PALLIATIVE CARE CONSULT SERVICE (3 MONTHS)
Wake Forest Baptist Medical Center is a 831-bed general medical and surgical facility with 38,555 admissions in the most recent year reported. It is the largest employer in Forsyth County with more than 13,440 employees and a total of 198 buildings on 428 acres. The fellow will participate in a consult service that receives over 1200 consults per year. The fellow will develop skills in consultative palliative care, symptom management, communication, inter-disciplinary care, transition management and end-of-life care.  The consult service consists of a staff of attending physicians, advance practice nurses, a social worker, and a chaplain. 

RADIATION ONCOLOGY ROTATION (2 WEEKS)
Fellows will spend 2 weeks rotating in radiation oncology. The goal of this rotation is so that fellows will have exposure to learn basic concepts and practices of radiotherapy and understand the common side effects along with the role of radiation on pain management.  

ONCOLOGY AND PALLIATIVE NEUROLOGY ROTATION (2 WEEKS)
Fellows will spend 2 weeks rotating in a variety of outpatient clinics to gain better knowledge of common side effects/adverse effects related to treatment of common oncological cancers along with a variety of neurological conditions. Fellows with rotate in the muscular dystrophy clinic, the ALS clinic, the Huntington’s disease, Multiple Sclerosis, Parkinson’s disease clinic, and a variety of different oncological clinic (e.g. lung cancer, breast cancer, GI cancers, etc). 

ANESTHESIA PAIN AND ADDICTION MEDICINE (3 WEEKS)
Fellows will be a chance to rotate with the Wake Forest Anesthesia Chronic Pain Service, both in the inpatient consult service and outpatient clinic. The fellow will gain confidence in all forms of pain control and be exposed to cutting-edge research in pain management. The purpose of this rotation is to have fellows learn when referral to an interventional pain specialist is appropriate and how these techniques can be used in the management of palliative care patients.

Fellow will also rotate in Addiction Medicine ,where they will gain exposure to Suboxone (Buprenorphine) clinic, gain a better understanding of Addiction and Substance Use Disorders, and learn what resources are available for patients with substance use disorders.

Brenner Children's Hospital is the 144-bed “hospital within a hospital’’ affiliated with Wake Forest Baptist Medical Center and Wake Forest University in Winston-Salem, North Carolina. It is a Level 1 Pediatric Trauma Center, as well as it has a pediatric Emergency Department, and pediatric and neonatal intensive-care units. More than 4,500 children are admitted to Brenner Children’s Hospital every year and more than 21,000 pediatric subspecialty visits occur at hospital-based outpatient clinics. The fellow will gain expertise in palliative care of pediatric patients through rounding with the pediatric palliative care team, participating in transitions of care between inpatient and outpatient care, and conducting family meetings.

PALLIATIVE CARE CONSULT SERVICE (1 MONTH)
Forsyth Medical Center is a 921-bed hospital, the largest hospital in the Novant Health system. The consult team was started in 2004 and sees over 2000 new consults per year and on average sees 30 inpatient palliative care encounters per day. There are also approximately 200 outpatient new referrals per year to Oncology Supportive Care Clinic. The interdisciplinary team consists of 3 physicians, 5 advanced practice providers, social worker, chaplain, case manager, pharmacist and clinical dietitian. Novant Health Forsyth Medical center was the first hospital in NC to achieve Advanced Certification in Palliative Care through Joint Commission and is also a Charter member Global Palliative Care Quality Alliance. The fellow will develop skills in consultative palliative care, symptom management, communication, inter-disciplinary care, transition management and end-of-life care.

INPATIENT PALLIATIVE CARE UNIT (1 MONTH)
This is a 19 bed acute inpatient palliative care unit. It was started in 2001. The fellow will develop skills in complex symptom management, communication, inter-disciplinary care, transition management and end-of-life care in an acute inpatient palliative care unit.

INPATIENT HOSPICE HOME (8-12 WEEKS)
HPCC is a large, not-for-profit, Medicare-certified, hospice with an average daily census of 500+ patients. It has a 40-bed inpatient facility that provides acute and residential care to hospice patients. The fellow will be responsible for rounding on patients’ daily, attending IDT meetings and participating in family discussions to provide high-quality patient care.

Hospice of Davidson County (0.5 months optional)
Fellows will have an option to rotate at Hospice of Davidson County in the Hinkle Hospice house as part of their inpatient hospice experience. This is a 12-bed inpatient unit.  The fellow will be responsible for rounding on patients’ daily, attending IDT meetings and participating in family discussions to provide high-quality patient care. 

Inpatient Hospice
SECU Hospice Care Center of Yadkin is a hospice inpatient facility located in Yadkin County, which opened in August 2017. It’s a 10,000-square-foot facility with six patient suites. The fellow will be responsible for rounding on patients daily, attending IDT meetings and participating in family discussions to provide high-quality patient care.

Home Hospice (Longitudinal)
Fellows will each be assigned a hospice team and will attend IDT meetings and go on home hospice visit on their patients every month. 

Bermuda Village is conveniently located less than 10 minutes from Winston Salem within the gated retirement community of the Bermuda Run Country Club. Bermuda Village offers all levels from independent living to acute rehabilitation to skilled nursing, along with a wellness clinic.

During this rotation, the fellow will learn the nuances of palliative care needs of the elderly, such as progression and management of neurologic illness (e.g., dementia, ALS, Parkinson’s), assessment and management of chronic non-cancer pain, wound care, geriatric syndromes (incontinence, delirium, non-cancer related functional decline, frailty), advance care planning, and policies and regulations of long-term care settings.

Long Term Care Rotation: The Geriatrics and Extended Care (G&EC) Program at Hefner VAMC provides care and support to veterans and their families with a goal of maximizing function and independence.

Collaborating and working together with the veteran to determine goals and interdisciplinary teams are comprised of

• Physicians
• Registered nurses
• Nurse practitioners
• Social workers
• Nutritionists
• Clinical Pharmacists
• Occupational and Physical Therapists
• Psychologists 

Fellows will rotate in the community living center (CLC) which provides Short term rehabilitation (wound care, occupational therapy, kinesiotherapy, physical therapy, speech therapy, skilled nursing, and restorative care), Long term maintenance (skilled nursing, dementia, psychiatric, and maintenance care), Respite care, and Palliative and Hospice Care.

During this rotation the fellow will learn the nuances of palliative care needs of the elderly, such as progression and management of neurologic illness (e.g. dementia, ALS, Parkinson’s), assessment and management of chronic non-cancer pain, wound care, geriatric syndromes (incontinence, delirium, non-cancer related functional decline, and frailty), advance care planning, and policies and regulations of long-term care settings

Longitudinal care of hospice and palliative care patients is provided in the WFBMC Supportive Care Oncology Clinic where the fellow will spend one half-day every week throughout the twelve-month fellowship training program. The fellow will manage patients at all disease stages with multiple physical, psychosocial, spiritual, and existential issues as part of a multidisciplinary team. The fellow will follow new patients longitudinally in the ambulatory setting as well as across settings if the patient is admitted to the hospital or goes to hospice.

Participation in scholarly activities during the clinical fellowship is required and the fellow will have a block rotation dedicated to the development and initiation of scholarly work based upon their interests which will be conducted throughout the year guided by faculty mentorship.

Several elective opportunities are open to the fellow based upon interestsm including:

• Interventional pain management
• Interventional radiology
• Clinical oncology
• Geriatric medicine
• Critical care medicine
• Pediatric palliative care
• Surgical oncology
• Geripsych
• Integrative medicine
• PACE medicine rotation
• Transitional care
• Pain management

• July Inpatient palliative care consults at Wake Forest
• August Inpatient hospice at Trellis Supportive Care; anesthesia pain and addiction medicine rotation
• September Inpatient palliative care consults and inpatient palliative care unit at Novant
• October Inpatient palliative care consults at Wake Forest; research time
• November Radiation oncology at Wake Forest; long-term care at VA
• December Inpatient hospice at Trellis Supportive Care
• January Pediatric palliative rotation at Brenner’s Children Hospital; elective
• February Inpatient palliative care consults at Wake Forest; long-term care at VA
• March Palliative neurology and oncology at Wake Forest; inpatient palliative care consults at Wake Forest
• April Inpatient palliative care consults and inpatient palliative care unit at Novant
• May Research time; elective
• June Inpatient hospice at Trellis Supportive Care; inpatient palliative care consults at Wake Forest