What We Teach:
The goal of the Acute Pain Medicine and Regional Anesthesia Fellowship is for fellows to develop the skills and knowledge base necessary to perform basic, intermediate, and advanced regional nerve blocks. After completion of the fellowship, graduates will be experts in the management of acute pain in the perioperative and peri-trauma period, will have developed the knowledge and skills necessary to be a valued consultant in the perioperative management of acute and acute-on-chronic pain, and will have developed expertise in the performance of peripheral nerve and central neuraxial blocks.
ACGME Accredited : No
ABA Certified: No
Duration of Program: 1 year advanced clinical training (hybrid faculty-fellow position)
Positions Available: 4
Application enrollment date(s) or deadline: April 1st (or until all slots filled)
Applicant Qualifications (which are required prior to starting program):
Completion of an ACGME-accredited residency anesthesia program
Eligible to hold:
Unrestricted Maryland State Medical License
Maryland State Controlled Dangerous Substances (CDS) registration
United States DEA Registration Certificate
Eligible to be credentialed and appointed as full faculty
J-1 Visa candidates CANNOT be considered at this time, due to CMS and JHU billing practices
- Complete online fellowship application.
- Submit the following supporting documents to the Program:
- CV with photo
- Medical School Transcripts
- Medical School Performance Evaluation (in English)
- USMLE (1 & 2) or COMLEX Scores
- In-Service Exam Scores (Peds Anesthesia Applicants Only)
- Minimum of 3 Letters of Recommendation (include one letter from current training program)
- Copy of Visa (if applicable)
- Copy of ECFMG Certificate (only applicants who attended medical school outside of the US)
- Interview with program director and faculty members.
- If position is offered and accepted, the prospective fellow will go through the Credentialing Process.
- If the prospective fellow successfully completes the credentialing process, he/she is then scheduled for an orientation.
Applications will be closely reviewed only after receipt of all required materials. The director of the fellowship initiates interview requests, and not all applicants are granted interviews. An on-site interview is required before consideration for acceptance. Intangibles such as evidence of scholarship, judgment, maturity, motivation, and interpersonal skills are all considered. Acceptance into a program is based on demonstrated academic qualification, interpersonal skills, and evidence of ability to function in a multidisciplinary setting.
Although the advanced training fellowship program is not ACGME accredited, the goals of the one (1) year advanced training program is organized according to ACGME core competencies.
Fellows are expected to:
- Act responsibly and with integrity with their patients, nurses, residents, fellows, and health care providers.
- Fulfill clinical duties in a timely and appropriate manner.
- Adhere to ethical principles including respect for patient privacy.
- 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. Fellows are expected to:
- Provide effective patient education regarding indications, risks and side effects of procedures.
- Obtain appropriate informed consent from patients, paying special attention to identifying laterality for unilateral procedures.
- Communicate effectively with other members of the team.
- Initiate and appropriately conduct a pre-procedure “timeout.”
- Properly and accurately document in the medical record any procedures performed.
- Provide education to more junior members of the care team, including residents, medical students, junior perioperative nurses, and other trainees.
By the end of training, fellows will demonstrate expert knowledge in the following areas:
Medical Management of Acute Pain:
- Local anesthetic pharmacology, toxicity, and appropriate clinical usage in peripheral, neuraxial, and systemic analgesia, and use of adjuvants.
- Appropriate use of opioids (systemic and neuraxial) in treating acute pain states, and implications related to their side-effects.
- 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).
- Management of patients with chronic pain and chronic opioid use/ abuse.
- Direct the acute pain medicine service with attending supervision.
Interventional Management of Acute Pain:
- Nerve localization techniques, including principles of ultrasound and nerve-stimulation technologies, and other localization methods (i.e. hanging drop, loss of resistance, landmark techniques).
- Methods, rational, and appropriate application of single-shot and continuous catheter techniques.
- Applied functional regional anatomy as relevant to the surgical procedure and/ or block technique employed, including positioning patients for performing blocks.
- Appropriate use of procedural sedation when performing interventional procedures.
- Appropriate patient selection for and choice of interventional nerve blockade.
- Recognition and management of complications related to interventional acute pain management (i.e. hemodynamic compromise, local anesthetic toxicity).
- Upper extremity blockade, including:
- Cervical plexus
- Brachial plexus (Interscalene, Supraclavicular, Infraclavicular
- Distal extremity nerve block
- Truncal blocks, including:
- Transversus Abdominus Plane
- Lumbar and thoracic epidural anesthesia/ analgesia
- Lower extremity blockade, including:
- Lumbar Plexus
- Saphenous/ adductor canal
- Sciatic (proximal and distal approaches)
- The art and science of spinal anesthesia and associated side effects.
- Appropriate postop management of peripheral nerve and epidural catheters to achieve effective pain control.
Practice-based Learning and Improvement
During training, fellows 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 monthlyJournal Club on topics relevant to the specialty.
By the end of the advanced training fellowship, graduating fellows will be expected to independently:
- Assess patients’ appropriateness for placement of peripheral or neuraxial nerve blocks.
- Setup and properly position patients for peripheral nerve blocks
- Select appropriate procedural sedation based on patient and/ or procedure factors
- Select the appropriate nerve localization technique using nerve stimulation vs. ultrasound vs. landmarks
- Select alternative approaches to perioperative pain control in non-traditional patient populations (i.e. chronic pain, anatomical variants, infected patients, low weight patients, etc.)
- Manage block failures (single-injection and/ or continuous catheter techniques)
- Perform and complete peripheral nerve and neuraxial procedures
- Medically manage surgical patients’ acute pain in the perioperative period (pre-, intra-, and post-op)
- Provide expert patient care recommendations as a consultant in Acute Pain Medicine to requesting medical and surgical specialists
- Counsel patients on appropriate modalities of pain management in the acute setting
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.
- Work effectively as a member of and with the patient care team.
- Understand basic principles of safety in administering regional nerve blocks.
- Identify areas for quality improvement in the administration of acute pain and regional anesthesia.
- Understand the documentation of regional nerve block and acute interventional pain procedures.
The fellow will receive electronic evaluations by the Division of Regional Anesthesia and Acute Pain Management, in addition to verbal feedback during his/ her clinical performance. Fellows 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
- Cadaver dissection lab hosted by University of Maryland
- Cadaver lab workshop for JH residents at JHUSOM (led by fellows)
- Annual Sonoanatomy/ ultrasonography course in regional anesthesia for JH residents
- Specialized rotation in Point-of-Care Ultrasound use in clinical care (cardiac echo, FAST, AAA, abdomen) done in conjunction with faculty from the JHU Department of Emergency Medicine
- Regular Journal Club (directed by fellows with faculty guidance)
- Fellow-directed specialty-topic discussions with residents on service
- Advanced lecture given by each fellow on a specific topic germane to the practice of Acute Pain/ Regional Anesthesia.
- Incremental increase in independent responsibilities to function as a Regional Block Attending while as attending in OR and as APS attending at end of fellowship year.
- Oral board prep tutorial (well regarded; long-standing history and run by a senior member of the JHU ACCM Faculty)
For qualified applicants, a 3-year combined program geared for candidates interested in pursuing an advanced academic research track is available. With this program, the 1-year Acute Pain Medicine and Regional Anesthesia clinical fellowship is combined with 2-years of faculty-level research training made possible by the NIH-sponsored institutional T32 research training grant. This research training grant provides funding for 80% protected non-clinical time, and also offers an opportunity for sponsored advanced study. Prior T32 trainees have chosen to use their grant time to fully fund and complete a MPH degree in clinical investigation, for example, with the Johns Hopkins University Bloomberg School of Public Health. This unique program is designed for developing research leaders in Acute Pain Medicine and Regional Anesthesia. Candidates who are interested in this program should inform the program staff of this interest when applying.
- The Military Advanced Regional Anesthesia and Analgesia Handbook
- Acute Pain Management by Sinatra et al.
- Essentials of Regional Anesthesia by Kaye et al.
- Textbook of Regional Anesthesia and Acute Pain Management by Hadzic
- Acute Pain Management: A Practical Guide, 3rd ed by MacIntyre & Schug
- Ultrasound-Guided Regional Anesthesia and Pain Medicine 4th ed by Bigeleisen
- Mayo Clinic Atlas of Regional Anesthesia and Ultrasound-Guided Nerve Blockade by Hebl
- Pain Resource Center on the American Society of Regional Anesthesia and Pain Medicine (ASRA)
- Links to Other ASRA Resources
- Regional Anesthesia & Pain Medicine (official journal of ASRA)
Rishi Chokshi, MD
Denise Cinquegrana, MD
Minho Kwon, MD
Maggie Miller, MD
Jennifer Smart-Abbey, MD
Acute Pain Medicine and Regional Anesthesia Fellowship Program
Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions
Sheik Zayed Tower 8120L
1800 Orleans Street
Baltimore, MD 21287