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Regional Anesthesiology & Acute Pain Medicine Fellowship Program

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Thank you for your interest in our Regional Anesthesiology & Acute Pain Medicine Fellowship Program!

Westchester Medical Center/New York Medical College (WMC/NYMC) is the major tertiary referral center and level one trauma hospital for the beautiful Hudson Valley located half an hour north of New York City. Westchester Medical Center offers a busy block schedule with a daily dedicated regional anesthesiologist. Our Regional Anesthesia Fellowship is designed to give advanced clinical, technical and research training in the field of regional anesthesia and acute pain medicine.

Under the leadership of regional anesthesia & acute pain management section, the Department of Anesthesiology at WMC has developed into a dynamic institution that thrives to perform regional anesthesia on a diverse population including orthopedic, general surgery, gynecologic, organ transplant, thoracic, vascular, trauma, and pediatric cases. Our varieties of blocks performed include neuraxial, truncal, and peripheral extremity nerve blocks.

In addition to the hands on training of regional anesthesia, fellow will be expected to manage perioperative pain on inpatients as an emerging acute pain specialist. The fellow will round daily with the acute pain management team and manage acute pain consultations, continuous peripheral nerve catheters and thoracic epidurals. The fellow will also participate in multimodal pharmacologic management of post-operative pain including, but not limited to the use of opioids, patient controlled analgesia, and adjunctive medications. Additionally, the fellow would have one month chronic pain management rotation, to learn the interventional pain procedures and chronic pain consultations.

The fellow’s responsibilities will be balanced between performing and supervising regional techniques perioperatively and dedicated time to produce clinical research and classroom education. We have a formal Regional Anesthesiology & Acute Pain fellowship curriculum that includes didactics lecture series, Journal Club, cadaver workshops, etc. Fellows will have protected research time. Fellow is expected to initiate and complete at least one major academic project during their fellowship, and is required to present at the national conference. In addition, the fellow will be involved in a research project with the goal of being published in a well-respected journal.

I hope that the information on this website provides you with a helpful overview of our training program, details about our current curriculum and objectives for our fellows, the application process, and an appreciation of the many opportunities for professional and personal growth here at WMC/NYMC. As you consider your choice of Regional Anesthesiology and Acute Pain Medicine fellowship programs, we hope that your individual goals and priorities will find a good fit here at WMC. As our fellows will tell you, I am always available to them, so if you have any questions about our program please feel free to contact me at any time.


Sincerely,


Jeff L. Xu, MD
Chief, Division of Regional Anesthesia & Acute Pain Management
Program Director, Regional Anesthesiology & Acute Pain Medicine Fellowship
Clinical Assistant Professor of Anesthesiology

Department of Anesthesiology
Westchester Medical Center/ New York Medical College
100 Woods Road, Valhalla, NY 10595
jeff.xu@wmchealth.org

Overview
Our Regional Anesthesiology & Acute Pain Medicine Fellowship Program is in the process to become ACGME accredited. The duration of the program is one year. Currently we have two positions available. Salary: $73,440, + benefits. $1500.00 is Professional Fund for conferences, books, and additional educational endeavors. More funding is available if presenting in the national conferences as the first author. There is also the opportunity to moonlight. Our application period is July 1st, until slots are filled. Applicant qualifications are:
1. Completion of an ACGME-accredited Anesthesia Residency program.
2. Eligible to hold unrestricted New York State Medical License, New York State Controlled Dangerous Substances (CDS) registration, and United States DEA Registration Certificate.

Curriculum Goals
The goal of the Regional Anesthesiology and Acute Pain Medicine Fellowship is for the fellow to develop the skills and knowledge base necessary to perform basic, intermediate, and advanced regional nerve blocks and manage acute pain.

After completion of the fellowship, graduates will:
• be experts in the management of acute pain in the perioperative and peri-trauma period
• have developed the knowledge and skills necessary to be a valued consultant in the perioperative management of acute and acute-on-chronic pain
• be able to perform the application and supervision of appropriate treatment protocols
• be able to assist with clinical data collection, to participate in research projects, presentations and teaching.

Clinical Practice Sites
Westchester Medical Center (WMC)
Maria Fareri Children’s Hospital
Danbury Hospital

Objectives
The goals of the one year advanced training program are organized according to ACGME core competencies.

Professionalism
Fellows are expected to:
1. Act responsibly and with integrity with their patients, nurses, residents, fellows, and health care providers.
2. Fulfill clinical duties in a timely and appropriate manner.
3. Adhere to ethical principles including respect for patient privacy.
4. Demonstrate an active interest in learning and participating in the care of patients receiving regional anesthesia.

Interpersonal and Communication Skills
As advanced trainees, fellows will be expected to interact well with and demonstrate cultural sensitivity to patients, nurses, nurse anesthetists, surgeons and attending anesthesiologists, residents, medical students, and other trainees. They will refine their skills in educating and preparing patients for the regional nerve blocks or other interventional acute pain procedures. Fellow is expected to:
1. Obtain appropriate informed consent from patients; provide effective patient education regarding indications, risks and side effects of procedures; paying special attention to identifying laterality for unilateral procedures.
2. Communicate effectively with other members of the team.
3. Initiate and appropriately conduct a pre-procedure “timeout.”
4. Properly and accurately document in the medical record any procedures performed.
5. Provide education to more junior members of the care team, including residents, medical students, junior perioperative nurses, and other trainees.

Medical Knowledge and Clinical Skills
By the end of training, fellows will demonstrate expert knowledge in the following areas:
1. Medical Management of Acute Pain:
1.1. Local anesthetic pharmacology, toxicity, and appropriate clinical usage in peripheral, neuraxial, and systemic analgesia, and use of adjuvants.
1.2. Appropriate use of opioids (systemic and neuraxial) in treating acute pain states, and implications related to their side-effects.
1.3. Advanced management of acute pain with multimodal analgesics, including understanding the pharmacology of NSAIDs, COX-2 inhibitors, NMDA antagonists, α2-agonists, α2δ-Ca2+ channel blockers (i.e. gabapentinoids).
1.4. Management of patients with chronic pain and chronic opioid use/abuse.
1.5. Direct the acute pain medicine service with attending supervision.

2. Interventional Management of Acute Pain:
2.1. Nerve localization techniques, including principles of ultrasound and nerve-stimulation technologies, and other localization methods (i.e. hanging drop, loss of resistance, landmark techniques).
2.2. Methods, rational, and appropriate application of single-shot and continuous catheter techniques.
2.3. Applied functional regional anatomy as relevant to the surgical procedure and/ or block technique employed, including positioning patients for performing blocks.
2.4. Appropriate use of procedural sedation when performing interventional procedures.
2.5. Appropriate patient selection for and choice of interventional nerve blockade with/without catheter placement.
2.6. Recognition and management of complications related to interventional acute pain management (i.e. hemodynamic compromise, local anesthetic toxicity).
2.7. Peripheral nerve blocks including (not limited):

A. Level I peripheral nerve block procedures
Supraclavicular Nerve Block
Axillary Nerve Block
Musculocutaneous Nerve
Femoral Nerve block
Adductor Cannel/Saphenous Nerve Block
Sciatic Nerve Block- Popliteal Region
Ankle Block
Transversus Abdominis Plane (TAP) Block
Rectus Sheath Block

B. Level II peripheral nerve block procedures
Cervical Plexus Nerve Block
Interscalene Nerve Block
Infraclavicular Nerve Block
Peripheral Single Nerve Block
- Median Nerve
- Radial Nerve
- Ulnar Nerve
Sciatic Nerve Block- Gluteal Region
Fascia Iliaca Nerve Block
PECS I & II
Lumbar Plexus Nerve Block
Quadratus Lumborum (QL) Block
Thoracic Paravertebral Block (PVB)
Continuous peripheral nerve catheter placement
2.8. The art and science of spinal anesthesia and associated side effects.
2.9. Appropriate postop management of peripheral nerve and epidural catheters to achieve effective pain control.

Practice-based Learning and Improvement
During training, fellow will further develop an understanding of and apply critical analysis of the relevant primary source literature relevant to the various acute pain phamacotherapeutic modalities, including regional nerve blockade techniques. Fellows will also moderate and lead a monthly Journal Club on topics relevant to the specialty.

Patient Care
By the end of the advanced training fellowship, graduating fellows will be expected to independently:
1. Assess patients’ appropriateness for placement of peripheral or neuraxial nerve blocks with/without catheters.
2. Setup and properly position patients for peripheral nerve blocks.
3. Select appropriate procedural sedation based on patient and/or procedure factors.
4. Select the appropriate nerve localization technique using nerve stimulation vs. ultrasound vs. landmarks.
5. Select alternative approaches to perioperative pain control in non-traditional patient populations (i.e. chronic pain, anatomical variants, infected patients, low weight patients, etc.)
6. Manage block failures (single-injection and/or continuous catheter techniques)
7. Perform and complete peripheral nerve and neuraxial procedures.
8. Medically manage surgical patients’ acute pain in the perioperative period (pre-, intra-, and post-op)
9. Provide expert patient care recommendations as a consultant in Acute Pain Medicine to requesting medical and surgical specialists, and counsel patients on appropriate modalities of pain management in the acute setting.

Systems-based Practice
The fellow will develop an awareness of and responsiveness to the needs of the large health care system as it relates to the acute pain patient receiving regional anesthesia, both as a primary anesthetic and for postoperative analgesia. He/she will also understand the rationale for and participate in hospital initiatives to improve quality and efficiency in the operating room as it pertains to acute pain medicine and regional anesthetic techniques.
1. Work effectively as a member of and with the patient care team.
2. Understand basic principles of safety in administering regional nerve blocks.
3. Identify areas for quality improvement in the administration of acute pain and regional anesthesia.
4. Understand the documentation of regional nerve block and acute interventional pain procedures.

Assessments
The fellow will receive evaluations by the Section of Regional Anesthesia and Acute Pain Management. Fellow will maintain a procedure log that will be evaluated quarterly or more frequently, as needed, by the fellowship program director for the number and type of nerve blocks or other regional anesthetic techniques to ensure they are obtaining adequate experience.

Additional Educational Opportunities
1. Lead the cadaver dissection lab workshop for WMC residents at New York Medical College.
2. Annual Sonoanatomy/ultrasonography course in regional anesthesia for WMC residents.
3. Specialized rotation in Point-of-Care Ultrasound use in clinical care (cardiac echo, FAST, AAA, abdomen) done in conjunction with faculty from the WMC Department of Radiology.
4. Regional anesthesia Journal Club (directed by fellows with faculty guidance)
5. Fellow-directed specialty-topic discussions with residents on service.
6. Advanced lecture given by each fellow on a specific topic germane to the practice of Regional Anesthesia & Acute Pain Management.
7. Incremental increase in independent responsibilities to function as a Regional Block Attending and as Acute Pain Service attending at end of fellowship year.

Class of 2017-2018


Bernd Dotzauer, MD
Residency: University of Connecticut, Farmington, CT
Fellowship: Critical Care Fellowship, Dartmouth Hitchcock Medical Center, Lebanon, NH

Class of 2018-2019

 

Victor Tseng, MD
Residency: Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Jeff L. Xu, MD
Chief, Division of Regional Anesthesia & Acute Pain Management
Program Director, Regional Anesthesiology & Acute Pain Medicine Fellowship
Assistant Professor of Anesthesiology
Department of Anesthesiology
Westchester Medical Center/New York Medical College

Corrie Burke, MD
Gabriel Bonilla, MD
Maureen F. Cooney, DNP
Tara Doherty, DO
Jian Hou, MD
Mario Inchiosa, PhD
Michael Jacoby, MD
Nitin Sekhri, MD
Wassim Ramzy, MD
Vicky Shapiro, DO
Garret Weber, MD
Saman Yaghoubian, DO
Applicants must meet the following qualifications prior to starting:

1. Completion of an ACGME accredited Anesthesia Residency program
2. Eligible to hold Unrestricted New York State Medical License
3. Personal Statement
4. CV with photo
5. Dean’s Letter (MSPE)
6. Copy of Medical School Transcript
7. USMLE Scores Transcript
8. ITE/AKT Score Report (if applicable)
9. Three Letters of Recommendation from the following: Director of Regional Anesthesia & Acute Pain Service or your Department Chair, Residency Program Director, one additional letter of recommendation
10. Copy of ECFMG (if applicable)
11. Copy of Medical Diploma
12. Copy of Internship Certificate (if applicable)

We support J-1 visa.
Louise Nyemchek,
Fellowship Program Coordinator
Email: Louise.Nyemchek@wmchealth.org
Phone: 914.493.7692

Address:
Regional Anesthesiology and Acute Pain Medicine Fellowship Program
Department of Anesthesiology
Westchester Medical Center/ New York Medical College
100 Woods Road, Macy Rm 2391
Valhalla, NY 10595
Telephone: 914.493.7692
Fax: 914.493.7927