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.
As peer interaction is essential for the fellows, each fellow will gain experience teaching nurses, allied health personnel, medical students and residents both in a structured and in an informal way.
Our fellowship has recently adopted 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. Additionally, they round with a hospice medical director weekly, participate in interdisciplinary team meetings, evaluate patients at home, and make visits to inpatient hospice units. Both the community hospice rotation and their own Palliative Care continuity clinic during the +1 week are longitudinal rotations.
Parkland Palliative Care Clinic
Dr. Elizabeth Paulk
During their +1 week, fellows attend Parkland Palliative Care clinic for four half-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 provides 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
Dr. Stephanie Terauchi
The fellows spend one half day per week 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 additional clinic experiences that help them meet their educational goals. In 2018-2019, our Pediatric-focused fellows spent time in Pediatric Oncology, Pediatric Complex Care Clinic, and Pre-Natal Palliative Care clinic. However, many options are available depending on the interest of the fellow.
Dr. Kelley Newcomer
Dr. Tamara McGregor
Our affiliated hospice agencies provide home hospice care to a diverse population of patients throughout the Dallas-Ft. Worth area. We also have arrangements with VITAS and Faith Presbyterian Hospice to round periodically at their inpatient hospice units to ensure that fellows have a well-rounded experience. Patients followed by our affiliated hospice agencies are ethnically-diverse, and represent a diverse group of oncologic and non-oncologic hospice diagnoses. Each fellow is assigned 1-2 hospice patients at a time for whom they act as the primary physician. This includes 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.
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 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.
Parkland Palliative Care Consult Service
Dr. Winnie Wang
Each fellows spends 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 98, 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.
Clements University Hospital Consult Service
Dr. Alexis Barina
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. Fellows spend two months* 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. (*one month for those training in Pediatrics).
VA Community Living Center
Dr. Patricia Larios
Fellowd who are training to practice Hospice and Palliative Medicine in the adult setting will 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 Our Children’s House (see below).
VA Inpatient Hospice
Dr. Oscar Dellinger
Dr. Kathryn Sawey
Fellows spend two months 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.
Children’s Medical Center Dallas
Dr. Stockton Beveridge
Dr. Katie Maddox
Fellows spend one month at Children’s Medical Center Dallas working with Drs. Stockton Beveridge and Katie Maddox in their practice of hospital-based pediatric palliative care. 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 chronic debilitating illnesses. 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.
Dr. Kiran Kumar
Fellows spend two weeks 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.
Dr. Jonathan Dowell
Fellows spend two weeks working in the Hematology/Oncology clinic at UTSouthwestern and the Dallas VA 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. A rotation in Pediatric Medical Oncology is available for those who prefer to focus on Pediatrics at Children’s Medical Center.
For fellows with a strong interest in Pediatrics, the following substitutions are available:
Cook Children’s Hospital in Fort Worth
Dr. Kaci Osenga
Cook Children’s is a nationally-renowned provider of pediatric Palliative Care, and she and her team have put together a phenomenal program at Cook Children's Hospital in Fort Worth. Fellows are integrated into an 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 team at Cook Children’s is very mature and provides another excellent example of a Pediatric Palliative Care team. The opportunity to see multiple versions of Pediatric Palliative Care teams can be vital for physicians pursuing a career in Pediatric Palliative Care.
Our Children’s House
Dr. Andrew Gelfand – Pulmonary
Dr. Rajashree Srinivasan – PM&R
Our Children’s House, a long-term care facility for children with chronic illness, 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.