The purpose of the hospice and palliative care rotation is to provide the PGYII
resident with supervised educational experiences in the long-term care and home
environments. Each PGYII resident will complete a two-week rotation under the
direction and supervision of a board certified physician specifically trained
in hospice and palliative care. This rotation will be conducted in the
inpatient as well as the outpatient setting.
Goal I: To develop competency in assessing and meeting the
healthcare needs of declining elders, addressing illness-related care.
Goal II: To deliver healthcare in diverse environments
including one or more of the following settings: the home, hospital, and
long-term facilities
Goal III: To gain practical, hands-on experience to manage
end-of-life care, palliative care and assessment of individual spiritual needs
for patients of all ages.
Goal IV: To develop an appreciation of the interdisciplinary
approach to the care of complex patients.
The resident is expected to:
Complete all required reading assignments
Attend didactic sessions demonstrating understanding and synthesis of the
assigned material
Report for rotation to the location at the time designated by the preceptor
Attend FMC clinic three ½ days per week
Patient Care/b>
Goal
Residents must be able to provide patient care that is compassionate,
appropriate, and effective for the treatment of health problems, end of life
issues, and pain management. Residents are expected to:
Competencies
Communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients and their families.
Gather essential and accurate information about their patients.
Make informed decisions about diagnostic and therapeutic interventions based on
patient information and preferences, up-to-date scientific evidence, and
clinical judgment.
Develop and carry out patient management plans with the interdisciplinary team.
Counsel and educate patients and their families.
Use information technology to support patient care decisions and patient
education.
Work with health care providers, including those from other disciplines, to
provide patient-focused care.
Objectives
The resident will:
Discuss the roles played by the various disciplines involved in the care of the
patient to provide excellent patient care.
Discuss the information resources available to aid in the care of the hospice
or palliative care patient.
Medical Knowledge
Goal
Residents must demonstrate knowledge of established and evolving
biomedical, clinical, epidemiological, and social-behavioral sciences, as well
as the application of this knowledge to patient care. Residents are expected to
know and apply the following:
Competencies
Demonstrate the ability to perform symptom assessments and to
subsequently develop plans for managing the patient in the hospice and
palliative care environment.
Objectives
The resident will:
De-emphasize diagnostics, maximize therapeutics for relief or
easing of suffering.
Appreciate a global focus including patient/family/caregivers
individually and as a unit.
Prioritize end of life goals.
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and evaluate their care of
patients, to appraise and assimilate scientific evidence, and to continuously
improve patient care based on constant self-evaluation and life long learning.
Residents are expected to develop skills and habits to be able to:
Competencies
Locate, appraise and assimilate evidence from scientific studies related to
their patients' health problems and end of life issues.
Objectives
The resident will be able to utilize information technologies to provide
excellent illness-related care.
Systems Based Practice
Goal
Residents must demonstrate an awareness of and responsiveness to the larger
context and system of health care, as well as the ability to call effectively
on other resources in the system to provide optimal health care. Residents are
expected to:
Competencies
Coordinate patient care within the health care system utilizing an
interdisciplinary team approach.
Incorporate considerations of cost awareness and risk-benefit analysis in
patient care.
Demonstrate understanding of the details regarding the function and application
of Advance Directives.
Objectives
The resident will be able to discuss the relative costs for treating the
hospice/palliative care patient and be able to evaluate and explain the risks
and benefits of treating an individual patient in a variety of settings.
Discuss the details of the function and application of Advance Directives.
Professionalism
Goal
Residents must demonstrate a commitment to carrying out professional
responsibilities and an adherence to ethical principles. Residents are expected
to demonstrate:
Competencies
Compassion, integrity, and respect for patients/families/caregivers to manage
end-of-life care, palliative care and assessment of individual spiritual needs
for patients of all ages.
Objectives
The resident will exhibit compassion and respect for patients,
families/caregivers and other members of the health care team.
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in
the effective exchange of information and teaming with patients, their
families, and professional associates. Residents are expected to:
Competencies
Communicate effectively with patients, families, and caregivers.
Communicate effectively with physicians, other health professionals, and health
related agencies.
Maintain comprehensive, timely, and legible medical records.
Objectives
The resident will be able to present the patient's medical condition to the
patient, families and caregivers in a compassionate and professional manner.
The resident will be able to communicate with physicians and other health care
personnel involved in the treatment of the patient and to explain diagnosis and
treatment plans to health related agencies.
The resident will maintain medical records for all patient encounters.
Teaching Methods
Resident/Preceptor interaction during visits to Circle of Life
Hospice and home visits. Interdisciplinary team meetings. Required reading from
educational texts provided by Circle of Life Hospice. Didactic sessions with
preceptor.
Assessment Method
At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations' supervising physician. When the completed evaluation is returned, the resident physician and the resident's faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form. Next, the program director reviews and attests to the document. Once all three have reviewed and attested the evaluation, it is included in the resident's permanent file.
Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation. The resident's faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.
Educational Resources
Educational Resources provided by Circle of Life Hospice:
Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 4th
edition, from the American Pain Society.
Pocket Guide to Hospice/Palliative Medicine from the American Academy of Hospice
and Palliative Medicine
