Pain Medicine Residency Program

Overview

The twenty-six block, two-year program will train candidates to become competent specialists in Pain Medicine, capable of assuming leadership roles in education, research, and clinical practice pertaining to the prevention, diagnosis, treatment, and rehabilitation of the spectrum of acute pain, cancer pain, and non-cancer pain problems. In many cases, the physician practicing in this subspecialty will be the medical director of a multidisciplinary team, and hence must be versed in pain management/relief methods employed by team members who are physicians or allied health professionals.

Candidates certified by the Royal College in Anesthesiology, Emergency Medicine, Internal Medicine, Neurology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, or Rheumatology are eligible for certification in Pain Medicine.

At the end of the two-year program, candidates will be eligible to sit for the examination in Pain Medicine and, if successful, will be certified by the Royal College in the subspecialty of Pain Medicine.

To access information from the Royal College about Pain Medicine Residency, please click here.

Download our brochure here Anesthesia Pain Brochure

The program details can be found here: 2020 Pain Medicine Residency Manual

Program Highlights

The Pain Medicine Residency Program at McMaster University has much to offer trainees:

 

Dedicated Teaching Facility

McMaster University boasts a large, diverse, and experienced clinical faculty in pain medicine from multiple backgrounds, including Anesthesia, Physical Medicine & Rehabilitation, Psychiatry, Neurology, and Surgery.

 

Clinical Experience

The two large academic chronic pain clinics, the Michael G. DeGroote Pain Clinic and St. Joseph's Healthcare Pain Clinic, are two of the busiest academic pain clinics in the province, providing pain medicine residents with exposure to and experience with a wide variety of pain conditions and pain treatments.

 

Excellence in Interventional Procedures

The program will offer residents numerous opportunities to participate in ultrasound and fluoroscopic guided procedure opportunities taught by faculty who are nationally-recognized speakers and lecturers at various conferences. There is a growing neuromodulation program that will offer residents an unparalleled opportunity to receive training in this state-of-the-art pain treatment modality.

 

Varied Elective Opportunities

McMaster has a well-regarded Contemporary Medical Acupuncture Program in which the resident can enroll and complete. We are able to offer a wide range of electives from research and biostatistics to neuromodulation, diagnostic imaging, public health and preventative medicine, and curriculum development, as well as work at the Institute for Pain Research and Care and the National Pain Centre (both associated with McMaster University).

 

Resident Clinic

Once the resident has completed at a minimum 4 blocks of multidisciplinary pain clinic (MDPC), and has been deemed by the residency program committee (RPC) to be competent based on a standardized evaluation process, he/she will be eligible to participate in the resident-run clinic (RRC).  With the RRC, the resident takes a primary role in the operation of a pain clinic.  She/he is responsible for the triage of new referrals, scheduling of patients, assessment of patients, formation of treatment plans, adjustments to the treatment plan, performance of the appropriate interventions, communication with the referring physician and/or primary care provider, provision of referral to another physician, and discharge of the patient from care. This is a longitudinal rotation.  The resident is still under the supervision of a faculty member who is immediately available to the resident in case issues arise; the resident reviews all patient encounters with the supervisor at the end of the day.

The resident, as part of the RRC, will also have access to regularly scheduled procedural time, whereby she/he can perform an interventional pain procedure under image guidance.  The supervising faculty member is present in the procedural suite but will not actively intervene unless he/she observes an issue with the resident’s performance, or the resident requests assistance.

As part of the educational process, the resident will be submitting billings for services provided through the Ontario Health Insurance Plan (OHIP).  The billings generated will go into a special educational fund, out of which funding for educational endeavours can be drawn.

Selection Criteria

Candidates should demonstrate strong academic achievements and interest in pain medicine, as well as excellent interpersonal skills, work ethic, and leadership potential. All active residents should be in good stand standing with their program director.

 

Criteria for Graduates of a Canadian Medical School
  • Who are currently in their final year (PGY-4 to PGY-5) or who have completed training in a Royal College of Physicians and Surgeons of Canada Anesthesiology, Emergency Medicine, Internal Medicine, Neurology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, and Rheumatology. Entry from other FRCPC programs such as Orthopedics, Neurosurgery, and Palliative Care is possible in exceptional cases.
  • Who are currently in their final year or who have completed training in an accredited US ACGME program in Anesthesiology, Family Medicine, Internal Medicine, Neurology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, and Rheumatology. Entry from other FRCPC programs such as Orthopedics, Neurosurgery, and Palliative Care is possible in exceptional cases. Applicants in this category must receive an official ruling or eligibility to to sit the Royal College of Physicians and Surgeons of Canada exams in their core specialty prior to application to be eligible to apply.

 

Criteria for International Medical Graduates
  • Who are currently in their final year (R4 to R5) or who have completed training in a Royal College of Physicians and Surgeons of Canada accredited program in Anesthesiology, Emergency Medicine, Internal Medicine, Neurology, Pediatrics, Physical Medicine & Rehabilitation, Psychiatry, and Rheumatology. Entry from other FRCPC programs such as Orthopedics, Neurosurgery, and Palliative Care is possible in exceptional cases.
  • Internal Medical Graduate applicants must declare any Return of Service obligations on the application and may be disqualified if their provincial obligations preclude subspecialty training.

 

Obtaining Credit for Previous Training

The Royal College has an established process to consider credits from previous resident training.

Residents who wish to have some of their previous training considered towards their prospective residency training should first discuss this with their future Program Director. The Program Director will determine if the previous training is relevant to the current training.

The Program Director must ensure that a resident's performance warrants a recommendation for credit, that the training time can be reduced for that resident, and that he/she will still meet the competencies and requirements in the specialty and be successful at the certification examinations.

Program Curriculum

The residency program is for 2 years. Program length of training does not exceed the Royal College of Family Physicians of Canada Standard.

The Pain Medicine Residency Program consists of twenty-six (26) four-week blocks. Some blocks are completed sequentially, while others are completed longitudinally.

13 blocks of clinical experience in an outpatient multidisciplinary pain clinic. Within these 13 blocks, there will be longitudinal rotations through Sleep Medicine and Neuromodulation. The 13 blocks include the following:

  • 1 block Acute Pain Service
  • 1 block Cancer Pain and Symptom Management
  • 1 block MSK - Physical Medicine & Rehabilitation and Rheumatology
  • 1 block Neurology
  • 1 block Pediatric Pain Service
  • 2 blocks Psychiatry, including one block of Addiction Medicine
  • 6 blocks to be chosen from one or more of the following:
    • Adolescent Medicine
    • Bioethics
    • Community-based experience in Pain Medicine
    • Diagnostic Imaging
    • Education/Curriculum Development
    • Gastroenterology
    • Interventional Pain Medicine/Neuromodulation
    • Obstetrics and Gynecology
    • Orthopedic/Spine Surgery
    • Public Health and Preventative Medicine
    • Research Methodology/Biostatistics
    • Sleep Medicine
    • Other rotations relevant to training in Pain Medicine, as approved by the Program Director

 

Annual Chair's Garden Party and Resident Welcome BBQ

This annual summer event takes place at the Chair's home where the entire faculty and their families are invited to meet the new residents and clinical fellows. Partners and children are welcome and encouraged to attend.

Resident Academic Events

A curriculum has been designed to cover the objectives associated with each of the CanMEDS roles (see the section Educational Objectives).  The dates, times, and locations of all educational activities are available on the Program’s online calendar (accessed by any calendar product that supports the iCal format) as well as the Medportal site.

 

Attendance at Academic Half Days

All residents are required to attend the weekly Academic Half Day (AHD) on Wednesdays.  All residents are excused from clinical duty as of 16:00 to attend the sessions; faculty are expected to ensure that residents are freed from any clinical responsibilities in a timely fashion so that the residents can attend the sessions.

Residents based away from McMaster University during an elective is expected to continue attending academic sessions, if close enough to do so (travel time to Hamilton less than 1 hour).  If the elective is at another academic centre, the resident will take part in the academic activities of that university program while training at that site.  Residents on community electives distant from McMaster (travel time to Hamilton greater than 1 hour) are not expected to attend in person, but video conferencing capabilities can be utilized to allow for participation.

 

Didactic Lectures

Lecturers conduct 60 to 90 minute sessions on topics chosen by the academic curriculum director.  They are designed to provide teaching on objectives of training that are not easily covered in the course of clinical training, e.g.  Anatomy, pharmacology; to provide supplemental teaching on topics encountered during the course of clinical work; and to promote discussion and reflection on non-medical expert CANMEDS competencies.

 

Trouble Rounds/Case Discussion

The faculty member overseeing the AHD, or one of the residents, presents either an interesting case encountered during clinical work, or a scenario created by the faculty member, to address topics related to the CANMEDS competencies.  The goals of the case discussions are two-fold:

  • to promote sharing of knowledge, ideas, and experiences between residents as well as with faculty
  • to encourage approaching a clinical scenario from multiple angles, considering not just the medical expert aspects of the situation, but to also think about and address issues such as advocacy to address the systemic shortcomings that may have lead to the situation, or the ethical dilemmas presented by competing interests.


Pain Grand Rounds

Held on the last Thursday of every month from September to June starting at 17:30 in Room 2232, Michael DeGroote Centre for Learning and Discovery (MDCL).  Lectures are given by local experts as well as invited outside speakers on various topics in pain medicine, ranging from basic science research, new clinical research, and in-depth topic review.

 

Pain Journal Club

Held every 3 months.  The residents present 2 papers on a new clinical study or basic science study from the pain medicine literature.  Each presenter prepares a formal presentation, which provides an overview of the study methodology, review the results, and summarize the author’s conclusions.  The presenter provides critical appraisal of the study and concludes with the applicability of the study’s conclusion(s) on one’s own practice.  A broad, multidisciplinary audience attends.

 

Additional intervention practice sessions

Organized by Dr. Park (fluoroscopy guided) and Dr. Forero (ultrasound guided) (held every 3-4 months)

 

National Educational Activities

Pain Ground School – held the first week of the academic year in Toronto; the 2 day workshop covers a wide variety of introductory topics that the incoming pain medicine residents across the country would find useful.

National Interventional Pain Management Workshop for Clinical Fellows and Residents - usually held in September in Toronto

Nationwide Academic Curriculum (Teleconference) – organized by the program directors across Canada, the teleconference is scheduled 3-4 times per year to cover topics of interest to all pain medicine residents, but which may be hard to organize locally at all centres

Pain Medicine Examination preparation course – 2 day review course held in May, in Toronto.

 

Conferences

The resident is expected to attend at least one recognized North American or International pain conference per year (suggested conferences are listed on the online academic calendar).

 

Education Fund

As part of a new initiative, billings generated from the resident-run clinic are kept in a dedicated account, and residents can receive financial support from this fund for the following expenses:

  • Books: Textbook or reference text (ebook or hardcover book) related to preparation for the Royal College pain medicine examination.
  • Conference/workshop: in order to be considered, a conference or workshop must qualify for continuing professional development (CPD) credits as described in sections 1 and 2 of the Royal College Maintenance of Certification program.
  • Learning aids or educational software - to be adjudicated on a case by case basis; it should be directly applicable to the preparation for the writing of the Royal College pain medicine examination, teaching of junior learners in pain medicine, or preparation of formal teaching activities in pain medicine.

All expenses to be considered for reimbursement must be preapproved by the program director (PD).

 

Ground School

 

Resident Research Opportunities

All residents will be required to complete a research project during their two-year residency training. Acceptable projects include: quality assurance project, retrospective study (chart review), systematic review (meta-analysis), or clinical trial.

In order to meet this requirement, the Department of Anesthesia has a Research Office with resources to assist residents. Dr. Harsha Shanthanna and Toni Tidy, members of the pain medicine faculty, are available to meet with residents and guide them in their research project plans.

There are also research opportunities through the National Pain Centre, Michael G. DeGroote Institute for Pain Research and Care, and the Chronic Pain Network.

Academic Schedule

Section under construction, information coming soon!