Pain Management Center In The Department of Anesthesia

Clinical Pain Medicine Fellowship

We are currently accepting applications for 2015-16.

2014 NRMP Timeline

  • Jun 4 - Match Registration Opens
  • Aug 6 - Ranking Opens
  • Sep 10 - Quota Change Deadline
  • Sep 24 - Rank Order List Deadline
  • Oct 8 - Match Day

For more information on the Match, please visit: http://www.nrmp.org/fellowships/anesthesiology-match/

Page Content:

 

Program Overview

The Division of Pain Medicine at Stanford University Medical Center offers a world-class ACGME-approved Clinical Pain Medicine Fellowship. This fellowship program focuses on comprehensive, interdisciplinary, collaborative training in and treatment of acute, chronic, and cancer pain. Fellows learn and practice the medical, interventional, physical and behavioral aspects of pain medicine so that upon graduation, they will be successful pain medicine physicians in both academic and community practices.

The specialty of Pain Medicine has experienced remarkable growth and change over the last several decades. Stanford has been at the forefront of these changes from clinical, educational and research perspectives. To treat chronic pain, Stanford employs state-of the-art, interventional therapies – implantable spinal cord stimulators, radio-frequency ablation, fluoroscopic and ultrasound-guided procedures, and intrathecal drug-delivery systems. Within the western United States, Stanford is fortunate to have the only inpatient, academic, chronic pain medicine unit, able to care for the most complex pain patients. With Stanford’s extraordinary, new Stanford Medicine Outpatient Center (SMOC), we have significantly expanded our range of treatment options as we move forward into this new decade.

A Message from the Chief

Thank you for your interest in the Stanford Pain Medicine Fellowship. I hope you will find our comprehensive, interdisciplinary approach to the management of acute, chronic and cancer pain in both inpatient and outpatient settings as exciting as we do. If you have not already read about our new clinical facilities at the Stanford Medicine Outpatient Center (SMOC) in Redwood City, I encourage you to do so.

Our approach to pain medicine is comprehensive and personalized. After we obtain a detailed diagnoses, we provide appropriate therapeutic interventional, medical, rehabilitative, psychological and complementary interventions tailored to individual patient needs. Fellows rotate through a variety of clinical settings: SMOC, inpatient ward, outpatient interventional procedures, Veterans Affairs Palo Alto Health Care System (VAPAHCS), and the Lucile Packard Children’s Hospital (LPCH) Pediatric Pain Service. Volunteer clinical faculty offer exposure to private community practice settings.

Our approach to pain medicine is also interdisciplinary and consultative. We emphasize that the pain medicine specialist is a consultant to the other medical specialists. However, during the inpatient rotation, fellows also perform primary management of our most complex pain patients in the Stanford Comprehensive Interdisciplinary Pain Program (SCIPP).

Fellows have opportunities to become competent in the variety of procedures and surgical techniques appropriate for the practice of comprehensive pain medicine. For example, fellows participate 3–4 days per week in our procedural rotation, where they learn and practice all basic neural, spinal and sympathetic blockades. In addition, they learn and practice the advanced interventional and surgical techniques of spinal cord stimulation, intrathecal pump placement, and percutaneous disk and lumbar decompressions in the Pain Medicine Center. We have also greatly expanded our use of ultrasound-guided diagnoses and interventions over the last several years.

A unique feature of our program is having our fellows maintain continuity with their patients. That means when a patient is evaluated by you, they will also follow up with you - with the attending acting as your consultant.  We believe this provides our fellows with the best training experience.

Academically, fellows participate in the pain service’s regular education sessions, including didactic lectures, journal club, and teaching rounds. During the year, fellows give presentations at these sessions to supplement their clinical education. Fellows also utilize their academic rotation for independent scholarly activities. I meet with each fellow at the beginning of the year to help structure their academic time to reach their individual career objectives.

Again, thank you for your interest in our program. Please take time to browse our entire site, in which you will find details about the pain medicine fellowship program, information about living in the San Francisco Bay Area, salary and benefits, life after fellowship, FAQs, and application information and required documents.

Please direct questions to: painfellowship@pain.stanford.edu

I look forward to reviewing your application.

Sincerely,

Sean Mackey, MD, PhD

Chief, Division of Pain Medicine

Program Director, Pain Medicine Fellowship

Stanford University School of Medicine

 

 

 

Primary Training Facility: Stanford Medicine Outpatient Center

 

 

In February 2009, we relocated our pain clinic to a new 7,500 square-foot clinical facility at the Stanford Medicine Outpatient Center (SMOC) in Redwood City, tripling our original square footage (detail here). SMOC is a state-of-the-art facility in which to deliver interdisciplinary treatment strategies. The Center’s décor and ambiance were modeled after a 5-star hotel, and technologically, it serves as the model for the new Stanford Hospital currently being developed. In addition to our pain clinic, there are on-site radiological services (MRIs, CT scans, X-rays) and fluoroscopy suites. We are extremely enthusiastic about our future in the new facility and are certain that our new class of fellows will share our excitement.

 

SMOC Lobby

 

Outpatient Surgery Center Procedure Room

 

Pain Clinic Exam Room

“We are very excited about the possibilities for patient care our expanded space at the Outpatient Center will support,” said Pain Management Center director Sean Mackey, MD, PhD. “We also know that our proximity to other clinics in the Outpatient Center will enrich our ability to offer patients the most convenient coordinated care, to help them understand how they can help themselves to modify and control their experience of pain.”

The Pain Medicine Center already works closely with surgeons and other physicians in pioneering approaches to pain relief and control. The Center’s comprehensive treatment philosophy and its innovative techniques using nerve blocks and other procedures gained its recognition as one of the Centers of Excellence nationwide recognized by the American Pain Society. Stanford first received this recognition in 2008 and most recently again in 2012. The new location for the Center means easier access to the state-of-the-art diagnostic equipment the Center employs for patient evaluations. The Center’s team of pain specialists will also find it easier to collaborate to build multidisciplinary treatments for their patients, Mackey said. “And we’ll be able to see more patients, provide them with more treatment options in one place and take advantage of the synergy you get when you’re not scattered about.” -- Sara Wykes, SHC Communications Office

 

What Makes Stanford's Pain Fellowship Special?

We are honored to be recognized as a Clinical Center of Excellence by the American Pain Society in 2008 and 2012. This award is a recognition and validation of the interdisciplinary model of pain medicine exemplified by the Stanford Pain Center.
  • The Stanford Comprehensive Interdisciplinary Pain Program (SCIPP) is the only med-behavioral inpatient unit of its kind in the western United States. It is designed to provide interdisciplinary evaluation, treatment, and management of complex, chronic pain problems. The SCIPP team consists of specialists from anesthesia, neurology, nursing, occupational therapy, psychiatry, physical therapy, and psychology. Together they focus on all biological, psychosocial, and physical factors that may play a role in the onset and persistence of a pain condition. They formulate and implement an individualized, comprehensive treatment plan for each patient in the SCIPP unit.
  • Stanford is the first major West Coast academic medical center to offer a Headache Clinic. This clinic, lead by nationally-renowned headache specialist, Dr. Rob Cowan, operates within the Pain Medicine Center. Our pain medicine fellows have the opportunity to work with 3 board-certified headache specialists as well as a dentist in the clinic. Fellows learn firsthand how to manage headache and facial pain patients in the hospital, working closely with neurology, neurosurgery, as well as ENT and plastic surgery. Additionally, they also have the opportunity to learn a multitude of procedures specialized for the head, from botox for migraine and ultrasound guided blocks of the occipital nerve, to occipital nerve stimulation.  Pain fellows will feel comfortable in the management of headache and facial pain at the end of their fellowship experience. More information about the Headache Clinic can be found here.

  • Our aim is to provide our fellows with the most rewarding fellowship experience possible. In addition to pursuing our core pain medicine training, fellows can also personalize their curricula. Whether they are interested in academics, community practice, industry, or policy and administration, fellows can work with the Program Director, full-time and volunteer clinical faculty, and various departments throughout Stanford to cultivate their interests and develop their professional goals. At the beginning of the fellowship, fellows will meet with the Program Director to discuss how they will utilize their academic time and create a structured plan to accomplish their goals.

 

Clinical Experience & Curriculum

As listed below, our fellows gain experience by treating a complex and diverse patient population in various clinical settings..

Fellows divide their time at four training sites throughout the year:

There are also 2 months of academic time allocated for independent research and development.

In addition to clinical responsibilities, fellows are expected to attend weekly didactic lectures, teaching rounds, monthly journal club meetings, grand rounds, and mortality and morbidity conferences. We also encourage our fellows to register and attend relevant national pain conferences and workshops.

 

Procedural Experience

Our fellows receive experience in performing a wide variety of interventional procedures comprehensively listed below. Should our fellows wish to gain experience in other procedures, arrangements can be made to train with our colleagues at Stanford (e.g. neurosurgery, orthopaedics) or with an affiliated community pain practice during their 2 months of academic time.

Advanced Procedures

  • Minimally Invasive Lumbar Decompression (MILD)
  • Intrathecal Pump Implantation
  • Spinal Cord Stimulator Implantation 
  • Spinal Catheter Placement and Infusion Trial
  • Spinal Cord Stimulator Lead Trial
  • Neuromodulation revision
  • Peripheral Nerve Stimulation 
  • Sacroiliac Denervation (via SImplicity III)
  • Indwelling Catheters for Infusion Therapy (eg- epidural, intraspinal, lumbar plexus, peripheral nerve)

Sympathetic Blocks

  • Stellate Ganglion
  • Celiac Plexus
  • Lumbar Sympathetic
  • Superior Hypogastric Plexus 
  • Ganglion Impar

Head and Neck Blocks

  • Trigeminal (Gasserian and Trigeminal Divisions)
  • Sphenopalantine Ganglion
  • Peripheral Nerve Blocks

Neurolytic Techniques

  • Continuous and pulsed radiofrequency treatments to medial branch nerves, peripheral nerves, scar neuromas
  • Absolute EtOH injections

Ultrasound Guided Pain Techniques

  • Major bursa and joint injections
  • Stellate ganglion blocks
  • Peripheral nerve blocks
  • Trigger point injections  

Infusion and Other Medication Therapies

  • Interthecal Ziconotide (Prialt)
  • Intravenous Ketamine
  • Intravenous Lidocaine
  • Topical 8% Capsaicin (Qutenza)

Neuraxial Procedures:

  • Epidural steroid injections
  • Epidural blood patches
  • Medial branch nerve blocks
  • Facet joint injections 
  • Selective nerve root blocks
  • Sacroiliac joint injections
  • Caudal injections

Other Pain Management Procedures:

  • Scar injections
  • Trigger point injections
  • Botox injections via the PREEMPT protocol for Migraine Headaches
  • Bier blocks  

 

Second Fellowship Year in Pain Research

Following completion of the first clinical year, a second fellowship in pain research is available to those who are interested. Research fellows will have 4 days/week (80% time) to conduct research and will work 1 day/week (20% time) as a Clinical Instructor in the Pain Clinic.

Applicants are also encouraged to apply for the T32 Anesthesia Training Program in Biomedical Research, or Dr. Mackey's recently awarded T32 Interdisciplinary Research Training in Pain and Substance Use Disorders (details of the Pain and Substance Use Disorders T32 will be posted shortly). Fellows will have a year of research targeted toward their individual needs and goals. For those interested, we have significant success in mentoring and developing fellows to obtain fellowship and NIH K award training. More information on the research being conducted in the Pain Division can be found at the Stanford Systems Neuroscience and Pain Lab (SNAPL) website.

 

Living in the San Francisco Bay Area

Without a doubt, the San Francisco Bay Area is one of the nation’s most desirable places to live: its diverse cultures, temperate year-round climate, world-class arts scene, food and wine, and access to recreation (ski slopes, hiking trails, redwood forests, beaches, wine country, and bustling cities) afford delightfully unique benefits. Stanford University sits within the dynamic Silicon Valley region, in the cosmopolitan town of Palo Alto – just 35 miles south of San Francisco and 15 miles north of San Jose.

Fellows train at four sites shown in the map below. To maintain proximity to these sites, fellows often reside in Redwood City, Menlo Park, Mountain View, or Sunnyvale – family-friendly towns with cheaper housing than Palo Alto. Stanford West Apartments, a convenient Stanford-owned option in Palo Alto, is available to fellows. These apartments are located across from the Stanford University Medical Center (SUMC). Fellows can bike, walk or ride the free Marguerite Shuttle bus to SUMC, LPCH, other campus sites, and the downtown Palo Alto train station.


View Stanford Pain Fellowship Training Sites in a larger map

Although the cost of living in the Bay Area is relatively high, Stanford’s stipend, reimbursements, benefits and one-time housing allowance are competitive.

 

Stipend & Benefits

Stanford University offers fellows an exceptional stipend and comprehensive benefits, as outlined below.

  • Competitive PGY-5 Stipend
  • Housing Allowance for first-time Stanford affiliates
  • Education Fund (GME)
  • Academic Payment (GME)
  • Departmental Discretionary Fund
  • CA Medical License Reimbursement
  • DEA Certificate Reimbursement

Medical, dental, vision, life, disability and malpractice insurance plans are available to our fellows. Insurance coverage is also available to their dependents.

Paid leave includes:

  • 15 days vacation/PTO
  • 5 days conference attendance
  • 20 days sick leave
  • 6 weeks pregnancy leave
  • 1 week paternity leave

 

Life After Fellowship

Our program focuses on training future leaders in the field of pain medicine, whether they pursue academic or community practices. The table below indicates the number and percentage of fellows between 2006 and 2012 who have pursued academic practice, community practice, or an additional fellowship, immediately following the conclusion of their fellowship.

Since our program’s inception in 1989, our graduates have established pain clinics throughout the country, developed institutional pain programs, and conducted groundbreaking pain research. We maintain close, collaborative relationships with our graduates throughout their careers. Here are some thoughts from graduates about their Stanford Pain Medicine Fellowship experience:

"I felt Stanford offered unique exposure to a challenging set of patients. This prepared us to face whatever came through our doors after leaving fellowship training. It was a fellow driven program where you could develop and carry out a treatment plan. I will always consider Stanford a second home and am grateful for the experience." --Dave Peng, MD (C/O 2012), Community practice, Michigan

"My time at Stanford would best be characterized not by the collection of specific abilities, be they interventional or otherwise, but rather by the fostering of an independent approach to both self-tutelage and problem solving. 365 days is a woefully inadequate period of time in which to comprehensively master the entirety of pain medicine, but the collaborative, integrative and multidisciplinary teaching model employed during fellowship provides the concrete foundation upon which clinical capabilities may continue to flourish throughout a thoroughly productive career." --Garret Morris, MD (C/O 2010), Asst. Professor, University of Rochester

"The multidisciplinary pain medicine fellowship at Stanford University is a great training ground. The facilities in Redwood City provide an extremely comfortable and upscale environment for patient care and education. Stanford fellows gain a world-class education in pain medicine theory and technique from the diverse educational backgrounds of the attending staff. A broad exposure to acute and chronic pain states lends opportunities for Stanford fellows to perform many interventional pain medicine procedures. The inpatient experience provides a variety of greater understanding of the behavioral component to pain medicine. Stanford's multidisciplinary pain medicine fellowship prepares fellows to become leaders in any post-graduate work environment. I am a proud graduate of Stanford University's pain medicine fellowship." --Jameson Stokes, MD (C/O 2009), Community practice, Georgia

A comprehensive list of graduates can be found here.

 

Frequently Asked Questions (FAQ)

1. What is the time table for the application process?

We will accept applications beginning January 1st through July 31st. We will begin to send out interview invitations in May and conduct interviews in July. Final offers will be announced through the NRMP match. The Match Day for pain medicine fellowships is October 8, 2014.

2. How many positions are available each year?

We have seven fully-funded, ACGME-approved positions. All positions will be available to the match.

3. Do you accept applications from candidates with non-anesthesia training?

Yes. We accept applications from all specialties. A majority of our fellows specialize in anesthesiology; however, we have accepted fellows who specialize in PM&R, neurology, and psychiatry.

4. How long is your program accredited for and when was your last review?

We had our ACGME site review in May 2011. In October 2011, we were pleased to receive the maximum of 5 years of continued accreditation. We exceeded all procedural, consultative, and educational experiences.

5. Is your program open to foreign trainees?

We only accept applications from international medical graduates who meet all the following criteria:

  • ECFMG from a foreign medical school
  • Successful completion of all three USMLE steps
    • Canadian M.D.s and D.O.s who are eligible for licensure may substitute documentation of successful completion of LMCC/MCCQE and COMLEX exams, respectively, in lieu of USMLE steps.
  • Completion of an ACGME-accredited residency
  • ABA board-certified or eligible
  • Eligible for an unrestriced California medical license

 

Application Information

We are currently accepting applications for 2015-16. We offer multiple start dates on the 1st of July, August, and January.

Please review these CA medical licensing requirements.

The following documents are required to complete your application:

  • Common Application Form
  • Curriculum Vitae
  • Personal Statement
  • 3 letters of recommendation (LOR)
    • LORs sent by e-mail must be written on letterhead with the author's signature and sent directly from the author's e-mail address.
  • Medical school diploma
  • ECFMG certificate (if applicable)
  • Letter/certification of internship year (PGY-1) completion
  • Medical school transcripts
  • USMLE Steps 1-3 / COMLEX / Board scores
  • Visa (if applicable) - Only applicants with J-1 visas will be considered

Your application will not be reviewed until all materials have been received.

Please submit all application materials to: painfellowship@pain.stanford.edu

If you are experiencing technical difficulties and are unable to submit any of the required documents via email, you may send unstapled hard copies to:

Pain Medicine Fellowship Program
C/O Matthew Chen
Stanford University
450 Broadway Street
Pavilion C, 4th Floor, MC: 6343
Redwood City, CA 94063

Please note that processing application materials received via postal mail may be delayed.

 

 

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