Medical Degree Program Admissions Application Criteria & Process Admission Requirements How to Apply FAQs Transfer Policy & Procedures Contact Us Curriculum Electives Information for Incoming Students Student Support 605C - Anesthesiology Acute Pain Service Students must obtain permission from the course coordinator who will obtain faculty approval based on availability prior to enrollment in this course. Home Education Medical Education Medical Degree Program MD Programs Curriculum Anesthesiology Elective > 605C - Anesthesiology Acute Pain Service Course Director, Coordinator and General Administrative Information Faculty & Staff Office Location Phone Email Director: Navid Alem, MD UCI Medical Center 101 The City Dr. S.Bldg. 53Orange, CA 92868 714-456-5518 alemn@hs.uci.edu Coordinator: Minnie Trinh UC Irvine Health Building 53, Room 205 minniet@hs.uci.edu DESCRIPTION Students will participate as an integral member of the Anesthesiology Acute Pain Service inpatient consulting team under the supervision of an attending. Other members of the team may include a fellow, resident, or nurse practitioner. Students will assume responsibility of assigned patients on the service and help manage pre- and postoperative patients with a wide variety of conditions including cardiovascular, hemodynamic, and endocrine abnormalities, etc. The management of acute and chronic pain in the perioperative setting, including regional and neuraxial block management, is a significant component of the experience. Students will perform consults on a variety of patients including patients in the intensive care units. Emphasis is on care of the patient and the student will become proficient in managing unique challenges in this subgroup. PREREQUISITES Successful completion of basic science courses (1st and 2nd year curriculum) and successful completion of either of the following clinical clerkships: general surgery, and/or internal medicine. Extramural students must be in their final year of undergraduate medical education. RESTRICTIONS Enrollment priority will be given to UCI students. This rotation is not accepting international students. This elective is open to third- and fourth-year UCI medical students. COURSE DIRECTOR Navid Alem, MD, Clinical Professor, Acute Pain Service; Course Director, 605E and 605C Clerkship; and, Course Director, Acute Pain Medicine Rotation for Anesthesiology Residents Dr. Alem has devoted much of his time to training students spanning from the early stages of secondary education to post-doctoral fellows. He has won many teaching awards and continuously tries to foster environments rooted in creating a light and dynamic culture of inquiry and education. He remains clinically active in the realms of anesthesiology, acute (inpatient) pain medicine, and chronic (outpatient) pain medicine. As an Associate Program Director for Residency in Anesthesiology, he oversees all curricular matters for the training program. He also serves as the Section Chief of the Acute Pain Service and is the Chief anesthesiology liaison for orthopedic and neurosurgical spine procedures at UCI. He has done research in the realm of perioperative pain optimization care paradigms as well as virtual reality therapy for patients. INFORMATION FOR THE FIRST DAY Minnie Trinh Medical Student Coordinator, UC Irvine Health Building 53, Room 205. Report at 0745 on the first day of the rotation. The resident or fellow assigned to the service for that date will give you the necessary templates for the rotation and assign you patients from the census. SITE: UCI Medical Center. DURATION: Two-week and four-week rotations. SCHEDULING COORDINATOR: UCI students please call (714) 456-8462 to make a scheduling appointment. Extramural students enrolled at a U.S. LCME medical school must use VSAS to apply. To apply please refer to the Visiting Student Learning Opportunities website. PERIODS AVAILABLE: The time of the course must be pre-approved by the elective directors at least three months prior to the start of the course. NUMBER OF STUDENTS ALLOWED: One student per time period (regardless of 2- or 4-week rotation). WHAT STUDENTS SHOULD DO TO PREPARE FOR THE COURSE Prior the start of the rotation the student should visit the Department of Anesthesiology website. All orientation, contact and syllabus information can be found on this site, as well as emailed to the student approximately one week prior to the start of the rotation. COMMUNICATION WITH FACULTY Questions about logistics should be directed to the Course Coordinator, Dean Wong. Direct questions, comments, or concerns about the course can also be directed to the Co-Course Directors. Contact information and office location are at the beginning of this document. The Co-Course Directors are also available to meet in person. Please email minniet@hs.uci.edu to arrange an appointment. To ensure that your email will not be lost in the large volume of email received, please use the following convention for the subject line: SUBJECT: COURSE NAME, your last name, your issue (e.g. XXX, Smith, Request for appointment) Course Objectives and Program Objective Mapping The following are the learning objectives for the 605C – Anesthesiology & Acute Pain Service course. Students are expected to demonstrate proficiency in these areas in order to satisfactorily complete the course. In addition, the extent of a student's mastery of these objectives will help guide the course evaluation and grade. Course Objective Mapped UCI School of Medicine Program Objective Sub Competency Core Competency Provide compassionate, appropriate and effective patient care. Use appropriate empathy in patient care while screening for abuse and diversion related issues. B-5. The ability to practice effective preventive medicine by identifying, addressing and advocating for strategies to maintain health and well-being, to identify and treat disease early where appropriate and to advise on lifestyle practices. Patient Management Skillful Take a thorough pain history, including pain location, radiation, intensity, quality, onset, duration, and exacerbating and alleviating factors. B-1. The ability to competently conduct a medical interview and counseling to take into account patient health beliefs, patient agenda and the need for comprehensive medical and psychosocial assessment. Medical Interview Skillful Perform a musculoskeletal and neurologic physical examination. B-2. The ability to competently perform a complete and organ- system-specific examination including a mental health status examination. Physical Exam Skillful Interact effectively with patients and their families. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations. Professionalism Altruistic Demonstrate respect and care for individuals, recognizing the role of psychosocial factors in chronic pain. C-2. Professional behaviors reflecting compassion and respect for patient privacy, altruism and a commitment to comprehensive, holistic medical care. Compassion Altruistic Identify patients that may require urgent or emergent intervention. B-5. The ability to practice effective preventive medicine by identifying, addressing and advocating for strategies to maintain health and well-being, to identify and treat disease early where appropriate and to advise on lifestyle practices Patient Management Skillful Formulate a differential diagnosis. A-3. Knowledge of basic clinical skills required to meet the skills objectives, including interviewing, physical diagnosis, communication and clinical reasoning processes. Basic Clinical Skills Knowledgeable Formulate a multimodal treatment plan based on the individual patient’s history, expectations and expected course of his/her condition. In many cases, patient education on realistic pain goals will be necessary. B-1. The ability to competently conduct a medical interview and counseling to take into account patient health beliefs, patient agenda and the need for comprehensive medical and psychosocial assessment Medical Interview Skillful Work together with other members of our interdisciplinary healthcare team to optimize patient care and enhance quality of life. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations. Professionalism Altruistic Demonstrate knowledge about established and evolving biomedical, clinical and cognate sciences and the application of this knowledge to patient care. A-4. Knowledge of population health, epidemiology principles and the scientific basis of research methods relevant to healthcare. Population Health and Epidemiology Knowledgeable Demonstrate basic knowledge of the anatomy, physiology and pharmacology of pain medicine. A-2. Knowledge of the pathogenesis of diseases, interventions for effective treatment, and mechanisms of health maintenance to prevent disease. Disease Pathogenesis and Treatment Knowledgeable Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations. Professionalism Altruistic Create and sustain a therapeutic and ethically sound relationship with patients. C-2. Professional behaviors reflecting compassion and respect for patient privacy, altruism and a commitment to comprehensive, holistic medical care. Compassion Altruistic Use effective listening skills to elicit appropriate clinical information. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations Professionalism Altruistic Work effectively with others in an interdisciplinary health care team. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations. Professionalism Altruistic Demonstrate respect, compassion and integrity. C-2. Professional behaviors reflecting compassion and respect for patient privacy, altruism and a commitment to comprehensive, holistic medical care. Compassion Altruistic Respond to the needs of patients and those of society; understand that those supersede self interest. C-3. Sensitivity and awareness of diverse cultures, health beliefs and social factors impacting patient health and illness. Cultural and Social Awareness Altruistic Demonstrate accountability to patients, society, colleagues, UCI, and our profession. D-3. A commitment to serve our community. Community Dutiful Demonstrate a commitment to excellence and on-going professional development. D-1. A commitment to lifelong learning and independently seeking new knowledge and skills in their own recognized areas of learning deficit. Lifelong Learning Dutiful Demonstrate a commitment to ethical principles pertaining to the provision or withholding of care, the confidentiality of patient information, informed consent and business practices. C-2. Professional behaviors reflecting compassion and respect for patient privacy, altruism and a commitment to comprehensive, holistic medical care. Compassion Altruistic Demonstrate responsiveness to patient’s culture, age, gender and disabilities. D-2. A commitment to patient care and to the well-being of patients and colleagues. Patient Care Dutiful Investigate and evaluate one’s own patient care practices, appraise and assimilate scientific evidence and improve patient care practices. B-4. The ability to search the medical literature, including electronic databases, and to locate and interpret up-to-date evidence to optimize patient care. Evidence-Based Medicine Skillful Locate, appraise and assimilate information and evidence from scientific studies related to patient’s healthcare problem(s), pain condition or interventional procedure. B-4. The ability to search the medical literature, including electronic databases, and to locate and interpret up-to-date evidence to optimize patient care. Evidence-Based Medicine Skillful Apply the knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness. A-5. Knowledge of medical practice, including healthcare economics and health systems impacting delivery and quality of patient care. Medical Practice Knowledgeable Use information technology to manage information, access online medical information and support one’s own education. B-4. The ability to search the medical literature, including electronic databases, and to locate and interpret up-to-date evidence to optimize patient care. Evidence-Based Medicine Skillful Demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. D-2. A commitment to patient care and to the well-being of patients and colleagues. Patient Care Dutiful Understand how one’s own patient care and other professional practices affect other healthcare professionals, the healthcare organization, and our larger society. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations. Professionalism Altruistic Understand which activities affect system performance. A-5. Knowledge of medical practice, including healthcare economics and health systems impacting delivery and quality of patient care. Medical Practice Knowledgeable Practice pain medicine within the context of this healthcare institution and in cooperation with other healthcare professionals. C-1. Honesty and integrity reflecting the standards of the profession, in interacting with colleagues, patients, families and professional organizations. Professionalism Altruistic Practice cost effect healthcare; prescribe medications that will be covered by insurance providers and avoid over-utilizing resources. C-3. Sensitivity and awareness of diverse cultures, health beliefs and social factors impacting patient health and illness. Cultural and Social Awareness Altruistic Advocate for quality patient care; assist patients in dealing with system complexities. D-2. A commitment to patient care and to the well-being of patients and colleagues. Patient Care Dutiful Know how to partner with healthcare managers and providers to assess, coordinate, and improve healthcare. Assume responsibility for interacting with healthcare services (social and home care services, physical therapy) and other providers (psychiatry, neurology, surgery…) for coordinating optimal patient care and authorization for coverage of appropriate pharmacologic and interventional therapeutics. B-6. The ability to function effectively within the context of complexity and uncertainty in medical care. Patient Management Skillful Conduct an evaluation and summarize the Chief Complaint and HPI (pain history), including the pain location, radiation, duration, frequency, onset, quality and pain onset. Also include alleviating and exacerbating symptoms and associated symptoms. B-1. The ability to competently conduct a medical interview and counseling to take into account patient health beliefs, patient agenda and the need for comprehensive medical and psychosocial assessment. Medical Interview Skillful Conduct a full medical, surgical history, social, psychological and pain treatment history. Incorporate an appropriate review of the systems (ROS) into the full historical examination. A-3. Knowledge of basic clinical skills required to meet the skills objectives, including interviewing, physical diagnosis, communication and clinical reasoning and processes. Basic Clinical Skills Knowledgeable Conduct an appropriate musculoskeletal and neurological physical examination, including, when appropriate, a cranial nerve examination, extremity manual motor testing, sensory testing and reflex examination and appropriate provocative and nerve tension testing. Use manual motor testing grades and reflex scores appropriately. B-2. The ability to competently perform a complete and organ- system-specific examination including a mental health status examination. Physical Exam Skillful Report on the type of pain: visceral, somatic, nociceptive, neuropathic, acute, chronic or mixed. B-5. The ability to practice effective preventive medicine by identifying, addressing and advocating for strategies to maintain health and well-being, to identify and treat disease early where appropriate and to advise on lifestyle practices. Patient Management Skillful Course Resources COURSE RESOURCES TEXTS AND READINGS: Essentials of Pain Medicine and Regional Anesthesia, 2nd edition Authors: Benzon, Raja, Molloy, Liu, Fishman Miller, R. D. (2010). Miller's anesthesia (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ADDITIONAL RESOURCES: UCI Department of Anesthesiology & Perioperative Care – Medical Education Website: http://anesthesiology.uci.edu/education_med.shtml Major Exams, Assignments and Grading MAJOR EXAMS, ASSIGNMENTS AND GRADING MAJOR ASSIGNMENTS AND EXAMS The rotation will cover Mondays through Fridays for the first week, and M/Th/Fr/Sa/Su for the remainder of the elective (both 2- and 4-week electives). Students will pre-round on their assigned patients, then present an interval update to the team during table rounds and formulate a tentative plan with the anesthesiology attending and other members of the team (fellow, resident and nurse practitioner). The team will then round on patients for teaching rounds. Students will write notes for the patients seen and over the course of the day may interview new patients and observe procedures. Students will also attend department grand rounds on Thursday mornings T 6:30 AM. Students are expected to demonstrate cooperation and teamwork while part of the anesthesia care team. THE GRADING SCALE Students will receive a final grade of Honors, Pass or Fail for this course. The standard UC Irvine elective evaluation form will be used to determine the student’s final grade. Given the clinical burden and our heavy emphasis on contributions to the team and clinical aptitude and effort, 85% of the student grade is based upon evaluations of the students' performance in the key entrustable professional activities. Faculty will be primarily responsible for evaluating students but evaluations from fellows and resident trainees will also be considered in the spirit of non-hierarchical 360 evaluation of the student performance. Only students that receive a designation of “consistent high-level performance” or “excellence in performance” of the core competencies in >50% of received evaluations will be eligible for honors. The remaining 15 percent of the grade will be a professionalism score based on the co-course directors’ assessment of the student’s effort, communication skills and overall contributions to the team environment. Lastly, 100% attendance is required to pass the course, missed days will result in an incomplete until the student makes up the time in the number of hours commensurate with those that were missed. You have 30 days from the date of the grade to appeal any aspect of this grade. Please contact your Clerkship/Course Director should you have any questions. Requirements for GRADING: Medical Students are graded using the following scale: (4-week rotation students) Honors (H), Pass (P), Fail (F) and Incomplete (I) & (2-week rotation students) Honors (H) Pass (P), Fail (F) and Incomplete (I). For further information, please review the Grading Policy. All attending physicians on APS working with the medical student will evaluate the student on a predetermined set of competencies, where they will assign grades. To pass the rotation, students must on average, meet expectations in every competency. To earn an “Honors” rating on this rotation, the student must on average, exceed expectations in 3 or more competencies. Requirements for “Pass”: To receive a grade of Pass, students must demonstrate successful performance in all the following areas: Knowledge Patient Care Practice-Based Learning Interpersonal & Communication Skills Professionalism Systems-Based Practice Requirements for “Honors”: To receive a grade of Honors, students must demonstrate at least 50% of evaluations that denote “exceeds expectations” or “outstanding” performance in the final overall evaluation and “agree” or “strongly agree” in >70% of the following core competencies: Knowledge Patient Care Practice-Based Learning Interpersonal & Communication Skills Professionalism Systems-Based Practice Grounds for “Incomplete”: You will not be issued a grade until all elements of the course have been completed. REMEDIATION Remediation, if needed, will be designed by the Course Director to suit the issue at hand. Grounds for “Fail”: You will receive a grade of "Fail" if the requirements for passing the course have not been met. Please refer to the Grading Policy for the impact of the "Fail" grade to the transcript.