Our fellowship program provides fellows with a range of experiences at different care facilities throughout the Boston area. Below, you can learn more about these locations and types of skills and projects our fellows are expected to foster and complete.
Inpatient Palliative Care Consultation at BIDMC
The BIDMC palliative care consultation service sees approximately 80 new consults per month. As a member of the inpatient palliative care consult team, the fellow will meet with the staff (MD/NP) on service each morning for daily rounds to receive patient assignments, review cases and plan the day. After the first 3 months of the fellowship, fellows will alternate with other staff carrying the pager for new consults and be asked to help assign and triage new consults. Fellows will see patients daily, communicate with the referring team, complete appropriate documentation and precept each patient with a staff member. Fellows will join the team at interdisciplinary team (IDT) meetings, attend clinical and educational conferences and participate in the education of rotating learners.
Inpatient Palliative Care Consultation – VA West Roxbury
The VA Boston palliative care program serves patients aged 22-100 years with illnesses including cancer, neurological and end-stage cardiac, pulmonary, liver, and renal disease, addressing physical, psychological, social and spiritual domains of care for veterans and families. Veterans are from diverse cultural backgrounds. The Palliative care team is consulted for various decisions which range from goals of care conversations, advance care planning discussions, hospice referrals and end of life care. The fellows will be supervised by a diverse cultural population of physicians who have expertise in Geriatrics, General Medicine, Oncology, Research and Palliative Care. This service sees 40 new patients per month and is staffed by a physician, NP, SW and RN team.
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Inpatient Palliative Care Unit – VA Brockton
While on service at the VA Brockton Hospice and Palliative Care Unit, a 15-bed unit located in a long-term care facility at the VA, fellows will round daily on patients with the team, present patients and review the plan of care with the nurse practitioner. Patients on this unit include veterans getting active treatment (e.g. daily radiation for head and neck cancer) and veterans at the end of life with complex symptoms warranting inpatient hospice care. Fellows also have the opportunity to manage patients on the 1-2 bed acute inpatient palliative care/hospice unit while rotating at the West Roxbury VA.
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Palliative Care Clinic
The BIDMC palliative care clinic sees nearly 200 new patients annually. Patients are referred for pain, non-pain symptom management, advanced care planning and psychosocial support. At each visit, patients complete the Edmonton Symptom Assessment Scale (ESAS) to gauge their level of symptom burden and five items rating their quality of life and levels of psychosocial and spiritual support. The fellow will have patients assigned to him/her during each scheduled half-day clinic session and will precept the patients with staff (MD or NP). Throughout the year, fellows will see patients and families with the team chaplain and social worker. The fellow will be expected to communicate recommendations to the referring provider, prescribe medications, do phone call follow-up when necessary and complete documentation. To ensure longitudinal care, patients will be booked subsequently with the fellow whenever feasible. The fellow will participate in weekly outpatient IDT whenever in clinic.
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Long-term Care Experience at Hebrew SeniorLife
Fellows will see patients in the long-term care setting as well as the short-term rehab unit (SNF level) for whom palliative care consultations are requested. Long-term care referrals are most often initiated following medical crisis or decline with need to re-address goals of care with unrealistic or conflicted families. Rehab patients are referred following frequent hospital readmissions or a recent decline in function or medical status. With supervision from the HSL team, fellows will assess and manage symptoms, explore goals of care, conduct family meetings and facilitate completion of advance directives, when appropriate. Rounding with the chaplain, attending physician, social worker and psychologist will provide exceptional opportunity to take part in spiritual and religious aspects of care, address end-of-life ethical dilemmas and work with challenging families.
Home Hospice Rotation
Good Shepherd Community Care, a free-standing hospice serving the community for 37 years, will serve as the site for the home hospice rotation. Unique to Good Shepherd is Krug Zaboty, the Russian Hospice program, staffed by Russian-speaking staff and providing culturally competent end-of-life care to the Russian-speaking community of greater Boston. Good Shepherd also has a growing Asian Hospice program and a robust Pediatric Palliative Care Program. During their rotation, fellows will make home visits primarily in conjunction with one of the hospice nurses and/or the Hospice Medical Director and less frequently with another team member. Fellows will participate in weekly IDT meetings, presenting patients they have seen. The didactic curriculum will include lectures on syndrome of imminently dying, non-oral routes of medication administration, and other topics. The Hospice Medical Director will meet each fellow to review key components of hospice administration, including regulatory, administrative, legal, ethical competencies, cost-effective policies and clinical skills appropriate for hospice patients.
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Pediatric experience will be provided to fellows during their home hospice rotation. The Pedi Pal program at Good Shepherd Community Care is compassionate, primarily home-based care for children age 18 and younger who have a life-limiting illness for which curative treatment is available but may not be successful. Pedi Pal focuses on the comprehensive management of the physical, psychological, social and spiritual needs of the child who is ill and his or her family. Fellows will spend one day a week doing home visits with a member of the Pedi Pal team. Through the Pedi Pal Program, fellows participate in helping parents navigate difficult decisions about care and coordinate existing services. Fellows will work with a team of specially trained nurses, social workers, volunteers, spiritual care providers and massage, art and music therapists.
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Fellows will attend a series of half-day didactic lectures held weekly during the first 2-3 months and then monthly thereafter. As the year progresses, the teaching sessions will evolve from fellows listening to lectures to fellows leading the teaching sessions and presenting their findings from quality improvement or research projects. Fellows will be expected to attend and participate in other educational sessions, such as Ethics Case Series, Pain and Palliative Care Rounds, Schwartz Rounds, Reflection and Renewal Rounds, and Journal Club. Fellows are also encouraged to attend Harvard Medical School Palliative Care Grand rounds and Faculty Seminars.
Quality Improvement Experience
Each fellow will be required to complete a quality improvement (QI) project. Fellows can participate in a training session familiarizing them with the principles of Quality Improvement that is offered to all sub-specialty fellows at BIDMC. They will be mentored in a quality improvement project during which they will identify a description of the problem, formulate an aim statement, measure the intervention and the outcomes, and identify lessons learned. Fellows with appropriate projects will be encouraged to submit their work for poster presentation at the annual Silverman Symposium, which showcases QI work throughout the medical center.
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Fellows can be connected with appropriate research mentors throughout BIDMC and the Boston VA. The BIDMC General Medicine Research Section includes researchers with expertise in palliative care, end-of-life and delirium. These researchers have mentored many fellows and junior faculty into successful clinical investigators. Motivated fellows should consider applying for the General Medicine Research fellowship after completion of their clinical HPM fellowship year.
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