Did CCM or Pain fellowship enhance your OR skills?

[MalloryWeiss]

For those who completed a CCM fellowship, in what ways do you feel this training has enhanced your OR skills?

Same question for those who did Pain.

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[BobBarker]

Pain - minimal impact

 

[Noyac]

CCM will definitely.
Pain not so much. I didn't do a full pain fellowship, mostly because it's hardly necessary. I'm not bagging on the fellowship but I didn't want to do pain exclusively so it wasn't necessary. But it didn't enhance my skills in the OR any.

 

[Hoya11]

Did pain fellowship, I think it makes you slicker with things like needle insertion, blocks, local anesthetics, can help with outpatient opioid management in pacu for pain patients, save a pain consult kind of thing, promote new concepts like multi-modal analgesia. It certainly does not improve your bare essential anesthesia skills like airway or vascular access that CCM would. But i certainly would say I feel more like the bottom line, expert, being a board certified pain specialist when talking about a perioperative pain management plan, talking about the best way to do cases for long term outcomes, and for having my needlesticks hurt less than the next guy I have learned subtleties in performing block procedures over and over that make me the guy you want doing your block and not the guy who did the ccm fellowship, trust me. I think as far as being in the OR and basic anesthesia skills who you are as an individual and how you did in residency are the biggest predictors of overall badass-ness, neither fellowship helps that part. but i would in the end agree with the above in that if you dont want to do a lot of practicing chronic pain, dont do the fellowship, its not worth it.

and as far as actually doing the pain blocks: you absolutely need a fellowship to learn to do proper pain injections. a general anesthesiologist i would be surprised if they could locate the facet joint on xray.

 

[Noyac]

and as far as actually doing the pain blocks: you absolutely need a fellowship to learn to do proper pain injections. a general anesthesiologist i would be surprised if they could locate the facet joint on xray.

Not true. Anyone can learn to locate the "Scotty dog". It's not the procedures that requires the fellowship but rather the work up and assessment of pain. The procedures are easy enough for any skilled general anesthesiologist. Why do you think crna's are starting to enter this realm of anesthesia? Because the procedures are easy and can be learned in a very short time.
You also don't need a pain fellowship to understand multimodal treatment. Or to be slick with blocks. Or to plan future pain relief. This is all well within the scope of a general anesthesia practice.

 

[epidural man]

Pain fellowship made my skills in OR worse.

Mostly a time in OR thing....

 

[Hoya11]

Not true. Anyone can learn to locate the "Scotty dog". It's not the procedures that requires the fellowship but rather the work up and assessment of pain. The procedures are easy enough for any skilled general anesthesiologist. Why do you think crna's are starting to enter this realm of anesthesia? Because the procedures are easy and can be learned in a very short time.
You also don't need a pain fellowship to understand multimodal treatment. Or to be slick with blocks. Or to plan future pain relief. This is all well within the scope of a general anesthesia practice.

not sure what your motivation is here. do you really feel comfortable doing fluoro guided blocks? celiac plexus? stim trials? cervical epidurals? RFAs? of the many general anesthesiologists I know, none are able to do anything like these procedures. do you think if you took the pain boards tomorrow you would pass? there is actually some real content to it and expertise to be gained. i completely disagree that most general anesthesiologists can do routine pain procedures without any additional training. thats why you do the fellowship.

 

[Noyac]

not sure what your motivation is here. do you really feel comfortable doing fluoro guided blocks? celiac plexus? stim trials? cervical epidurals? RFAs? of the many general anesthesiologists I know, none are able to do anything like these procedures. do you think if you took the pain boards tomorrow you would pass? there is actually some real content to it and expertise to be gained. i completely disagree that most general anesthesiologists can do routine pain procedures without any additional training. thats why you do the fellowship.

I am different from the usual anesthesiologist in that I have done and can do all those blocks you mention. I've even done IDET and IT pumps. I wouldn't do them now since I haven't in about 10yrs. I have however done hundreds of cervical epidurals, facets injections, fluoro guided blocks, celiac plexus blocks with both CT and fluoro guidance. I've done it all and I can tell you it made very little difference in my general practice other than the increased comfort with regional. And this may be why I don't find US to be a useful as others do. Because I have done all of this I feel qualified to comment. I wouldn't say that this makes me better at regional than my partners since their blocks also seem to work very well. Maybe on a rare occasion I can add something that others haven't thought of when dealing with difficult pain pts. But that is rare.

But those procedures you mention have nothing to do with being in the OR. So your point isn't clear to me.

And what does my ability to pass the pain board tomorrow have to do with anything?

I think you are confusing the question. The question was, does a pain fellowship help in the OR? Most here said not much or very little. Unlike CCM fellowship.

But you have turned this around by stating that gen anesthesiologist can't do pain procedures. That wasn't the question.

I'm not knocking anyone for doing a pain fellowship. I'm just saying it isn't as beneficial as CCM when you are in theOR. AND MOST LIKELY A WASTE OF TIME IF YOU ARE NOT GOING TO PRACTICE PAIN MANAGEMENT.

 

[Hoya11]

Not true. Anyone can learn to locate the "Scotty dog". It's not the procedures that requires the fellowship but rather the work up and assessment of pain. The procedures are easy enough for any skilled general anesthesiologist. Why do you think crna's are starting to enter this realm of anesthesia? Because the procedures are easy and can be learned in a very short time.
You also don't need a pain fellowship to understand multimodal treatment. Or to be slick with blocks. Or to plan future pain relief. This is all well within the scope of a general anesthesia practice.

"Its not the procedures that require the fellowship..." "The procedures are easy enough for any skilled general anesthesiologist".. I was correcting that statement.

I was responding to this comment, initiated by you, claiming that any general anesthesiologist should be able to do pain blocks. Which I hold is not true, and the fact that you have this additional training before fellowship was around is an exception. Most general anesthesiologist do not know how to do these blocks and hence need a fellowship.

The fellowship may not be a tremendous advantage to regional skills, but it doesnt hurt and I would say improved mine. Would I do it again knowing that I want to do general anesthesiology? No. Does it make me the point person for pain related issues in my group? yes.

The point about passing the boards is to reinforce that general anesthesiologists actually DONT have the knowledge to do pain procedures, manage pain patients, and that there is actually valuable (different) knowledge in fellowship to be learned that is NOT taught in anesthesia residencies. Your tone of downplaying any real knowledge conveyed in the fellowship (as if you knew it all from our awesome general anesthesia training), I found naive.

 

[Noyac]

I'm not trying to stir anything up with you, I'm just giving an opinion.
I'll answer a few of your remarks here and hopefully this will suffice.
I meant that any gen Anesth could do the block with some amount of training of which would not require a full fellowship. It's not the blocks that the fellowship really teaches as much as it is the "knowledge" which you alluded to when asking about the board exam. So we can probably agree in that. This is also why I refered to CRNA now doing these blocks. They didn't do a fellowship. But they don't have the knowledge as you say.
I didn't say the fellowship would hurt your skills. I just said it wouldn't help as much as CCM would in the OR.
And don't misunderstand why "some" of your colleagues refer the difficult pain pts your way.

I hope this clarifies my point. It is not an argument. It is an opinion.

 

[Hoya11]

I understand, agree, and respect your opinion