Parkland Palliative Care Consult Service
The fellow will spend two months on the Parkland Memorial Hospital Palliative Care inpatient service. The service gets 30 to 40 new inpatient consults per month. Patients range in age from 18 to 98, and are living with diagnoses spanning the full 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, the fellow will see one new patient per day and one to five follow-up patients per day.
UT Southwestern Pain Management
The fellow will spend one month with Ankit Patel, M.D. at the McDermott Pain Center of UT Southwestern Medical Center providing consultation in Acute and Chronic Pain Management primarily in an ambulatory setting. The primary function of this rotation is to give the fellow the opportunity to gain expertise in the assessment and treatment of a variety of pain syndromes. Patients are experiencing both malignant and non-malignant pain, and represent a full spectrum of functional status. Each year, 550 new and 724 follow-up visits occur at the McDermott Pain Center. The fellow will participate both in the ambulatory evaluation of pain and the administration of pain-modifying procedures.
Geriatrics Acute Care Unit
The fellow will spend one month on 9 South-South (9SS) the Acute Care Unit at Parkland Memorial Hospital (PMH). This is a 20-bed unit for medical patients over 65 years admitted to PMH. On average there are between 20 and 30 patients admitted to 9SS each week. The fellow will perform formal consults (between four and six per week) and informal consults (all patients admitted to the Unit) during this rotation. At the beginning of the rotation, Dr. Roche will introduce the fellow to the interdisciplinary team and outline the expectations for the month. At the end of the rotation, the fellow and attending will review the month to highlight areas for improvement and areas of positive experience. The fellow is expected to be on 9SS from 8 a.m. to 5 p.m., Monday through Friday, except when they have clinic or an otherwise specified appointment.
Home Hospice Rotation
The fellow will have two types of learning experiences with Community Hospice. First, the fellow will have year-long experience, following one or two hospice patients at a time for whom the fellow will act as the primary physician. The fellow will provide hospice care, which will include clinical evaluations, pain management, symptom relief, comfort care, and end-of-life issues, under careful supervision. The fellow will work closely with the interdisciplinary team to facilitate patient and family/caregiver issues. Patients will be selected to favor patients with diverse groups of medical problems and psychosocial issues.
The fellow will also spend a month doing exclusively home hospice care. During this time they will receive didactic instruction in the organizational and administrative aspects of operating and maintaining a hospice care program. Community Hospice admits 500 new patients per year, and has an average daily census of approximately 50. Twelve to 20 of these patients are pediatric hospice patients.
Inpatient Hospice Unit, Dallas Veterans Affairs Medical Center
The fellow will spend two months working with Elizabeth Polanco, M.D. at the Inpatient Hospice Unit affiliated with the CLC at the Dallas Veterans Affairs Medical Center, a 19-bed inpatient hospice unit. Based on the numbers of hospice patients currently cared for at the CLC, it is anticipated that there will be one admission per day on average, and that the unit will be maximally occupied.
Patients are generally older and represent wide range of diagnoses. There are many palliative care patients with non-malignant disease. The fellow will be first on call for consultations for hospice placement from the medical and surgical services at the VA Medical Center. 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. The fellow will follow four to six patients at a time longitudinally.
Additionally, the fellow will take home call for patients in the unit once every six weeks. It is anticipated that most matters will be handled over the phone, and that this will very rarely mean coming in to the hospital. There is no weekday call, and there is 24-hour faculty backup for the fellow on call.
Parkland Hospital Palliative Care Clinic
The Parkland Palliative Care Clinic meets two half-days per week, and the fellow is expected to attend these clinics every week. This clinic provides primary care and palliative care consultation for patients with life-limiting illness. Patients are from diverse ethnic backgrounds, and represent diverse diagnoses, including malignancy, lung disease, end-stage renal disease, and congestive heart failure. The clinic also provides care for patients all along the spectrum of palliative care, from new diagnoses of life-limiting illnesses to patients being co-managed with hospice. The fellow will see two new patients and three to four follow-up patients per session, and will also have their own panel of 25 patients for whom they will provide coordination of care.
Radiation Oncology, VA Medical Center
William Hittson, M.D.
The fellow will spend two weeks working in the Radiation Oncology unit at the VA Medical Center. The purpose of the rotation is to help the fellow become familiar with the indications for radiation therapy, the basic principles underlying treatment, and the assessment and management of the most common side effects. The fellow will be on call during the day for consults and will work closely with faculty to devise a plan of care for patients.
Community Living Center
The Hospice and Palliative Medicine fellow will spend one month of their fellowship participating in a nursing home rotation primarily at the Dallas VA Community Living Center (CLC). The CLC is a 120-bed skilled nursing facility attached to the main VA Medical Center. This rotation will include both clinical and didactic experiences designed to provide learners with expertise in caring for patients in long-term care. The clinical experience will include exposure to geriatric rehabilitation and wound care, as well as palliative care, hospice, and respite care.
The fellow will be assigned two to three patients at the start of the rotation for whom they will act as primary providers. They will follow these patients longitudinally, and will admit one to two more per week for the remainder of the month. Each fellow will be assigned patients with a view to optimal case mix, such as patients with stroke, congestive heart failure, chronic pulmonary conditions, pressure ulcers, and patients with dementia with behavioral problems. The fellow will attend weekly interdisciplinary team (IDT) meetings on their patient, and throughout this rotation are expected to interact with other health professionals, such as social workers, physical and medicine rehabilitation attendings, PT/OT, the chaplain, pharmacy personnel and nursing personnel, to coordinate their patient's care, and if indicated, discharge.
Hematology/Oncology, VA Medical Center
The fellow will spend two weeks working in the Hematology/Oncology Clinic at the Dallas VA Medical Center. The rotation is to help the fellow become familiar with presentation, evaluation, and management of the most common cancers. He/she will also learn the basic principles underlying treatment, and the assessment and management of the most common side effects.