ACGME Accredited : Yes

Duration of Program:  1 year advanced clinical training

Positions Available:  5

Approximate salary for the Class of 2021: $65,000 – $67,000

Applications accepted starting: December 1st

Application deadline: March 1st (or until all slots filled)

Applicant Qualifications (which are required prior to starting 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

The institution will approve candidates for a ECFMG J-1 visa. The institution will also approve candidates who currently hold an H1-B visa, but unfortunately will not approve candidates for a new H1-B visa.

To provide more consistency and predictability to the RAAPM fellowship application process, nearly 60 RAAAPM fellowship programs have decided to participate in a common application and match process provided by SF Match for recruitment. The Johns Hopkins Regional Anesthesia and Acute Pain Medicine Fellowship program is proud to be one of these programs participating in this new match process for the upcoming interview season for the 2024-2025 Academic year.

This matching process, provided by SF Match, analogous to the current match system for trainees in Cardiac, Critical Care, and Obstetric Anesthesiology, will allow fellowship applicants an opportunity to visit and evaluate various training programs systematically over a larger window of time. This resulting match system will improve the equity of the process, create a more flexible and comprehensive interview process, and benefit both applicants and individual programs.

Applicants will have to register with and apply to our program through the SF Match website below. SF Match will be the central site involved in processing applications, accepting rank lists, processing of the match itself, as well as providing post-match vacancy matching.

Regional Anesthesiology & Acute Pain Medicine Fellowship with SF Match Portal (link)

1. Application Portal opens January 9th, 2023
2. Locate program(s) of interest using the ASRA Fellowship Directory
3. Register as an applicant to Regional Anesthesia and Acute Pain Medicine (RAAPM) Fellowship on SFMatch.org.
4. Complete the RAAPM application documents within the SF Match system.
5. Locate program(s) of interest using the ASRA Fellowship Directory
6. Programs will set up interviews once applications are received via SF Match portal.
7. Note all pertinent deadline dates for your application cycle on SF Match website, or the ASRA RAAPM Fellowship Page.
8. Submit rank list before deadline date.
9. In some cases, you may be eligible to commit to a program with an exception agreement, after registration on SF Match. These agreements are initiated by the program director and not the applicant.
10. Obtain match results on date published by SF Match.

We participate in the San Francisco Match.
Application deadline: May 5, 2023
Match Day: June 12, 2023

‌STEP 1

• Complete ASRA Common Application for Regional Anesthesiology ‌
• Submit the following supporting documents to the Program ([email protected]):

1. • CV with photo
   • USMLE (1 & 2) or COMLEX Scores
   • In-Service Exam Scores
   • ABA Basic Score Report
   • 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)

STEP 2

• Interview with program director and faculty members.

STEP 3

• If position is offered and accepted, the prospective fellow will go through the Credentialing Process.

STEP 4

• 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.

Objectives

The Advanced Training in Regional Anesthesia and Acute Pain Program is an accredited one (1) year advanced training program. The goals are organized according to the ACGME core competencies.

Professionalism

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.

Medical Knowledge

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, Axillary)
  • Distal extremity nerve block

• Truncal blocks, including:

• • Paravertebral
  • Quadratus Lumborum
  • Transversus Abdominus Plane
  • Pecs 1, 2, and Serratus Plane
  • Lumbar and thoracic epidural anesthesia/ analgesia

• Lower extremity blockade, including:

• • Lumbar Plexus
  • Femoral
  • Saphenous/adductor canal
  • Sciatic (proximal and distal approaches)
  • Ankle

• 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 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:

• 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

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.

• 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.

Assessments

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

• Rotation with addiction medicine to learn more about inpatient vs outpatient therapy
• Protected research time to work on QI projects or IRB approved studies
• Joint Journal  Clubs with University of Maryland and Walter Reed Hospital
• Cadaver lab workshop for JH residents at JHUSOM (led by Regional Division)
• Annual sonoanatomy/ultrasonography course in regional anesthesia for JH residents  (led by Regional Division)
• 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.  Additional “Bootcamp” day in July for a POCUS crashcourse introduction.
• Regular Journal Club (directed by fellows with faculty guidance)
• Fellow-directed specialty-topic discussions with residents on service
• Advanced lecture series including topics on Contract Negotiation, Private vs Academic Job searches, Program Building, Burn Pain Management, etc.
• Optional elective to do Pediatric Regional Anesthesia and Acute Pain at All Children’s in Florida
• Elective within Chronic Pain Division, access to daily high quality lectures
• Oral board seminar (well regarded, free, network with other fellows from different specialties)OSCE board prep in state of the art simulation center (well regarded and free for fellows)
• Optional Moonlighting as an attending in the Operating Room

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)

2024-2025 Fellows

Shuna Gao, MD

Kelly Kanesniro, MD

Kayvon Mobarakeh, MD, DO

Reade Tillman, MD