The fellowship program is structured along the Accreditation Council for Graduate Medical Education (ACGME) competencies in Hospice and Palliative Medicine. Through a series of clinical rotations, didactics, participation in scholarly activities, and varying seminars, the fellow will:
- Satisfy the requirements to sit for the ABIM Hospice and Palliative Medicine board certification exam.
- Develop expertise in assessment and management of symptoms related to chronic and life-limiting illness and provide high-quality end-of-life care.
- Master the knowledge of hospice and palliative medicine and commit to life-long learning.
- Employ effective communication skills in interaction with patients, families, and other healthcare professionals.
- Incorporate and support interdisciplinary team-care in future clinical venues.
- Appreciate a supportive environment where professionalism, ethical principles, and teamwork are furthered.
The overall educational mission is to create successful and competency-based clinicians that can care for patients and their families who face life-limiting or life-threatening illness.
The clinical curriculum includes:
- 4 months of Inpatient Palliative Care Consults and Inpatient Palliative Care Unit
- 3 months of Inpatient and Home Hospice
- 1 month Research/Scholarly Time
- 3 weeks of Anesthesia Pain and Addiction medicine
- 2 weeks of Pediatric Palliative Care
- 2 weeks of Palliative Neurology and Oncology
- 2 weeks of Radiation Oncology
- 1 month of Long Term Care
- 1 month of Elective Time
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.
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.
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.
HOME HOSPICE SERVICE (4 WEEKS)
Fellows will gain extensive experience managing hospice patients in home care through time spent with HPCC. Fellows will meet weekly during the rotation with the hospice interdisciplinary team, providing clinical support and guidance to the team. Two two-week blocks of the fellow’s time are spent doing hospice home visits.
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.
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
- Registered nurses
- Nurse practitioners
- Social workers
- Clinical Pharmacists
- Occupational and Physical Therapists
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
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
- Integrative medicine
- PACE medicine rotation
- Transitional care
- Pain management
- July: Inpatient Palliative Care Consults at Wake Forest
- August: Inpatient Hospice at Trellis Supportive Care/HPCC and Anesthesia Pain and Addiction Medicine rotation
- September: Inpatient Palliative Care Consult and Inpatient Palliative Care Unit at Novant
- October: Home Hospice at Trellis Supportive Care/HPCC and Research Time
- November: Radiation Oncology at Wake Forest and long-term care at VA
- December: Inpatient Hospice at Trellis Supportive Care/HPCC
- January: Pediatric Palliative Rotation at Brenner’s Children Hospital and “Elective”
- February: Inpatient Palliative Care Consults at Wake Forest and long-term care Bermuda Commons
- March: Palliative Neurology and Oncology at Wake and Inpatient Palliative Care consults at Wake
- April: Inpatient Palliative Care Consult and Inpatient Palliative Care Unit at Novant
- May: Research Time and “Elective”
- June: Inpatient Hospice at Trellis/HPCC and Inpatient Palliative Care consults at Wake