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 Eugene McDermott Center for Pain Management, 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 Eugene McDermott Center for Pain Management. The fellow will participate both in the ambulatory evaluation of pain and the administration of pain-modifying procedures.
One of the most important experiences for palliative care fellows is geriatric medicine. Palliative Care fellows will spend one month of their fellowship participating in a geriatric medicine rotation that includes ambulatory care, long-term care, and housecalls program.
During this rotation, the fellows will be exposed to the tenets of geriatric medicine. This rotation will include both clinical and teaching experiences.
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, including 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 exclusively doing 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 Inpatient Hospice Unit will be maximally occupied.
Patients are generally older and represent a 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 Inpatient Hospice 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 into the VA Medical Center. There is no weekday call, and there is 24-hour faculty backup for the on-call fellow.
Parkland Hospital Palliative Care Clinic
The Parkland Palliative Care Clinic meets two half-days per week, and the fellow is expected to attend these every week. The Parkland Palliative Care 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, including patients with stroke, congestive heart failure, chronic pulmonary conditions, pressure ulcers, and patients with dementia and 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 care professionals, such as social workers, physical and medicine rehabilitation attendings, PT/OT, the chaplain, pharmacy personnel, and nursing personnel, to coordinate 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 the 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.