Hospice and Palliative Medicine Fellowship

Curriculum

    Program Goals & Objectives

    The Hospice and Palliative Medicine Fellow will:

    1. Participate as an effective, active interdisciplinary member in the planning for care of a wide variety of children and adults of all ages with need for symptom management, coordination of care, assistance with clarification of goals of care, and decision making at the end of life.
    2. Become knowledgeable in the psychosocial issues related to care of patients with terminal illnesses, including advance directives, resuscitation status, and other decisions at the end of life.
    3. Learn and practice communication skills that demonstrate empathy and result in effective information exchange and collaboration with patients, their families, and other health care professionals.
    4. Demonstrate extensive knowledge of pain and symptom assessment and management, including the concept of total pain.
    5. Learn to recognize chemical coping and substance abuse and adjust treatment plan accordingly
    6. Acquire the advanced skills necessary to provide symptom relief, including palliative sedation, complex opioid management, and management of delirium and agitation.
    7. Promote scholarship through didactic and practical curricula as well as presentation of seminars, journal club and case discussions.
    8. Pursue and participate in scholarly activities through development and implementation of research projects, with goal of publication and presentation.
    9. Demonstrate socioeconomic awareness, sound ethical practice and professionalism in all patient care.
    10. Demonstrate knowledge of the palliative care continuum including outpatient resources, acute inpatient care, home and inpatient hospice, and long term care facilities in caring for patients with life-limiting illnesses, in order to ensure smooth transitions across settings.
    11.  Demonstrate awareness of one’s own response to death and dying and care of patients who are acutely ill and dying. Demonstrate awareness of bereavement issues and understanding of normal and pathologic grief.
    12.  Demonstrate awareness of importance of family and bereavement, and how to provide comfort and assistance through utilization of communication skills and pastoral care.
    13.  Become an independent practitioner in the practice of Hospice and Palliative Medicine.
    14.  Demonstrate appreciation for and commitment to self-evaluation and lifelong learning through ongoing scholarship and study.
    15.  Demonstrate a patient/family centered approach to care, taking special consideration to clinical situation, prognosis, and patient/family preferences and goals of care.
    16. Recognize signs and symptoms of impending death and provide appropriate symptom management for the patient and prepare family members and caregivers for the patient’s death.
    17. Analyze and apply evidence-based medicine to the practice of palliative care.
    18. Foster leadership in the field of palliative medicine and serve as teachers and role models for trainees.

    Typical Schedule

    Rotation* Location Length
    VCU Inpatient VCUHS 13 Weeks
    VCU Consults VCUHS 13 Weeks
    VA Inpatient/Consults VAMC 13 Weeks
    AAHPM Variable 1 Week
    Home Hospice Variable 2 Weeks
    Ambulatory ACC 2 Weeks
    Pediatric Palliative Variable 1 Week
    Electives** Variable 4 Weeks
    * Rotations consist of alternating 2-week intervals
    ** Electives include scheduled rotations in areas of interests and potential time for research.

    Rotations

    Fellows rotate across 4 settings: VCU inpatient palliative care unit, VCU consultation service, VA inpatient hospice and consultation service, and Elective.

    • The VCU inpatient palliative care service cares for up to 12 patients at a time and is centered on the Thomas Palliative Care Unit with an active and dedicated interdisciplinary team, palliative-trained nurses, and a well-established volunteer program all focused on providing the best care possible to patients with life-limiting illness and their loved ones. In addition to caring for patients at the end-of-life or those transitioning to hospice care, the VCU inpatient palliative care service uniquely also cares for oncology patients earlier in their disease process while they may still be receiving disease-directed therapy and planning to return to the outpatient setting for further care.
    • The inpatient hospice at the VA, known as Journey’s Way, is a 9-bed unit with a dedicated interdisciplinary team located in the long-term care portion of our VA medical center. This unit provides end-of-life care as well as respite care for veterans and their caregivers.
    • Consultation services are hospital-wide in both locations and focus on symptom management and goals of care, as well as identifying patients appropriate for transfer to the inpatient palliative care or hospice unit at VCU and the VA, respectively.
    • The Elective rotation is an opportunity for scholarly activity, community hospice experiences, and scheduled electives. HPM Fellows will schedule electives in a variety of settings that can be tailored to each fellow’s specific interests. These settings include medical oncology, radiation oncology, cardiology, hepatology, pulmonology, neuromuscular disorders, interventional pain, ethics, pastoral care, and advanced care planning.

    Fellows work closely with 3 local hospices for their community hospice experience: Hospice of Virginia, New Century Hospice, and Noah’s Children. Fellows will attend the interdisciplinary conferences and round on home, nursing home, and inpatient hospice patients directly with the hospice nurses and physicians. Special attention is paid to continuity of care, and fellows will be able to provide direct care for those patients whom the fellow is listed as one of the hospice physicians.

    Fellows are required to participate in both a scholarly and quality improvement project in the areas of their choice, with attentive mentoring by palliative care faculty. They are provided with administrative support and protected time for these projects. For fellows interested in a more in-depth research experience, we offer enrollment in the Department of Internal Medicine’s 10-week research intensive series to educate fellows on the research process and formally guide them in the development and implementation of their research projects.

    Conferences

    Conference Day/Time Frequency
    CORE FELLOWSHIP CONFERENCES (see descriptions below)
    Orientation Intensives 3-5pm M-F during 1st week of fellowship 5 afternoons for 1 week in July
    Practice-Based Learning and Improvement (PBLI) Tuesdays 12-1pm Weekly
    Pre-Clinic Conference and Journal Club Wednesdays 12-1pm Weekly
    Program Director and Fellow (PDF) Conference Tuesdays 1-2pm Quarterly
    Hematology/Oncology and Palliative Care (HOP) Division Grand Rounds Tuesdays 5-6pm 3 weeks / month starting in August
    CORE DEPARTMENT CONFERENCE (see descriptions below)
    Internal Medicine Grand Rounds Thursdays 12-1pm Weekly

    Orientation Intensives
    This educational conference is held in the afternoons during the first week of fellowship to prepare fellows for the upcoming year. The series is designed to introduce new fellows to the basic clinical concepts, as well as the urgent issues, that they will encounter in their fellowship.

    Practice-Based Learning and Improvement (PBLI)
    The interdisciplinary team gathers weekly for this didactic conference in which the fundamentals of palliative medicine are explored and relevant cases presented for in-depth evidence-based discussion.

    Pre-Clinic Conference and Journal Club
    This weekly conference focuses on outpatient palliative care issues in journal club format as well as interdisciplinary discussion of our Supportive Care Clinic patient panel.

    Program Director and Fellow (PDF) Conference
    This quarterly conference is designed specifically for the fellows and program director and provides an opportunity for feedback and discussion of topics relating to the HPM fellowship.

    Hematology/Oncology and Palliative Care (HOP) Division Grand Rounds
    The Division of Hematology/Oncology and Palliative Care host grand rounds 3 weeks out of each month as a didactic lecture series presented by visiting faculty, VCU faculty, and the fellows. 

    Internal Medicine Grand Rounds
    Weekly department-wide didactics presented by department faculty and visiting professors.

    Unique Learning Opportunities

      Communication Intensive
      AAHPM Annual Meeting
      M4 Debrief