Clinical Activities and Responsibilities
The Hospice and Palliative Medicine curriculum has been specifically designed to ensure that each fellow has the opportunity to achieve the knowledge, professional attitudes, and practical experience required of a physician caring for the seriously ill patient. Each fellow will participate in and will be closely supervised by trained faculty in the clinical activities described below. Each portion of the fellowship has clearly defined expectations, objectives, and goals. Both the preceptor and the fellow are expected to complete timely written evaluations.
Our fellowship follows a 4+1 model, in which the fellows spend four weeks intensively participating in a single, usually inpatient, experience, followed by one week of ambulatory experiences. The Palliative Care continuity clinic during the +1 week is a longitudinal rotation.
We offer both adult and pediatric tracks in our fellowship, see below for specific requirements of each.
Longitudinal Rotations
Ambulatory Clinics
- Parkland Palliative Care Clinic
During their +1 week, when assigned to Parkland clinic, fellows attend Parkland Palliative Care clinic for 3-4 full-day sessions. Fellows see new patients, and are then able to schedule both their clinic patients and patients they have seen in the hospital to follow up with them in clinic. They also have the option, if their clinic patient transitions to hospice, to continue to follow those patients with one of our hospice medical directors. The Parkland site provides fellows with diverse ethnic and social experiences, and will provide 1-2 new patients per session and 2-3 follow up visits per session (depending on the volume), allowing the fellows to spend a minimum of a third of their ambulatory time providing continuity of care.
- Simmons Cancer Center
During their +1 week, when assigned to Simmons Cancer Center (SCC) clinic, fellows spend 2-3 full-day sessions seeing patients in this University-based Cancer Center of Excellence, where many patients are on clinical trials or receiving novel therapies. This provides familiarity with a different socioeconomic population but also with the side effects of an entirely different group of therapies.
- Additional Clinic Experiences
Fellows round out their +1 week with scheduled scholarly activity time and additional half-day experiences that help them meet their educational goals.
Block Rotations
During the year fellows have specific block rotations that focus and concentrate on important areas of Hospice and Palliative Medicine, including inpatient consultation, pediatric palliative care, long-term care, and both inpatient and outpatient hospice. The rotations are monthly unless otherwise specified. Each rotation has an evaluation form to be completed at the end of service by both HPM fellows and faculty. These evaluations are used as part of an ongoing quality assurance program implemented to improve, modify and update the program.
- Children’s Medical Center Dallas
Pediatric track fellows spend 2 blocks at Children’s Medical Center Dallas and adult track fellows spend 1 block at Children’s Medical Center. Children’s Medical Center is a large, free-standing children’s hospital with 500 beds, a level I trauma center, level IV NICU, and an active PICU and CVICU. The palliative care team is well integrated into the hospital and, as such, fellows are exposed to pediatric patients with both life-limiting and multiple chronic conditions. Fellows gain expertise in the unique medical, social, and psychological aspects of caring for children living with serious illness and their families. Fellows also have an opportunity to see patients with pediatric diseases who have aged out of pediatric care and into adulthood. The service receives 10-20 new consults per week, and follows 45-60 inpatients at any given time. The service also has a robust outpatient clinic, provides prenatal consultation for expected fetal complexity, and covers the Parkland NICU.
- Children’s Medical Center Inpatient Therapy Unit
Pediatric track fellows spend one month in the Integrated Therapy Unit, a long-term care facility for children with chronic illness. This unit provides a variety of services, including inpatient and outpatient therapy programs for children with neurologic illnesses, feeding programs for those with difficulty eating solid foods or swallowing, pulmonary services for children who need short-term tracheotomy/ventilator assistance and those who are vent-dependent and will return home, and rehabilitation services for children who have been involved in accidents or had a life-changing diagnosis. Formerly a stand-alone rehabilitation hospital, the program has now been integrated with Children's Medical Center Dallas. The rotation affords the opportunity to care for children with medical complexity in a multidisciplinary and longitudinal way.
- Clements University Hospital Consult Service
Clements University Hospital, UT Southwestern's flagship hospital, is a tertiary referral center where patients come for advanced therapies in cardiology, oncology, transplants, and more. Adult track fellows spend two months and pediatric track fellows spend one month working closely with faculty experienced in the care of patients pre- and post-transplant, receiving experimental therapies, on LVAD’s, ECMO, and more. They also hone formalized communication training skills with faculty specially trained in VitalTalk.
- Community Hospice
All fellows will work with various physicians and nurses during their 2-month community hospice block, attending hospice interdisciplinary team (IDT) meetings, and making periodic visits to both Faith and Vitas inpatient hospice units to participate in rounds there. This will be accomplished through partnerships with VNA, Faith, Community, and Vitas Hospices, who serve both pediatric and adult patients and families. The fellow will work closely with the IDT to facilitate patient and family/caregiver issues. Patients will be selected to ensure a diversity of medical and psychosocial backgrounds. The fellows will participate in a curriculum to ensure a full education regarding the regulatory and financial aspects of serving as a Hospice Medical Director and a physician in long-term care. The fellows will be able to tailor their experience to provide more of one setting, as well as longitudinal care for specific patients, if they wish to pursue hospice as a career goal.
- Medical Oncology
Adult track fellows spend one week working in the Hematology/Oncology clinic at UTSouthwestern and the Dallas VA Medical Center. Pediatric track fellows spend one week in the Hematology/Oncology clinic at Children’s Medical Center. The purpose of the rotation is to help them become familiar with presentation, evaluation, and management of the most common cancers. Fellows also learn the basic principles underlying treatment, and the assessment and management of the most common side effects.
- Parkland Palliative Care Consult Service
All fellow spend three months on the Parkland Palliative Care inpatient consult service. Parkland is the safety-net hospital for Dallas County and moved in 2015 to a new state-of-the-art facility. The service receives 30-40 new inpatient consults per week. Patients range in age from 18 to 105, and are living with diagnoses spanning the spectrum of advanced, progressive, life-threatening conditions (common cancers, common non-cancer diagnoses, chronic diseases, and emergencies). Most are indigent or working poor. On average, fellows see one new patient per day and 1-5 follow-up patients per day, but the volume is tailored to the fellow’s level of ability.
- Radiation Oncology
All fellows spend one week working in the Radiation Oncology unit at UTSouthwestern. The purpose of the rotation is to help fellows become familiar with the indications for radiation therapy, the basic principles underlying treatment, and the assessment and management of the most common side effects. Fellows are on call during the day for consults, and work closely with faculty to devise a plan of care for patients.
- VA Community Living Center
Adult track fellows spend one month at the VA Community Living Center, a long-term care facility for veterans at the Dallas VA Medical Center. The CLC receives consults from both the surgical and medical teams at the VA hospital. During their time on the CLC, fellows learn which patients would benefit most by transfer to the Unit, as well as the continuum of care from acute to subacute care and then appropriate and timely disposition to permanent residence. Fellows who are planning to practice in the pediatric setting spend their long-term care experience at the Children’s Medical Center Inpatient Therapy Unit.
- VA Inpatient Hospice
All fellows spend two weeks working at the 19-bed Inpatient Hospice Unit at the Dallas VAMC. Patients are generally older, and represent a range of diagnoses. There are many palliative care patients with non-malignant disease. Fellows are first on call for consultations for hospice placement from the medical and surgical services at the VA hospital. Requests for consultation come from throughout the 289-bed acute care medical center, as well as the 90-bed skilled nursing facility and the 30-bed Spinal Cord Injury Center.
Elective
Fellows have 1 block dedicated to clinical electives and are free to tailor elective time to their interests and needs.
Cook Children’s Hospital in Fort Worth
During their elective time, pediatric track fellows have the opportunity to rotate at Cook Children’s Hospital in Fort Worth. Fellows will be integrated into their interdisciplinary team of physicians, nurse practitioners, nurses, social workers, chaplains, and others to manage symptoms, provide emotional support, help families access community resources and guide transitions of care. The opportunity to see multiple versions of Pediatric Palliative Care teams can be vital for physicians pursuing a career in Pediatric Palliative Care.