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Hospice & Palliative Medicine Rotations

Timeframes below are approximate.

Orientation

Fellows spend a didactic block at ’s Gerstenberg Center at the beginning of the fellowship year. They gain insight into the clinical, regulatory, and administrative knowledge required in the practice of hospice & palliative medicine and are introduced to core foundational skills including empathy, teamwork, and communication.

• Administrative – 2 weeks

Home Hospice

Fellows become part of a hospice home team that cares for patients both at home and in skilled nursing facilities. During the initial block rotation, fellows visit patients with the team physician and other team members to gain insight into the roles and responsibilities of the interdisciplinary team.�� Thereafter, fellows follow a patient panel on this team longitudinally throughout the academic year. This experience ensures participation in the plan of care from the time of terminal diagnosis through various stages of terminal illness and allows for critical interactions with patients, families, and other support systems.

• Home Hospice – 6 weeks + longitudinal

Inpatient Hospice & Palliative Care

The fellows’ inpatient rotations provide intense day-to-day management of a varied spectrum of hospice & palliative care patients. During the first month of fellowship, fellows spend an introductory 2 weeks on the robust, 15-bed located within . Throughout the remainder of the year, fellows spend block months on the inpatient unit where they engage in hospice care and inpatient palliative care consultations.�� There are additional months dedicated to the busy inpatient palliative care consultation service at DMC.

• Inpatient Hospice Unit and Inpatient Palliative Care Consultations – 16 weeks
• Dedicated Inpatient Palliative Care Consultations – 8 weeks

Outpatient Palliative Care

Fellows rotate in the Charles Levitetz Advanced Symptom and Support Individualized Care Program, one of the area’s only outpatient palliative care programs. Not only will fellows learn about assessing and treating the broad spectrum of patients’ palliative care needs, they will also gain appreciation for the day-to-day work done by an outpatient palliative care physician and team.

• Lynn Cancer Institute Charles Levitetz Advanced Symptom and Support Individualized Care Program – 4 weeks

Integrative Health

In this rotation, fellows will gain an appreciation for integrative medicine and its application to seriously ill patients. They will acquire experience in developing a comprehensive approach to complementary and integrative health and healing for their patients and for themselves. Fellows will learn about the philosophies, fundamentals, and therapies of integrative medicine and describe possibilities for an integrative care plan for patients with various diseases/conditions.

• The at ����ý Medicine – 2 weeks

Oncology

By rotating in outpatient and offices, fellows are able to follow patients longitudinally and understand the patient experience and role of palliative care across care settings.

• Lynn Cancer Institute (Delray Beach locations)
  • Radiation Oncology – 2 weeks
  • Hematology-Oncology – weekly half days over a minimum of 6 months longitudinally

Pediatrics

While rotating with the , fellows gain a deeper appreciation of the psychosocial aspects of serious childhood illness and its impact on patients and families and develop approaches to maximizing the quality of life for children with cancer.

• Pediatric Oncology Support Team – 4 weeks

Long-Term Care

Fellows rotate at and where they gain an appreciation for the complex needs of older adult patients and patients who are appropriate for palliative and hospice care. They acquire experience in assessing older adults’ functional status, nutritional status, social support, advance directives, and goals of care; screening for fall risk, depression, delirium, dementia, incontinence, and polypharmacy; and addressing identified needs using an interdisciplinary approach.

During this rotation, fellows also spend time at The Louis and Anne Green where they gain appreciation for caregiver stress and bereavement by participating in the care of patients with memory disorders and their caregivers, including participating in caregiver support groups and bereavement groups.

• Multiple sites – 4 weeks

Humanities & Self-Care

The self-care curriculum takes place at a variety of sites and emphasizes awareness of fellows’ own vulnerabilities and self-care. Sites include the and where fellows reflect on topics including empathy, conflict, and flourishing. Time is protected for longitudinal reflective activities including the “����ý Medical Humanities: Coffeehouse Conversations” series.

• Multiple sites – longitudinal

Electives

A variety of electives in fields clinically relevant to hospice & palliative care are available and can be tailored to fellows’ interests and plans. Fellows can complete two 2-week electives or one 4-week elective.

• Variable sites – minimum 4 weeks