chronic pain conditions. This in combination with an increasing number of physicians trained in SCS placement has produced significant changes in utilization, expense and sites of service related to SCS. In particular, there has been a large increase in SCS placement by non-surgeons, use of percutaneous leads and performance in ambulatory surgery centers instead of inpatient settings. There are also notable differences in SCS use related to age, race, insurance coverage and geography. There is a large potential market and use of these therapies is predicted to grow from $2.41 billion in 2020 to $4.12 billion US dollars globally by 2027. At the same time, there is increasing scrutiny around utilization of this therapy related to cost, complications, long-term efficacy and explant rates that has the potential to impact access to this therapy in the future. We must examine our indications, technique and management to optimize outcomes and utilization of SCS going forward.
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Affiliation(s)
- Courtney Chow
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
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Tieppo Francio V, Gill B, Hagedorn JM, Pagan Rosado R, Pritzlaff S, Furnish T, Kohan L, Sayed D. Factors involved in applicant interview selection and ranking for chronic pain medicine fellowship. Reg Anesth Pain Med 2022; 47:rapm-2022-103538. [PMID: 35760514 PMCID: PMC9411898 DOI: 10.1136/rapm-2022-103538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/16/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Applicants to chronic pain medicine fellowship programs often express confusion regarding the importance of various selection criteria. This study sought to elucidate program directors' considerations in applicant selection for fellowship interviews and ranking and to correlate these criteria with match statistics to provide a guide for prospective candidates. METHODS An electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited chronic pain fellowship directors. The importance of various applicant characteristics were evaluated and compared with recent match data. RESULTS Fifty-seven program directors completed the survey. The most important factors involved in applicant interview selection were perceived commitment to the specialty, letters of recommendation from pain faculty, scholarly activities, and leadership experiences. Although completion of a pain rotation was valued highly, experience with procedures was of relatively low importance. There was no preference if rotations were completed within the responders' department. Variability was noted when considering internal applicants or the applicant's geographic location. When citing main factors in ranking applicants, interpersonal skills, interview impression and applicant's fit within the institution were highly ranked by most responders. DISCUSSION Assessment of an applicant's commitment to chronic pain is challenging. Most responders prioritize the applicant's commitment to chronic pain as a specialty, scholarly activity, participation in chronic pain rotations, pain-related conferences and letters of recommendation from pain faculty. Chronic pain medicine fellowship candidates should establish a progressive pattern of genuine interest and involvement within the specialty during residency training to optimize their fellowship match potential.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Benjamin Gill
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, Missouri, USA
| | | | - Robert Pagan Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Pritzlaff
- Department of Anesthesiology and Pain Medicine, University of California Davis, Davis, California, USA
| | - Timothy Furnish
- Department of Anesthesiology, UC San Diego, San Diego, California, USA
| | - Lynn Kohan
- Divsion of Pain Medicine/Department of Anesthesia, University of Virginia, Charlottesville, Virginia, USA
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Bihani P, Jaju R, Saxena M, Paliwal N, Tharu V. “The show must go on”: Aftermath of Covid-19 on anesthesiology residency programs. Saudi J Anaesth 2022; 16:452-456. [DOI: 10.4103/sja.sja_563_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022] Open
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Deer TR, Russo MA, Grider JS, Pope J, Rigoard P, Hagedorn JM, Naidu R, Patterson DG, Wilson D, Lubenow TR, Buvanendran A, Sheth SJ, Abdallah R, Knezevic NN, Schu S, Nijhuis H, Mehta P, Vallejo R, Shah JM, Harned ME, Jassal N, Gonzalez JM, Pittelkow TP, Patel S, Bojanic S, Chapman K, Strand N, Green AL, Pahapill P, Dario A, Piedimonte F, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for Surgical Technique for Spinal Cord Stimulation. Neuromodulation 2022; 25:1-34. [PMID: 35041578 DOI: 10.1016/j.neurom.2021.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/21/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The field of neurostimulation for the treatment of chronic pain is a rapidly developing area of medicine. Although neurostimulation therapies have advanced significantly as a result of technologic improvements, surgical planning, device placement, and postoperative care are of equal importance to optimize outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for these often-overlooked areas of neurostimulation practice. MATERIALS AND METHODS Authors were chosen based on their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from the last NACC publication in 2017 to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on evidence strength and consensus when evidence was scant. RESULTS This NACC project provides guidance on preoperative assessment, intraoperative techniques, and postoperative management in the form of consensus points with supportive evidence. These results are based on grade of evidence, strength of consensus, and expert opinion. CONCLUSIONS The NACC has given guidance for a surgical plan that encompasses the patient journey from the planning stage through the surgical experience and postoperative care. The overall recommendations are designed to improve efficacy and the safety of patients undergoing these neuromodulation procedures and are intended to apply throughout the international community.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Centers of the Virginias, Charleston, WV, USA.
| | - Marc A Russo
- Hunter Pain Specialists, Newcastle, New South Wales, Australia
| | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | - Philippe Rigoard
- Department of Spine Surgery and Neuromodulation, PRISMATICS Lab, Poitiers University Hospital, Poitiers, France
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ramana Naidu
- California Orthopedics & Spine, Larkspur, CA, USA
| | | | - Derron Wilson
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy R Lubenow
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Samir J Sheth
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA, USA
| | - Rany Abdallah
- Center for Interventional Pain and Spine, Milford, DE, USA
| | - N Nick Knezevic
- Department of Anesthesiology and Surgery at University of Illinois, Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Stefan Schu
- Leitender Arzt Neuromodulation, Neurochirurgie, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Harold Nijhuis
- Department of Anesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Jay M Shah
- SamWell Institute for Pain Management, Colonia, NJ, USA
| | - Michael E Harned
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Jose Manuel Gonzalez
- Hospital Clínico Universitario Virgen de la Victoria, Servicio Andaluz de Salud, Málaga, Spain
| | - Thomas P Pittelkow
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, England, UK
| | - Kenneth Chapman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, The Pain and Spine Institute of New York, New York, NY, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, England, UK
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alessandro Dario
- Department of Neurosurgery, ASST Settelaghi, Insubria University, Varese, Italy
| | | | - Robert M Levy
- International Neuromodulation Society, Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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D'Souza RS, Peterson A, Barman R, Moman RN, Olatoye O. Radiation Use Trends During Spinal Cord Stimulator Placement Performed by Fellow Trainees. PAIN MEDICINE 2021; 22:3100-3102. [PMID: 34255077 DOI: 10.1093/pm/pnab218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ashley Peterson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ross Barman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rajat N Moman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Oludare Olatoye
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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12
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Naidu RK, Chaturvedi R, Engle AM, Mehta P, Su B, Chakravarthy K, Amirdelfan K, Henn J, Sayed D, Grider J, Deer T. Interventional Spine and Pain Procedure Credentialing: Guidelines from the American Society of Pain & Neuroscience. J Pain Res 2021; 14:2777-2791. [PMID: 34531681 PMCID: PMC8439288 DOI: 10.2147/jpr.s309705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/22/2021] [Indexed: 01/18/2023] Open
Abstract
Background The discipline of interventional pain management has changed significantly over the past decade with an expected greater evolution in the next decade. Not only have the number of procedures increased, some of the procedures that were created for spine surgeons are becoming more facile in the hands of the interventional pain physician. Such change has outpaced academic institutions, societies, and boards. When a pain physician is in the credentialing process for novel procedure privileges, it can leave the healthcare system in a challenging situation with little to base their decision upon. Methods This paper was developed by a consensus working group from the American Society of Pain and Neuroscience from various disciplines. The goal was to develop processes and resources to aid in the credentialing process. Results These guidelines from the American Society of Pain and Neuroscience provide background information to help facilities create a process to appropriately credential physicians on novel procedures. They are not intended to serve as a standard or legal precedent. Conclusion This paper serves as a guide for facilities to credential physicians on novel procedures.
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Affiliation(s)
| | - Rahul Chaturvedi
- School of Medicine, University of California - San Diego, San Diego, CA, USA
| | - Alyson M Engle
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
| | | | - Brian Su
- California Orthopedics & Spine, Larkspur, CA, USA
| | - Krishnan Chakravarthy
- Department of Anesthesiology, University of California - San Diego, San Diego, CA, USA
| | | | - Jeffrey Henn
- Joint Implant Surgeons of Florida, Fort Myers, FL, USA
| | - Dawood Sayed
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jay Grider
- Department of Anesthesiology, University of Kentucky, Lexington, KY, USA
| | - Timothy Deer
- The Spine & Nerve Centers of the Virginias, Charleston, WV, USA
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13
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Hagedorn JM, Moeschler S, Furnish T, Sayed D, Durbhakula S. Impact of COVID-19 on Pain Medicine Fellowship Training. Reg Anesth Pain Med 2020; 46:188-189. [PMID: 32345656 DOI: 10.1136/rapm-2020-101534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan Moeschler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy Furnish
- Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Dawood Sayed
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Shravani Durbhakula
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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14
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Pittelkow TP, Hagedorn JM, Bendel MA, Eldrige JS, Pingree MJ, Mauck WD, Gazelka HM, Lamer TJ, Sanders RA, Billinges HA, Moeschler SM. Pain medicine fellow neuromodulation surgical skill assessment tool: a pilot. Reg Anesth Pain Med 2019; 45:rapm-2019-100761. [PMID: 31694935 DOI: 10.1136/rapm-2019-100761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) is an evidence-based therapy for the treatment of refractory pain. Current American College of Graduate Medical Education requirements for pain medicine fellowship graduation include observation of five neuromodulation cases. Matriculating fellows have varying degrees of technical skill, training, and experience. The purpose of this study was to use an innovative skill-based assessment tool using the validated Zwisch scale to evaluate fellow surgical performance during SCS cases. DESIGN Cross-sectional survey SETTING: Mayo Clinic, Rochester, Minnesota. SUBJECTS Consultant faculty (10) in the Division of Pain Medicine and pain medicine fellows (5). METHODS A list of faculty-driven neuromodulation surgical objectives was formed and a rubric was created that focused on technical approach, imaging, epidural access and wound closure. Consultants who perform surgical cases were instructed to use the Zwisch scale as a guide to evaluate fellow surgical performance during a neuromodulation case. Faculty and fellows were surveyed before and after implementation of the tool to determine their satisfaction with use of the skill assessment tool. RESULTS The consultants reported they were more satisfied, consistent, and efficient with feedback provided to the trainee on every aspect of neuromodulation surgical cases. The improvement was most significant during the fellows' intraoperative skill assessment. The fellows indicated increased satisfaction, improved communication, and increased efficiency of feedback when the tool was utilized. The fellows reported greater intraoperative skill assessment and consistency of feedback provided. CONCLUSIONS The diverse nature of primary specialty backgrounds observed in pain medicine fellowship training offers a unique opportunity to assess and improve fellow skill and surgical competence in the field of neuromodulation. Both faculty and fellows reported improved satisfaction, consistency and efficiency with feedback provided. Importantly, this pilot project observed that implementation of a skill assessment tool was beneficial for both the faculty and fellow as the feedback received was viewed as strongly beneficial to the educational experience.
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Affiliation(s)
- Thomas P Pittelkow
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan M Hagedorn
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Markus A Bendel
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason S Eldrige
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Pingree
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - W David Mauck
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Halena M Gazelka
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tim J Lamer
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heather A Billinges
- Mayo Clinic, Rochester, Minnesota, USA
- Office of Applied Scholarship and Education Science, Mayo Clinic, Rochester, MN, USA
| | - Susan M Moeschler
- Mayo Clinic, Rochester, Minnesota, USA
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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