Palliative Care Service
The Palliative Care Service is a service without walls, providing care in the inpatient palliative care unit, nursing homes, emergency departments, and critical care units, as well as in HIV, chronic pain, and cancer pain clinics.
Rotations and Goals
Inpatient and Consult Services (6 four-week blocks)The interdisciplinary clinical team includes physicians, nurse practitioners, and social workers, consulting on an average of 150 patients per month. The program includes a volunteer doula component as well as complementary and alternative medicine services.
Fellows rotate through Montefiore's 15-bed inpatient palliative care unit, learning a multi-disciplinary team approach to to patient care. Fellows participate weekly palliative oncology clinics, collaborating with physical medicine and rehabilitative medicine interventional pain specialists and learning outpatient pain management.
- Perform biopsychosocial assessments of patients
- Develop, implement and monitor symptom management, including appropriate assessment and adjustment of the plan of care
- Coordinate the team providing patient care
- Integrate other disciplines providing consultation into management of patient care
- Coordinate and conduct family meetings
- Discuss advance directives, medical information and health care decision making with patients and families
- Document patient care in the medical record, accurately and appropriately
- Present and discuss teaching cases with other physicians, residents and medical students
- Apply EBM principles and clinical guidelines to the decision making process
Hospice (2 four-week blocks)
- Understand how to do a community assessment
- Perform in-home assessment of patients, identifying family and environmental supports and barriers to care, including patient mobility, nutrition, and safety
- Provide clinical interventions to patients at home, including wound care
- Re-evaluate and treat pain symptoms at home
- Participate in interdisciplinary team meetings with hospice staff
- Understand the major entitlement programs available to patients
- Identify additional needs of family and patient
- Observe bereavement programs and pastoral/spiritual care
Pediatrics (1 two-week block)Fellows rotate with the Metropolitan Jewish Health System Pediatrics Team.
- Identify normal stages of cognitive and emotional development for children
- Use the stage of development to provide child-centered care and guide psychological adaptation to dying
- Identify symptom control for life threatening illnesses: e.g.,cancer, HIV, neurodegenerative and metabolic diseases,cystic fibrosis
- Understand physical and emotional problems unique to children and adolescents
- Participate in counseling specific to children and their families
- Initiate pain management protocols for children using pediatric doses
- Identify mechanisms of support for child and family
- Identify special services available for dying children
- Observe bereavement counseling with families; parent, siblings and extended members
Long Term Care Rotation (1 four-week block)
- Observe coordination of clinical interventions specific to the geriatric population
- Participate in prescribing symptom (including pain) management protocols specific to the geriatric population
HIV (10 Longitudinal Consult Sessions)Dr. Peter Selwyn, Chair of the Department of Family and
Social Medicine, directs the longitudinal experience of ten consult-based sessions with patients affected by HIV/AIDS. Dr. Selwyn is a world-renowned expert in HIV palliative care who has
authored numerous articles and books on the subject and who develops grants
for the largest government-funded HIV palliative care program.
- Understand how harm reduction can be incorporated into medical care
- Understand and manage the challenges associated with delivering care to a disenfranchised and marginalized population
- Collaborate with community-based organizations in the delivery of health care services
Interventional Pain Management (1 two-week block)Fellows participate weekly palliative oncology clinics,
collaborating with physical medicine and rehabilitative medicine interventional
pain specialists and learning outpatient pain management.
- 1 two week block session to observe and understand options for imaging-guided interventional pain management
- Outpatient Palliative and Interventional Pain Management Clinic (weekly)
- Identify clinical problems requiring intervention
- Coordinate referrals, as needed, for additional care/resources/services
- Develop, implement and monitor a pain and symptom management plan
- Coordinate supportive services for the patient and family
Longitudinal Curriculum
Didactic, Clinical, Research Modules
- Psychosomatic Medicine: 6 monthly case-based teaching fousing on psychologic concerns in medically ill patients.
- Core Psychosocial Curriculum: Fellows will participate in MonteTalk, an intensive 2 day course focusing on improving communication skills and breaking bad news with standardized patients.
- Core Bioethics Curriculum: Fellows interact extensively with the integrated bioethics service, developing communication and problem resolution skills. Additionally, fellows spend one half day per week participating in the Bioethics Certificate Program at Cardozo School of Law.
- QI, Writing Group, or Research Project:
- Faculty from Division of Education, Department of Family and Social Medicine
- Decisions, Designs, and Data
- Quantitative and Qualitative Research Methods in Medical Education
- Advanced Literature Review, Databases
- Project mentoring
- CITI online certificate course in the protection of human subjects