The University of Miami/HCA Florida JFK Hospital Palm Beach Regional Graduate Medical Education Consortium Hospice and Palliative Medicine Fellowship prepares the selected physician for board certification in hospice and palliative medicine. The ad hoc fellowship admissions committee selects up to two fellows each year for participation in the program. The program gained ACGME accreditation under the HCA Florida JFK Hospital Internal Medicine Program in May of 2010. Several participating institutions provide the clinical base for the accredited fellowship.
The program embraces the following ACGME-specified objectives for the selected fellow:
Patient Care: Demonstrate compassionate, appropriate, effective care for treating health problems and promoting well-being in a palliative care setting.
Medical Knowledge: Relate empirical medical knowledge and apply it to patient care.
Practice-based Learning: Analyze practice experience and perform practice-based improvement activities using systematic knowledge.
Interpersonal and Communication Skills: Create and sustain a therapeutic and ethically sound relationship with patients, families and other healthcare professionals.
Professionalism: Demonstrate professionalism that supersedes self-interest through care, compassion, integrity and responsiveness to the needs of patients and society.
Systems-based Practice: Practice cost-effective healthcare and resource allocation that does not compromise the quality of care; advocate for quality patient care and assist patients in dealing with system complexities.
The palliative medicine fellow will gain clinical expertise through a variety of patient care experiences in a range of settings.
The fellow will undergo an extensive orientation program conducted by the University of Miami Miller School of Medicine Palm Beach Regional Campus, HCA Florida JFK Hospital, VAMC, and Trustbridge. This orientation will include HR policies and procedures, benefits, EMR training, University of Miami Calder Library training to name just a few of the topics covered.
Hospice/Palliative Medicine Core Inpatient
The Fellow begins his or her course of study on the Trustbridge dedicated hospice in-patient care center located at Bethesda Memorial Hospital. The objective of the first month rotation is to provide the fellow core concepts in both the medical and psychosocial aspects of palliative care. The fellow will be expected to pre-round on the patients admitted to the inpatient unit. Teaching Rounds follow working rounds with the Faculty concludes the morning patient care. The noon-time lecture is followed by didactic lectures on core concepts and articles, new patient consults and other clinically relevant activities.
The outpatient homecare assignment will be a four-week rotation. Subsequent to the intense four-week rotation, the fellow will continue to follow a small cohort of patients for 20 weeks. The focus of this experience is to allow the fellow to follow patients with a prognosis of six months or less throughout the trajectory of their terminal illness. The homecare team carries an average daily census of 60-80 patients. This patient population provides a strong mix of ethnicities and cultures, as well as the opportunity to provide generational care. This experience will allow the fellow to participate in care planning from time of terminal diagnosis through difficult decision-making options, and allow for critical interactions with patient/family and other support systems. This rotation will allow the fellow an opportunity to develop the skills needed to function in an outpatient setting and experience the unique challenges of caring for patients in the home. The fellow will attend weekly interdisciplinary team meetings and visit patients in their homes with various members of the team.
Outpatient Palliative Care Longitudinal Clinic
The fellow will attend the Outpatient Palliative Care Clinic at the West Palm Beach VA one-half day per week, for approximately 6 months. The fellow will attend clinic one afternoon a week and be part of an interdisciplinary team. This will include a Clinical Phar.D. Resident, SW, ARNP, Clinical Pharmacist, and other staff members. The WPBVA Palliative Care Team is led by a distinguished team of board-certified physicians and ARNPs, and ancillary staff committed to providing their patients with the finest medical care available. The fellow will participate in the delivery of high-quality medical care and interventions to palliative care patients. Care is delivered in a warm, compassionate, and comfortable setting. The fellow will perform a thorough assessment of the referred patient and participate in the initial and subsequent plan of care.
Long Term Care (LTC)
The Community Living Center (CLC) at the West Palm Beach Veterans Administration Medical Center will be the designated site for the LTC experience. The CLC provides an excellent site for meaningful longitudinal care of patients. The CLC contains a 60-bed LTC facility, as well as a 10-bed palliative care and 10-bed hospice unit. The fellow will assume responsibility for evaluation of the LTC residents' daily medical needs, as well as following patients as they transition to the palliative and hospice units. This experience will allow the fellow to gain valuable insight into the needs of the geriatric population. The fellow is also afforded the opportunity to follow patients longitudinally through the experience at the VAMC. The fellow may follow patients in the LTC setting and subsequently as they are transitioned to a hospice or palliative care unit.
Inpatient Palliative/Hospice Consult/Service
The inpatient acute care experience will provide day-to-day management of hospice patients who are admitted for symptom management, as well as consultative services for palliative care within the hospital. The four-month experience will take place on a dedicated 14-bed hospital-based inpatient care center located at Bethesda Memorial Hospital. The fellow reports to the unit at 7:30 a.m. for pre-rounds. Teaching rounds will be completed with the interdisciplinary team. Upon completion of rounds, the fellow will dictate progress notes. The fellow, with the assistance of the social worker and attending physician, will arrange for family conferences as needed. The fellow will cover the assigned didactic topic with the resident. In the afternoon, the fellow will join the JFK Palliative Care consult team. The fellow will be notified by palliative care coordinator of pending palliative or hospice consults and complete in timely manner. The fellow will attend extubations and learn through mentoring the art of delivering bad news to families. The fellow will attend pertinent resident noon conferences and present at least two during the course of the fellowship. The fellow will work under the supervision of the attending, and maintain telephone communication with attending when not on the unit. Two months will be spent at on the WPB VAMC Palliative Care Unit as well as the LTC Center.
Trustbridge provides care to patients of all ages. A 4-week rotation with the Palm Beach Pediatric Hematology Oncology office will be required. Additionally, time will be spent in an outpatient experience with the Pediatric Oncology Support Team (POST) at the Parent Child Center. This experience will provide an opportunity for the fellow to follow children who are chronically as well as terminally ill. The Pediatric Oncology Support Team Program is a comprehensive psychosocial program utilizing a specialized team to provide longitudinal care to patients and their families. The fellow will work with the interdisciplinary team to evaluate and establish a plan of care for chronically ill children with conditions such as cystic fibrosis, cerebral palsy, leukemia, etc.
The Radiation Oncology experience will be a 4 week rotation during the fellowship. The fellow will be assigned to GenesisCare. During this clinical rotation, the fellow will be under the direct supervision of Thomas Klein, MD, PhD. The fellow will participate in the delivery of high-quality medical diagnosis and interventions to cancer/palliative care patients. Care is delivered in a warm, compassionate and comfortable setting.
The Surgical Palliative Care experience is a 2-week rotation and will be at Trustbridge. During this clinical rotation, the fellow will be under the direct supervision of Barry Miskin, MD. The fellow will participate in the delivery of high-quality palliative care procedures and interventions for cancer/palliative care patients. Care is delivered in a warm, compassionate and comfortable setting.
The fellow will select a one-month elective which will be subject to the approval of the Program Director. Opportunities available, but not limited to:
- Critical Care Medicine
- Radiation Oncology
- Invasive Pain Management
- Infectious Diseases
In addition to clinical training, the fellow will be required to attend scheduled didactic lectures and monthly journal club meetings. The fellow will be expected to assist with topic selection and moderate discussions during the meetings.
The fellow will also learn the art of mentoring while working with medical students, Internal Medicine Residents, and other clinical staff. One-on-one mentoring in hospice regulations, documentation and billing will take place with the fellow by either the Program Director or one of the senior faculty members. Although research is not a required component of the program, the fellow will be expected to complete a scholarly project or presentation prior to the end of the fellowship.
The fellow will receive a competitive salary and benefits package from the University of Miami Miller School of Medicine Palm Beach Regional Campus.