Hospice & Palliative Care PGYII

Description of Rotation or Educational Experience

The purpose of the hospice and palliative care rotation is to provide the PGYII resident with supervised educational experiences in the long-term care and home environments. Each PGYII resident will complete a two-week rotation under the direction and supervision of a board certified physician specifically trained in hospice and palliative care. This rotation will be conducted in the inpatient as well as the outpatient setting.

Goal I: To develop competency in assessing and meeting the healthcare needs of declining elders, addressing illness-related care.

Goal II: To deliver healthcare in diverse environments including one or more of the following settings: the home, hospital, and long-term facilities

Goal III:  To gain practical, hands-on experience to manage end-of-life care, palliative care and assessment of individual spiritual needs for patients of all ages.

Goal IV:  To develop an appreciation of the interdisciplinary approach to the care of complex patients.

The resident is expected to:

·        Complete all required reading assignments.

·        Attend didactic sessions demonstrating understanding and synthesis of the assigned material

·        Report for rotation to the location at the time designated by the preceptor.

·        Attend FMC clinic three ½ days per week.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems, end of life issues, and pain management.  Residents are expected to:

Competencies

• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
• Gather essential and accurate information about their patients.
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
• Develop and carry out patient management plans with the interdisciplinary team.
• Counsel and educate patients and their families.
• Use information technology to support patient care decisions and patient education.
• Work with health care providers, including those from other disciplines, to provide patient-focused care.

Objectives

The resident will:

• Discuss the roles played by the various disciplines involved in the care of the patient to provide excellent patient care.

• Discuss the information resources available to aid in the care of the hospice or palliative care patient.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.  Residents are expected to know and apply the following:

Competencies

• Demonstrate the ability to perform symptom assessments and to subsequently develop plans for managing the patient in the hospice and palliative care environment.

Objectives

The resident will:

• De-emphasize diagnostics, maximize therapeutics for relief or easing of suffering.
• Appreciate a global focus including patient/family/caregivers individually and as a unit.
• Prioritize end of life goals.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to develop skills and habits to be able to:

Competencies

• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems and end of life issues.

Objectives

• The resident will be able to utilize information technologies to provide excellent illness-related care.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

Competencies

• Coordinate patient care within the health care system utilizing an interdisciplinary team approach.
• Incorporate considerations of cost awareness and risk-benefit analysis in patient care.
• Demonstrate understanding of the details regarding the function and application of Advance Directives.

Objectives

• The resident will be able to discuss the relative costs for treating the hospice/palliative care patient and be able to evaluate and explain the risks and benefits of treating an individual patient in a variety of settings.
• Discuss the details of the function and application of Advance Directives.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for patients/families/caregivers to manage end-of-life care, palliative care and assessment of individual spiritual needs for patients of all ages.

Objectives

• The resident will exhibit compassion and respect for patients, families/caregivers and other members of the health care team.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to:

Competencies

• Communicate effectively with patients, families, and caregivers.
• Communicate effectively with physicians, other health professionals, and health related agencies.
• Maintain comprehensive, timely, and legible medical records.

Objectives

• The resident will be able to present the patient’s medical condition to the patient, families and caregivers in a compassionate and professional manner. 
• The resident will be able to communicate with physicians and other health care personnel involved in the treatment of the patient and to explain diagnosis and treatment plans to health related agencies.
• The resident will maintain medical records for all patient encounters.

Assessment Method

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations’ supervising physician.  When the completed evaluation is returned, the resident physician and the resident’s faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident’s permanent file. 

Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident’s faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

Teaching Methods

Resident/Preceptor interaction during visits to Circle of Life Hospice and home visits.  Interdisciplinary team meetings.  Required reading from educational texts provided by Circle of Life Hospice.  Didactic sessions with preceptor.

Educational Resources

Educational Resources provided by Circle of Life Hospice:

Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 4^th edition, from the American Pain Society.

Pocket Guide to Hospice/Palliative Medicine from the American Academy of Hospice and Palliative Medicine.