Pain Medicine Fellowship

The Pain Medicine Fellowship Program is a 1-year ACGME-approved program within the Department of Anesthesiology.

Each year the pain fellow is exposed to a wide variety of patients experiencing all aspects of the pain continuum, including acute pain, chronic pain and cancer-related pain. Our fellows are an integral part of our interdisciplinary team within our Center for Pain and Spine. The fellow achieves greater autonomy in the decision-making process as their experience grows. Our team provides a full range of pain management services including diagnostic evaluations, medical management and procedural therapy using an interdisciplinary approach with a focus on functional improvement.

We see approximately 8,000 patients a year, on average, in our Pain Clinic and perform over 3,000 procedures per year. These procedures include most all diagnostic spine and nerve block procedures, neurolytic procedures, spinal cord and peripheral nerve stimulation, implantable pump placement, and musculoskeletal (MSK) procedures using both fluoroscopic and ultrasound guidance.

We have a very active didactic schedule geared towards preparing the fellow for independent practice and for the Pain Medicine board certification examination. We have joint conferences with the Spine team, Neurology, Psychology, Rehabilitative Medicine, Interventional Radiology, Rheumatology and Anesthesiology.

Our Pain Medicine Fellowship offers a well-rounded experience for those wishing to pursue a career in the field of pain medicine, whether in academics, private practice, or a mixture of both. Dartmouth Hitchcock Medical Center offers a collegial and non-pressured atmosphere to study and learn with a wide variety of experiences available. The Upper Valley offers a beautiful and highly cultured location in which to live and learn in during the fellowship year.

Fellowship Director's Message

Thank you for your interest in our ACGME-accredited Multidisciplinary Pain Medicine Fellowship in the Center for Pain and Spine at Dartmouth Hitchcock Medical Center. Our Center is a past winner of the Clinical Centers of Excellence in Pain Management award by the American Pain Society. We are also the teaching hospital for the Geisel School of Medicine at Dartmouth. We train four Pain Medicine fellows per year. The fellowship is 12 months in length and starts during the second week of July each year. Our Center for Pain and Spine is a multidisciplinary acute and chronic pain center and serves as a resource for the medical center and for a large part of New England.

We are a division within the Department of Anesthesiology and function in a multidisciplinary capacity. We integrate the disciplines of Physical Medicine & Rehabilitation, Neurology, Neurosurgery, Psychiatry, Addictionology, Behavioral Medicine, Radiology, Oncology and Palliative Medicine. Post graduate year two and three Anesthesiology residents rotate through the Center for Pain and Spine as do residents from other medical specialties and medical students from the Geisel School of Medicine at Dartmouth. The fellowship program combines clinical training, a structured didactic schedule, complimentary rotations, the opportunity to teach, and research opportunities. Innovation in our institution is supported by the passion of our diverse staff, as well as through the Dartmouth SYNERGY Clinical and Translational Science Institute and the Dartmouth Center for Program Design & Evaluation, which provide research support for our fellows. We also have the great fortune to be associated with the world famous Dartmouth Institute for Health Policy & Clinical Practice, which has been helping to improve medicine for over 30 years.

The core fellowship providers are made up of numerous faculty members, each with unique interests and experience, but all possessing a passion and commitment to teaching. We seek to further the careers of the best of the next generation of pain physicians in both private practice and academia.

Our fellowship program offers a well-balanced mixture of medical, physical, psychological, and interventional modalities. We offer a strong didactic experience including morning conferences by institutional experts. The comprehensive didactic schedule, structured to complement the clinical experience prepares the fellow for independent practice as well as certification examinations. In addition to the typical topics, this didactic schedule also includes discussions on practice management, the business of medicine, and medicolegal aspects of pain management.

We include training and rotations in the Center for Pain and Spine, as well as a Palliative Care service for our seriously ill population. The interventional pain aspect of the fellowship includes training in basic techniques such as peripheral blocks, neuraxial blocks, and neurolysis among many others. We are also active in the area of neuromodulation with the use of spinal cord, peripheral nerve, and craniofacial nerve stimulation trials and implantations. For unremitting cancer-related pain, we offer intra-thecal and epidural administration of analgesics by means of spinal infusion systems. We utilize both fluoroscopic and ultrasound guidance techniques. We have a strong relationship with our orthopedic colleagues and for non-spinal musculoskeletal pain we offer comprehensive work-ups and frequently utilize ultrasound-guided MSK procedures.

We have the privilege to offer our patients a unique comprehensive interdisciplinary pain program through the Functional Restoration Program. This is a 4-week daily program with a focus helping patients meet their functional goals and built to target all of the factors in patients life that contribute to their pain. Our fellows spend time rotating through this program both in a patient role to gain perspective on patient experience as well as in an interdisciplinary provider role.

We are exceedingly fortunate to have the Dartmouth Cancer Center, designated by the National Cancer Institute as a comprehensive cancer center, within our medical center. Time with the Palliative Medicine service allows our fellows to learn the skills of cancer-related pain assessment and treatment from the passionate and dedicated medical providers within this Center.

Dartmouth Hitchcock Medical Center is located in one of the most beautiful places in the world. High quality outdoor areas a bound here, allowing one the opportunity to explore a variety of activities, such as hiking, mountain biking, trail running, mountaineering, camping, alpine skiing, cross country skiing, rowing, snowshoeing, kayaking and more. Our institution brings world-class speakers and entertainers, as well as division one college-level sports, to the area. The culture in our institution is collegial and exceedingly friendly. We believe that our program is exemplary, with unparalleled academic resources. We constantly strive to improve the care we provide to our patients and innovation is the rule.

We accept applications for each academic year through ERAS and all positions are assigned through the NRMP match. For more information regarding stipends and benefits, I invite you to visit the GME at Dartmouth Hitchcock Medical Center website.

Sincerely,

Kimberly M. Youngren, MD
Program Director, Pain Medicine Fellowship
Clinical Assistant Professor in Anesthesiology
Geisel School of Medicine at Dartmouth

Research Opportunities

Research opportunities exist at many levels during the Pain Fellowship year and are strongly encouraged.  We expect each fellow to participate in a scholarly activity that may result in a publication.

It may consist of an on-going clinical research project, a quality improvement project, a clinically relevant project such as web development or note templating, a book chapter, or a "value" project (productivity improvement/cost reduction).

We are closely affiliated with The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and our trainees have obtained joint degrees in leadership or public health while completing their fellowship requirements.

We offer a diverse and challenging experience for our trainees.