Mission

Develop world-class military physicians into skilled pain medicine physicians.

Vision

Graduate medical education and training to develop ready, patient centered military pain medicine physicians.

Aims

Our program provides outstanding opportunities, aims for excellence, thoughtfully considers wellness, and ensures a ready medical force.

• Mastery of the evaluation and management of painful conditions and disease states with ongoing exposure to and appreciation for specialized, complex, and safe procedural and operative care.
• Emphasize the importance of quality improvement and patient safety by engaging in continual quality improvement and patient safety endeavors.
• Embrace the multidisciplinary approach to pain management through integration and collaboration with other disciplines and specialties.

Various methods of instruction are utilized by the pain medicine fellowship for education of the fellow to prepare you for the board exam and a career as a Pain Medicine Physician. The curriculum consists of didactics, simulation, cadaver workshops, journal clubs, critical incident conferences (formerly known as mortality and morbidity conferences), problem-based learning discussions, attendance of national academic conferences and one-to-one faculty-to-fellow instruction for all clinical activities. Most formal academic activities are conducted on Tuesday afternoon from 1 p.m. – 4 p.m.

Didactics

Formal presentations on relevant topics in Pain Medicine by faculty and guest speakers are held Tuesday afternoon from 12:30 – 4 p.m. Guest speakers from Anesthesiology, Complimentary and Integrative Medicine, Orthopedic Surgery, Neurology, Neurosurgery, Physical Medicine & Rehabilitation (PM&R), Radiology and Psychiatry present topics on chronic pain.

Journal Club

Journal club presentations are held monthly. A virtual Joint Department of Defense (DoD)/Veterans Affairs (VA) Pain Medicine journal club presentation occurs on the third Tuesday of every month. Journal club presentations are done by various fellows throughout the DoD.

Critical Incident Conference (CIC)

A critical incident conference is held once per month during didactics. It is the responsibility of the fellow to find cases or patient encounters in which critical incidences occurred (these cases do not necessarily have to result in mortality or morbidity to qualify). This should be a team effort in coordination with relevant faculty members involved in the cases. Interesting case presentations can also be done during these sessions. At minimum, an organized case presentation, review of the literature, and recommendations on methods or processes to prevent such an incident from re-occurring should be part of the CIC.

Problem Based Learning Curriculum

Monthly case discussions to challenge fellows by presenting real world problems to solve. These cases allow introduction of key concepts, facilitating group discussion and problem solving.

Pharmacy Curriculum

Lecture series presented by our clinical pharmacist and pain medicine faculty presenting pain medications and adjuncts. Additional topics include chronic opioid therapy conversion exercise, topical medication lab, battlefield acupuncture.

The NCC Pain Medicine Fellowship program is one year (12 months) in length and follows the training requirements outlined by the American Board of Anesthesiology (ABA) and the Accreditation Council for Graduate Medical Education (ACGME).

• Rotations include four weeks in the Regional Anesthesia Service, Neurology, Palliative Care, Neuroradiology and Physical Medicine & Rehabilitation.
• Fellows complete a civilian partner rotation of four weeks in duration. The civilian rotation is meant to supplement the training with a high volume of clinic, procedure, and operative exposure.
• The remainder of the fellowship is spent in the Pain Medicine Clinic acquiring procedural and operative experience.

• Neuroradiology
• Neurosurgery
• Research
• C-arm utilization
• Complimentary Integrative Medicine

The fellow is expected to respond to all Chronic Pain Inpatient Consults in a professional and timely manner during working hours, after hours during the working week, weekends, and holidays unless on leave or temporary duty. Part of this duty includes communicating appropriate and updated contact information to the on-call team, on-call staff, and Pain Medicine Clinic support personnel and following the Pain Medicine Fellowship Transitions of Care policy.

The program focuses on care of the military service member as well as multidisciplinary and rehabilitative care focused on return of the service member to duty. Further, multidisciplinary conferences and care coordination conferences will focus on return of function, care for the active-duty service member and considerations for return of servicemember to full duty and discussion of deployment restrictions. Additional experience and techniques include Battlefield Ear Acupuncture, rotations at the National Intrepid Center of Excellence and Complimentary and Integrative Medicine Clinic.

Required courses include periodic re-certification of Advanced Cardiac Life Support and Basic Life Support.

• Fellows participate in a quarterly simulation curriculum to gain experience in infrequent, yet high risk patient encounters.
• Utilization of high-fidelity simulators and live patient models to enhance learning.

A robust curriculum for developing leaders in pain medicine and in the military. Opportunities start from day one and the fellow is expected to be the leader of the Pain Management Service and Clinic and representative on all things pain in the military treatment facility:

• Leadership and team building exercises
• Peer mentorship
• Quarterly program leadership and mentoring sessions
• Resident leadership roles, including educational, clerkship, research, wellness, etc.

Research is an important component of the relatively new specialty of Pain Medicine and, as such, is required for all fellows. During the fellowship year, each fellow will be required to complete a scholarly activity. Examples of scholarly activities include but are not limited to: authorship on a publication in a peer-reviewed journal (e.g., Institutional Review Board (IRB)-approved study, case report, technical description, review paper) or book chapter; creation and implementation of an IRB-approved protocol; and poster presentations at a local, national, or international academic conference. Research meetings are conducted throughout the academic year and fellows should attend and actively participate in the Pain Medicine research activities.

As a component of its next accreditation system, the ACGME has established the Clinical Learning Environment Review (CLER) program to assess the GME learning environment of each sponsoring institution and its participating sites. CLER emphasizes the responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care. The intent of CLER is “to generate national data on program and institutional attributes that have a salutary effect on quality and safety in settings where residents learn and on the quality of care rendered after graduation.” CLER provides frequent on-site sampling of the learning environment that will: increase the educational emphasis on patient safety demanded by the public; and, provide opportunity for sponsoring institutions to demonstrate leadership in patient safety, quality improvement, and reduction in health care disparities.

As such, each fellow is required to develop or participate in a patient safety or quality improvement activity that is part of the Pain Medicine clinic or part of the command. The Pain Medicine Fellowship follows guidelines set forth by the GME for resident and fellow education in patient safety and quality improvement and it is expected that the fellow will complete this educational checklist in conjunction with the Program Director and/or Associate Program Director.

Funding for fellows to attend at least one professional conference during training when presenting a scholarly activity. Our fellows have given national lectures, research podium presentations, held national leadership board positions, and taught procedural courses.

• Walter Reed National Military Medical Center
• National Intrepid Center of Excellence
• National Institutes of Health
• Fort Belvoir Community Hospital
• Stellate Ganglion Institute
• Virginia Hospital Center

Our program offers rotations to residents interested in applying to 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-pain@health.mil and follow guidance through WRNMMC Graduate Medical Education regarding rotation logistics.

Interested candidates should contact dha.ncr.walter-reed-med-ctr.list.ncc-pain@health.mil to schedule an interview.

Program graduates take the Pain Medicine board exam from their respective certification board as the specialty is multi-disciplinary. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam three months following graduation. To be eligible to take specialty board exams, graduates must be board certified in their primary specialty. As a multi-disciplinary specialty, not all certifying specialty boards recognize pain medicine subspecialty education. Prior to enrollment in this program, any interested applicants should discuss with the program director and their service specialty consultant to determine individual board eligibility for the respective certifying board.

Fellows are expected to assume increasing levels of responsibility as teachers to their peers and rotating trainees in the department throughout their time.

Fellows are offered an opportunity to teach at local, regional, national, and international conferences including ultrasound and fluoroscopic interventions and lecture throughout the Defense Health Agency/Veteran’s Administration.

All Faculty are double board certified in their primary specialty and Pain Medicine. There are 13 faculty assigned to the fellowship and pain medicine center at any time.

The fellow is assigned a primary mentor at the start of fellowship; however, all faculty have mentorship expectations and at least 75% of the faculty have prior or current military experience. Faculty mentors are rotated each quarter. The program utilizes an Individualized Learning Plan to facilitate mentorship.

The fellowship program and its curriculum have been restructured to ensure maximal opportunities for fellow growth and wellness. We have worked to consolidate all official activities in such a manner as to maximize off time without reducing the maximal opportunities for training. Fellows can participate in an optional Wellness Committee geared at optimizing program wellness and involvement with hospital-wide peer wellness and support groups. Work life and family balance are encouraged.