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
Program Goals
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.
Clinical Rotations
The clinical curriculum includes:
- 4-5 months of inpatient palliative care consults and inpatient palliative care unit
- 8 weeks of inpatient hospice
- 1 month research/scholarly time
- 2 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
- 2 weeks home hospice
Over the 12-month fellowship program, rotations occur at locations that include:
- Wake Forest Baptist Medical Center
- Brenner Children's Hospital
- Trellis Supportive Care
- W.G. Hefer VA Medical Center
- Novant Health Forsyth Medical Center
- Bermuda Village
- Mountain Valley Hospice and Palliative Care
Fellows also will have a longitudinal continuity clinic embedded within the Wake Forest Baptist Health Comprehensive Cancer Center and a longitudinal experience in home hospice through Mountain Valley Hospice and Palliative Care.
PALLIATIVE CARE CONSULT SERVICE (4-5 MONTHS)
Wake Forest Baptist Medical Center has 1,535 licensed beds system-wide and 885-beds on the main campus, which includes level 1 trauma center, Brenner Children’s hospital, and Comprehensive Cancer Center with 60,023 admissions in the most recent year reported. It is the largest employer in Forsyth County with more than 19,000 employees system-wide. 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 faculty physicians, nurse practitioners, physician assistants, supportive care nurses, social workers, chaplains, and pharmacists.
RADIATION ONCOLOGY ROTATION (2 WEEKS)
Fellows will spend 2 weeks rotating in radiation oncology. The goal of this rotation is to provide fellows with opportunity 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, and Parkinson’s disease clinic; and a variety of different oncological clinics (e.g. lung cancer, breast cancer, GI cancers, etc).
ANESTHESIA PAIN AND ADDICTION MEDICINE (2 WEEKS)
Fellows will 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.
Fellows 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.
Wake Forest Baptist Medical Center has 1,535 licensed beds system-wide and 885-beds on the main campus, which includes level 1 trauma center, Brenner Children’s hospital, and Comprehensive Cancer Center with 60,023 admissions in the most recent year reported. It is the largest employer in Forsyth County with more than 19,000 employees system-wide. 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 faculty physicians, nurse practitioners, physician assistants, supportive care nurses, social workers, chaplains, and pharmacists.
RADIATION ONCOLOGY ROTATION (2 WEEKS)
Fellows will spend 2 weeks rotating in radiation oncology. The goal of this rotation is to provide fellows with opportunity 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, and Parkinson’s disease clinic; and a variety of different oncological clinics (e.g. lung cancer, breast cancer, GI cancers, etc).
ANESTHESIA PAIN AND ADDICTION MEDICINE (2 WEEKS)
Fellows will 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.
Fellows 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’’ located on the main campus of Wake Forest Baptist Medical Center. It is a Level 1 Pediatric Trauma Center and 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)
Novant Health is a not-for-profit integrated system of 15 medical centers with 2,683 beds system-wide. Forsyth Medical Center is a 901-bed hospital, the largest hospital in the Novant Health system which also includes locations in Clemmons, Thomasville, and Kernersville. 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 is also an Oncology Supportive Care Clinic. The interdisciplinary team consists of 3 physicians, 5 advanced practice providers, social worker, chaplain, and case manager. 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.
Novant Health is a not-for-profit integrated system of 15 medical centers with 2,683 beds system-wide. Forsyth Medical Center is a 901-bed hospital, the largest hospital in the Novant Health system which also includes locations in Clemmons, Thomasville, and Kernersville. 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 is also an Oncology Supportive Care Clinic. The interdisciplinary team consists of 3 physicians, 5 advanced practice providers, social worker, chaplain, and case manager. 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 HOSPICE HOME (1 month)
Trellis 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 gain extensive knowledge about the hospice medical director role, be responsible for rounding on patients daily, attending IDT meetings and participating in family discussions to provide high-quality patient care.
Trellis 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 gain extensive knowledge about the hospice medical director role, be responsible for rounding on patients daily, attending IDT meetings and participating in family discussions to provide high-quality patient care.
Inpatient Hospice
Mountain Valley Hospice and Palliative Care has two inpatient hospice units. The Joan & Howard Woltz Hospice Home which opened in 2009 is located in Dobson, NC and has 20 beds. The SECU Hospice Care Center which opened in 2017 is located in Yadkinville, NC and has 6 beds. The fellow will gain extensive knowledge about the hospice medical director role, 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.
Mountain Valley Hospice and Palliative Care has two inpatient hospice units. The Joan & Howard Woltz Hospice Home which opened in 2009 is located in Dobson, NC and has 20 beds. The SECU Hospice Care Center which opened in 2017 is located in Yadkinville, NC and has 6 beds. The fellow will gain extensive knowledge about the hospice medical director role, 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.
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 interests including:
- Interventional pain management
- Interventional radiology
- Clinical oncology
- Geriatric medicine
- Critical care medicine
- Pediatric palliative care
- Surgical oncology
- Geriatric psychiatry
- Integrative medicine
- PACE medicine rotation
- Transitional care
- Pain management
July: Inpatient PC consults at Wake Forest -- Anesthesia Pain/Addiction Medicine
August: Inpatient PC consults at Wake Forest -- Research
September: Inpatient hospice at Trellis -- Inpatient PC consults at Wake Forest
October: Elective -- Inpatient PC consults at Novant -- Research
November: Inpatient hospice at Mtn. Valley -- LTC at Bermuda Village
December: Inpatient PC consults at Wake Forest -- Inpatient PC consults at Novant
January: Radiation Oncology -- Inpatient PC consults at Wake Forest
February: Oncology/Neurology clinic -- Inpatient PC consults at Novant
March: Inpatient hospice at Mtn. Valley -- Inpatient PC consults at Wake Forest -- Research
April: Pediatric Palliative Care -- Inpatient hospice at Trellis
May: LTC at Bermuda Village -- Inpatient PC consults at Novant
June: Elective -- Inpatient PC consults at Wake Forest
August: Inpatient PC consults at Wake Forest -- Research
September: Inpatient hospice at Trellis -- Inpatient PC consults at Wake Forest
October: Elective -- Inpatient PC consults at Novant -- Research
November: Inpatient hospice at Mtn. Valley -- LTC at Bermuda Village
December: Inpatient PC consults at Wake Forest -- Inpatient PC consults at Novant
January: Radiation Oncology -- Inpatient PC consults at Wake Forest
February: Oncology/Neurology clinic -- Inpatient PC consults at Novant
March: Inpatient hospice at Mtn. Valley -- Inpatient PC consults at Wake Forest -- Research
April: Pediatric Palliative Care -- Inpatient hospice at Trellis
May: LTC at Bermuda Village -- Inpatient PC consults at Novant
June: Elective -- Inpatient PC consults at Wake Forest