Mission

The purpose of the fellowship in Regional Anesthesia & Acute Pain Medicine is to train qualified individuals committed to learning, enhancing, and promoting the specialty of regional anesthesia and acute pain management. A fellow will also become a skilled educator of trainees in the subspecialty of regional anesthesia and acute pain management. This focused training differentiates a consultant in anesthesiology from an expert in the subspecialty of regional anesthesiology and acute pain medicine. Research activities, the development of educational methods, and advanced patient management will be emphasized to achieve goal of creating subspecialists in regional anesthesia and acute pain management. The fellowship is also designed to enhance the clinical experience of National Capital Consortium residents in regional anesthesia and to contribute to the ongoing development of the specialty of regional anesthesia within the NCC.

Vision

Creating consultants in regional anesthesia and acute pain equipped to lead and innovate in support of military operations worldwide.

Aims

Over the course of the 12-month fellowship, the fellow will:

• Enhance his or her cognitive, psychomotor, and affective skills to safely and effectively administer and teach regional anesthesia as a consultant in anesthesiology.
• Be responsible for decisions related to patient selection and technique application to facilitate efficient operating room throughput; safe, effective, cost prudent patient care; and enhanced patient recovery. 
• Be expected to develop the skills needed to establish a regional anesthesia and acute pain management practice as a primary component of his or her future practice in
  anesthesiology.

Weekly lectures and discussions from Regional Anesthesiology & Acute Pain Medicine attendings, Access to Anesthesia Toolbox, Weekly Grand Rounds through the Walter Reed National Military Medical Center (WRNMMC) Anesthesia Department, and access to multiple oral board examiners skilled in preparing trainees for the American Board of Anesthesiology APPLIED Exam.

Our fellowship offers the following rotations: 

• Regional Anesthesiology - 6 to 7 months*
• Chronic Pain - 1 month
• Acute Pain - 4 months

*There is an optional research month in lieu of a Regional Rotation. Amount of allocated research days during the rest of the year would be reduced as appropriate bringing total regional months to a minimum of six.

Most rotations are completed at WRNMMC with the exception of: 

• Three months of Regional Anesthesiology (in one month duration blocks) at the following locations:
  • University of Maryland Shock Trauma Center, Baltimore, Maryland
  • University of Florida  College of Medicine, Gainesville, Florida
  • Brooke Army Medical Center, San Antonio, Texas

There are no electives offered in our one year program. 

There is no required after-hours call. Trainees are encouraged to coordinate with the APS attending to share weekend rounding duties but there is no mandatory weekend rounding schedule.

Working at WRNMMC continues to involve taking care of those injured in the line of duty, both downrange and stateside. We also have a large volume of wounded warrior patients who continue to receive care for injuries incurred in the Global War on Terror. Both the regional service and the Acute Pain Service present opportunities to care for these patients. There is also the ability to interact with the Regional Anesthesia and Pain Medicine in Military Medicine American Society of Regional Anesthesia and Pain Medicine (ASRA) Special Interest Group, and Regional Anesthesia and Pain Medicine Journal Club.

Our program holds a monthly cadaver lab.

Built into our fellowship curriculum, large part of the fellowship is functioning as RAAPM expert and teaching trainees from multiple specialties, from medical student through other fellows. Large amount of time at WRNMMC involves leading and teaching residents.

Multiple ongoing research projects for fellows to participate in, and support to pursue/develop their own projects. Attendance at two conferences/year funded by program, and access to Defense and Veterans Center for Integrative Pain Management (DVCIPM) and WRNMMC Anesthesiology Residency for research/quality improvement partnerships.

One project expected over the course of fellowship year and there is ample time for completion.

• WRNMMC = Walter Reed National Military Medical Center
• HSS = Hospital for Special Surgery, New York, New York
• UF = University of Florida College of Medicine, Gainesville, Florida
• BAMC = Brooke Army Medical Center, San Antonio Texas

Our program offers rotations to residents interested in applying to Regional Anesthesia and Acute Pain Medicine. Rotations are typically four weeks (one block) long and include clinic, procedures, operative cases, didactic opportunities, simulation experiences, and catered time for learning about the values and culture of the program. Students interested in rotating with our program should contact dha.ncr.walter-reed-med-ctr.list.ncc-reganes-acutepain@health.mil and follow guidance through WRNMMC Graduate Medical Education regarding rotation logistics.

Interviews occur with Program Director and Associate Program Director in person for local applicants and over Google Meets for geographically distant ones. Interviews are scheduled in the fall, following review of application packets submitted through the military's online application system. Reach out to PD/APD with questions.

No specialty board exam offered in Regional Anesthesia and Acute Pain Medicine. Applicants must be board eligible or certified in Anesthesiology.

• Present once during the second half of the fellowship year at Anesthesia Grand Rounds covering a topic or case relevant to regional anesthesia.
• Prepare resident education lectures or journal reviews for the regional anesthesia subspecialty conference.
• Participate in and direct portions of the fresh cadaver anatomy labs organized for anesthesia residents as part of their annual curriculum.
• Participate in the an annual recognized scientific meeting with poster, lecture, or problem-based learning presentations where possible.
• Solidify teaching techniques by instructing residents at the bedside in the Regional Anesthesia Area under the supervision of faculty.
• Learn teaching techniques by directing the acute pain service under the supervision of faculty in the second half of the academic year.
• Participate in the education of residents and student nurse anesthetists as part of the fellow’s clinical commitment in the general OR.
• Review and enhance web-based teaching resources including the resident handbook, curriculum document, and self-study and testing materials.

• First day of each month a fellow is responsible for giving the "nuts and bolts" presentation and ensuring new rotating residents have viewed the lecture and been given the opportunity to ask questions if not available on the day it was given (i.e., post call from another service, etc.
• Review and select articles for monthly journal club and moderate each monthly Journal Club session; attendance is expected monthly when not on vacation.
• Participation in the resident lecture series.
• The fellow is expected to remain to assist with all block procedures and ensure patient disposition is accounted for before leaving the unit:
  • Block assignments are to be made for the following day in consultation with the attending faculty member responsible for the following day’s regional assignment.
  • Daily operating room schedule surveillance for patients with appropriate diagnoses and procedure posting.
  • Identification of patients suitable for regional anesthetic techniques and release of the block list daily before 12 p.m. for the following day’s operating room schedule when possible.

• Regional Anesthesia and Acute Pain Medicine
• Obstetric Anesthesia
• Chronic Pain Medicine

Fellow works each day with two faculty devoted exclusively to Regional Anesthesiology & Acute Pain Medicine. Faculty cohort is a close knit group dedicated to fellow education, fellow integrated with faculty education and research projects.

The RAAPM Fellowship follows the guidelines set by the ACGME with respect to monitoring and addressing the wellbeing of trainees and faculty. The program recognizes that burnout is a significant issue for Anesthesiology and its subspecialties. To this end, the RAAPM fellowship prioritizes efforts to engender resilience and wellness among trainees while ensuring they achieve the necessary competencies to become consultants in this field. The Fellowship Program has incorporated Wellness modules in its online training curricula via the Anesthesia Toolbox. Walter Reed National Military Medical center offers multiple resources to help foster trainee and faculty wellbeing, these include:

• Monthly lecture series organized by the Chair of the Provider Resiliency Committee. Topics include resiliency, leadership, conflict resolution, feedback, and team building
• Self and peer referral to the Integrative Health and Wellness Service
• Self-referral to the Adult Outpatient Behavioral Health Service
• Walter Reed Resiliency Services are offered through the Psychological Health Services
• Chaplain Services
• Military One Source offer short term therapy programs for service members and their families