Top regional fellowships

[Fastrach]

Yeah, I read the old posts about private practice being the best way to hone your regional skills out of residency. But I'm curious where people would currently recommend doing a regional fellowship these days, let's say your top 5 choices.

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[Tenesma]

i hate to say this but regional fellowships are over-rated ...

if you have done tons of ultra-sound regional during residency you will do fine...

or go to HSS - they have a year fellowship

 

[usnavdoc]

i hate to say this but regional fellowships are over-rated ...

if you have done tons of ultra-sound regional during residency you will do fine...

or go to HSS - they have a year fellowship

Thats the issue though. Having several friends around the country in different programs the only ones getting "tons of ultra-sound regional" are the residents at programs that have these fellowships.

 

[2ndyear]

A couple of issues here. I'd say that most programs do regional really adequately. There are some notable exceptions, but most places are quite average. That being said, I'm happy being comfortable with a few blocks but I can do them well. I think if you can do a good supraclavicular, femoral, and popliteal you're in pretty good shape. Throw in an interscalene too for the shoulders. That's not a lot of blocks really. And you can get a whole lot of mileage from them. Fancy stuff like lumbar plexus? I say epidural.

 

[VentdependenT]

Thats the issue though. Having several friends around the country in different programs the only ones getting "tons of ultra-sound regional" are the residents at programs that have these fellowships.

Really? How many U/S guided ISB/SupraclaviB/AxB/FemB do you need to do before you become proficient? I say not many.

If you use just a nerve stimulator, then I'd argue differently.

 

[usnavdoc]

Really? How many U/S guided ISB/SupraclaviB/AxB/FemB do you need to do before you become proficient? I say not many.

If you use just a nerve stimulator, then I'd argue differently.

I think with the bread and butter blocks(ISB/SupraclaviB/AxB/FemB/pop/Sci) you are right but more advanced blocks is what I meant. I guess our definition of "Tons" is different.

 

[VentdependenT]

I think with the bread and butter blocks(ISB/SupraclaviB/AxB/FemB/pop/Sci) you are right but more advanced blocks is what I meant. I guess our definition of "Tons" is different.

WHat other blocks do you need? Lumbar plexus block (for a hip in a guy who you dont wanna do under GA and has an impossible back/or vasculopath undergoing fem-something bypass) I suppose. That would be a cool one under U/S. Never tried it. But I'd imagine with that block your incidence of causing a hematoma/retroperitoneal bleed would be about the same (Never tried it so dunno...wonder how good the doppler would be at that depth). Anyways I'm able to do one old school style but rarely find true indications for this block vs an epidural. Bleeding complications with this one are high.

Paravertebral? Maybe but what the hell for.

Illioinguinal? Surgeons do that one. Plus its just a field block from what I've read.


The fellowship would be good for PNB catheter placement/management in outpt setting. Learning how to get that up and running safely on your own for an outpt center/outpt surgeries once you grad could be a BIG Ka-Ching maker.

 

[Gator05]

WHat other blocks do you need? Lumbar plexus block (for a hip in a guy who you dont wanna do under GA and has an impossible back/or vasculopath undergoing fem-something bypass) I suppose. That would be a cool one under U/S. Never tried it. But I'd imagine with that block your incidence of causing a hematoma/retroperitoneal bleed would be about the same (Never tried it so dunno...wonder how good the doppler would be at that depth). Anyways I'm able to do one old school style but rarely find true indications for this block vs an epidural. Bleeding complications with this one are high.

Paravertebral? Maybe but what the hell for.

Illioinguinal? Surgeons do that one. Plus its just a field block from what I've read.


The fellowship would be good for PNB catheter placement/management in outpt setting. Learning how to get that up and running safely on your own for an outpt center/outpt surgeries once you grad could be a BIG Ka-Ching maker.

Agreed. Single-shots here at UF are the domain of residents. Catheters are another story. It seems the threshold for proper placement is higher, and requirements for needle tip placement tighter as well.

I think regional fellowship may be ideal for a couple of reasons. First, if you're interested in academics, somebody's gotta teach even the easy blocks. Second, if you dig Ilfeld's work, joint replacements may become outpatient procedures in the nearer future. These will by necessity have catheters. With an aging geriatric population coming in for knees and shoulders, I don't see this direction growing smaller. Third, I think this area is hot for research right now. Cheaper procedures (ie not hospitalized for pain control), pain-free and faster recovery times...even the insurance companies will catch up sometime.

Finally? It's just really fun. Very rewarding to see those folks leave 20-30min later fully awake, no hangover, telling their spouse since they feel this good maybe they will be able to make that game...

 

[RickKane]

Here is a list I compiled of U.S. programs offering Regional Fellowships. Some of the fellowships are combined with Acute Pain, Orthopaedic Anesthesia, or even OB. Others are a combination of fellowships and a junior faculty position.

Brighams and Womens
Columbia
Cornell-Hospital for Special Surgery
Dartmouth
Duke
Florida
Iowa
John Hopkins
Mayo Cinic (the real one)
Northwestern
St Lukes-Roosevelt
Thomas Jefferson
UCLA
UCSD
Univ Pitt
Unv Houston
Unv Illinois
Unv Miami
Unv Washington
Unv Wisconsin Madison
Virginia Mason
Walter Reed
Yale

 

[Fastrach]

Here is a list I compiled of U.S. programs offering Regional Fellowships. Some of the fellowships are combined with Acute Pain, Orthopaedic Anesthesia, or even OB. Others are a combination of fellowships and a junior faculty position.

Brighams and Womens
Columbia
Cornell-Hospital for Special Surgery
Dartmouth
Duke
Florida
Iowa
John Hopkins
Mayo Cinic (the real one)
Northwestern
St Lukes-Roosevelt
Thomas Jefferson
UCLA
UCSD
Univ Pitt
Unv Houston
Unv Illinois
Unv Miami
Unv Washington
Unv Wisconsin Madison
Virginia Mason
Walter Reed
Yale

Thanks for the list! But I'm wondering, doesn't Unv Utah have a fellowship as well?

 

[RickKane]

Thanks for the list! But I'm wondering, doesn't Unv Utah have a fellowship as well?

I couldn't find anything about a regional fellowship on the U of U website. It mentions pain, OB, neuro and echo but someone at Utah might have a better idea. Utah could be like Vanderbilt. When I interviewed at Vandy they said they are willing set up a fellowship in just about anything for the residents. I remember hearing they even set up a transfusion medicine fellowship for one of the residents.

 

[bubalus]

Thanks for the list! But I'm wondering, doesn't Unv Utah have a fellowship as well?

Yes.

 

[RickKane]

Here is the updated list. If anyone out there knows of a regional fellowship not on the list feel free to add it on.

Brighams and Womens
Columbia
Cornell-Hospital for Special Surgery
Dartmouth
Duke
Florida
Iowa
John Hopkins
Mayo Cinic (the real one)
Northwestern
St Lukes-Roosevelt
Thomas Jefferson
UCLA
UCSD
Univ Pitt
Unv Houston
Unv Illinois
Unv Miami
Unv Utah
Unv Washington
Unv Wisconsin Madison
Virginia Mason
Walter Reed
Yale

 

[drccw]

I wouldnt consider the Univ of Washingto a place for regional....

apparently the new chair wants to expand their regional offerings but right now the residents there are only barely getting enough of the bread and butter blocks (ISB, FNB, SNB, AX)

 

[serenity]

Here is the updated list. If anyone out there knows of a regional fellowship not on the list feel free to add it on.

Brighams and Womens
Columbia
Cornell-Hospital for Special Surgery
Dartmouth
Duke
Florida
Iowa
John Hopkins
Mayo Cinic (the real one)
Northwestern
St Lukes-Roosevelt
Thomas Jefferson
UCLA
UCSD
Univ Pitt
Unv Houston
Unv Illinois
Unv Miami
Unv Utah
Unv Washington
Unv Wisconsin Madison
Virginia Mason
Walter Reed
Yale

Please see the recently updated list on ASRA.I interviewed at U Pitt recently(for Regional Fellowship),they do catheters only and run a Acute Pain Service.No epidurals here,its all continuous paravertebral ,lumbar plexus amongst others.Both Nerve stimulator and Ultrasound.

 

[mille125]

duke has a good high volume program