American Society of Regional Anesthesia and Pain Medicine August 2017 - 35

Establishing a Multidisciplinary Fellowship in Pain Medicine and Preparing
Graduates to Depart: Contemporary Challenges in Post-Graduate Medical Education
A NEW BEGINNING
Reda Tolba, MD
Currently, there are 100 Accreditation Council for Graduate
Medical Education (ACGME) accredited pain fellowship programs
with approximately 376 new graduates each year. Despite these
numbers, large areas of the country remain without fellowshiptrained pain physicians. In the absence of specialty expertise,
comprehensive management strategies often remain unexplored.
This is especially true when nonspecialists are tasked with
addressing chronic pain on top of a multitude of other comorbid
conditions. Even with the expansion of our specialty, it remains a
rarity to have comprehensive interdisciplinary pain management
available to patients outside of metropolitan areas.
Establishing a pain fellowship at Ochsner proved to be an exciting
experience. The initial step was to obtain internal institutional
approval from the graduate medical education (GME) department
by proving that fellowship training will add value to the core
anesthesiology residency and align with the educational mission
of the institution. Financial feasibility analysis was done to assure
that starting such a training program parallels the institution's
vision. Securing stakeholders-from anesthesiology, neurology,
physical medicine and rehabilitation, psychiatry, palliative care,
and acute pain-is pivotal to ensuring a comprehensive fellowship
education with the broad range of specialties that treat pain.
Beyond the intellectual commitment, real estate including call
rooms, office space, and research areas warranted physical
consideration.
Striking the balance between service and education is a fine line.
Core faculty should have dedicated time for educational activities.
Quantifying educational effort is not usually as transparent as
quantifying clinical workflow. After obtaining institution approval,
the next step on the agenda is to apply to the ACGME to get
approval for an accredited fellowship. It is a lengthy process that
requires a collaborative effort between the assigned program
director, the GME department, hospital administrators, and core
faculty. I consider this experience to be a marathon rather than a
sprint. You need a slow steady pace to achieve your goal and be
able to complete the race successfully.

Reda Tolba, MD
Pain Management and
Anesthesiology Physician Staff
Assistant Professor (Senior Lecturer)
of Anesthesiology
Ochsner Health System
Ochsner Clinical School at
The University of Queensland
Brisbane, Australia

Robert Bolash, MD
Assistant Professor
Anesthesiology in the
Departments of Pain
Management and Evidence Based
Pain Research
Cleveland Clinic Foundation
Cleveland, OH

Section Editor: Dalia Elmofty, MD
Section Editor's note: Chronic pain fellowship graduates Dr. Reda Tolba
and Dr. Robert Bolash continue to collaborate after joining their respective
clinical faculty. Dr. Tolba is in the process of establishing a new fellowship
in Pain Medicine at Ochsner Health System while Dr. Bolash is tasked with
helping his graduates transition into life beyond fellowship. Both of them
write about their respective experiences.

CONSIDERING THE END
Robert Bolash, MD
Postgraduate fellows accomplish a multitude of clinical tasks during
their fellowships as they move from novice interventionalists to
safe and competent independent practitioners. They are challenged
to apply the basic fundamentals of multidisciplinary pain medicine
while progressively privileged with increasing independence in a
supervised clinical practice.
Besides a reference letter, the task of securing employment had
historically been overlooked by teaching faculty. Nonetheless,

"Investing in our specialty warrants fostering future pain
physicians' success as they are entering postgraduate training
or transitioning to their next stage of practice."

American Society of Regional Anesthesia and Pain Medicine
2017

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