Curriculum
Rotation Schedule – Block Diagram
The typical block rotations for the year are described below.
Rotation:
| IP | Inpatient consult team/unit |
| PCHU | Dedicated palliative care/hospice unit |
| LTC | Long-term care |
| HHC | Home hospice care |
| AC | Ambulatory care |
| ELECT | Elective |
Institution/Site:
| 1 | Wake Forest Baptist Medical Center |
| 2 | Hospice and Palliative CareCenter |
| 3 | Carolinas Pain Institute |
| | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 |
| Rotation | IP | PCHU | HHC/
LTC | SA | Elect | IP | Peds
(IP) | PCHU | PM/
Onc | HHC/
LTC | IP | PCHU | Elect |
Institution/
Site | 1 | 2 | 2 | 1 | 1 | 1 | 1 | 2 | 3 /1 | 2 | 1 | 2 | 1 |
Duration
of Experience | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks | 4
wks |
Legend: SA = scholarly activity
Peds = pediatric inpatient palliative care rotation
PM = pain management
Onc = oncology
Ambulatory Care: The ambulatory care experience will be based at the WFBMC Palliative Care Clinic where fellows will spend one half-day every other week throughout the entire clinical year.
Home hospice care and LTC rotations will be split into two, two-week periods during the same block rotation Pain management and Oncology will be split into two, two-week periods during the same block rotation |
Training Sites/Clinical Rotations:
Wake Forest Baptist Medical Center (http://www.wakehealth.edu)
Palliative Care Consult Service/Palliative Care Unit Service
The fellow will participate in a consult service that receives over 800 consults per year as well as a Palliative Care Unit service which cares for over 400 patients and families per year on its 10-bed dedicated unit. The fellow will develop skills in consultative palliative care, symptom management, communication, inter-disciplinary care, transition management and end-of-life care.
Pediatric Palliative Care Service at Brenner Children’s Hospital (http://www.brennerchildrens.org)
With over 4,500 admissions per year, the Brenner Children’s Hospital provides comprehensive care to children from birth to age 18 and has staff physicians representing all pediatric medical/surgical specialties including a palliative care service established in 2008. The fellow will gain expertise in palliative care of pediatric patients through rounding with the pediatric palliative care team, participating in transitions of care between inpatient and outpatient care, and conducting family meetings.
Clinical Oncology Service (http://www.wakehealth.edu/Comprehensive-Cancer-Center)
The WFBMC Comprehensive Cancer Center is one of 40 National Cancer Institute designated comprehensive cancer centers in the country, meeting the highest standards for cancer care of patients and families. The hospice and palliative medicine fellow will be able to participate in inpatient and outpatient care of cancer patients and their families during this two-week rotation.
Scholarly Activity rotation
Participation in scholarly activities during the clinical fellowship is required and the fellow will have a block rotation dedicated to the development and initiation of scholarly work based upon their interests which will be conducted throughout the year guided by faculty mentorship.
Elective
Several elective opportunities are open to the fellow based upon interests.
Hospice and Palliative CareCenter (http://www.hospicecarecenter.org)
Inpatient Hospice Home
HPCC is a large, not-for-profit, Medicare-certified, hospice with an average daily census of 500+ patients. It has a 30-bed inpatient facility that provides acute and residential care to hospice patients. The fellow will be responsible for rounding on patients daily, leading IDT meetings and participating in family discussions to provide high-quality patient care. The Core Faculty of the hospice agency will provide supervision to the fellow in training.
Long-term care Service
HPCC cares for 160+ long-term care patients daily, spread throughout multiple facilities in the region, both in assisted-living and skilled nursing facilities. The fellow will spend two, two-week periods rounding on patients in various LTC settings with supervision provided by a HPM physician and/or nurse practitioner. During this rotation the fellow will learn the nuances of palliative care needs of the elderly, such as progression and management of neurologic illness (e.g. dementia, ALS, Parkinson’s), assessment and management of chronic non-cancer pain, wound care, geriatric syndromes (incontinence, delirium, non-cancer related functional decline, and frailty), advance care planning, and policies and regulations of long-term care settings.
Home Hospice Service
Fellows will gain extensive experience managing home care and hospice patients through time spent with HPCC. Fellows will meet weekly during the rotation with the hospice interdisciplinary team, providing clinical support and guidance to the team. Two two-week blocks of the fellow’s time are spent doing hospice home visits.
Outpatient Hospice and Palliative Care Service
Longitudinal care of hospice and palliative care patients is provided in the new WFBMC Palliative Care Clinic where the fellow will spend one half-day every other week throughout the twelve-month fellowship training program. The fellow will manage patients at all disease stages with multiple physical, psychosocial, spiritual, and existential issues as part of a multidisciplinary team. The fellow will follow new patients longitudinally in the ambulatory setting as well as across settings if the patient is admitted to the hospital or goes to hospice.
Carolinas Pain Institute (http://www.carolinaspaininstitute.com)
Pain Management Service
The Carolinas Pain Institute is a comprehensive pain clinic that provides outpatient care as well as a dedicated research facility for all phases of pharmaceutical and device-related clinical studies. The fellow will gain confidence in all forms of pain control and be exposed to cutting-edge research in pain management.
Electives:
- Interventional Pain Management
- Clinical Oncology
- Bioethics
- Geriatric Medicine
- Critical Care Medicine