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Hospice and Palliative Care

Curriculum

Rotation Schedule – Block Diagram

The typical block rotations for the year are described below.

Rotation:  

 ROTATION

 DURATION

LOCATION 

Inpatient palliative care consults  

 8 weeks

 Wake Forest Baptist Medical Center

Inpatient palliative care unit  

 8 weeks

Novant Medical Center 

Palliative Neurology

2 weeks 

Wake Forest Baptist Medical Center 

Inpatient hospice

 9 weeks  

HPCC 

Home hospice

 4 weeks

HPCC 

LTC

 2 weeks

VA 

LTC

 2 weeks 

Bermuda Commons 

Pediatric palliative care  

 3 weeks 

Brenner's Children Center 

Research/scholarly activity  

 4 weeks

Wake Forest Baptist Medical Center

Anesthesia pain medicine  
Addiction Medicine

 3 weeks

Carolina Pain Institute and 
Wake Forest Psychiatry 

Radiation Oncology

 2 weeks

Wake Forest Baptist Medical Center 

Elective

 4 weeks

Wake Forest Baptist Medical Center 

TOTAL

12 months

 


Clinical Rotations:

Wake Forest Baptist Medical Center

Palliative Care Consult Service (2-3 months)

Wake Forest Baptist Medical Center is a 831-bed general medical and surgical facility with 38,555 admissions in the most recent year reported. It is the largest employer in Forsyth County with more than 13,440 employees and a total of 198 buildings on 428 acres. The fellow will participate in a consult service that receives over 1200 consults per year. The fellow will develop skills in consultative palliative care, symptom management, communication, inter-disciplinary care, transition management and end-of-life care.  The consult service consists of a staff of attending physicians, advance practice nurses, a social worker, and a chaplain. 

Radiation Oncology Rotation (2 weeks)

Fellows will spend 2 weeks rotating in radiation oncology. The goal of this rotation is so that fellows will have exposure to learn basic concepts and practices of radiotherapy and understand the common side effects along with the role of radiation on pain management.  

Palliative Neurology Rotation (2 weeks)

Fellows will spend 2 weeks rotating in a variety of outpatient clinics to gain a strong knowledge of common neurological conditions. Fellows will rotate in the muscular dystrophy clinic, the ALS clinic, the Huntington’s disease, Multiple Sclerosis, and Parkinson’s disease clinic.

Pediatric Palliative Care Service at Brenner Children’s Hospital (1 month)

Brenner Children's Hospital is the 144-bed “hospital within a hospital’’ affiliated with Wake Forest Baptist Medical Center and Wake Forest University in Winston-Salem, North Carolina. It is a Level 1 Pediatric Trauma Center, as well as it has a pediatric Emergency Department, and pediatric and neonatal intensive-care units. More than 4,500 children are admitted to Brenner Children’s Hospital every year and more than 21,000 pediatric subspecialty visits occur at hospital-based outpatient clinics.  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.

Novant Health Forsyth Medical Center

Palliative Care Consult Service (1 month)

Forsyth Medical Center is a 921-bed hospital, the largest hospital in the Novant Health system. The consult team was started in 2004 and sees over 2000 new consults per year and on average sees 30 inpatient palliative care encounters per day. There are also approximately 200 outpatient new referrals per year to Oncology Supportive Care Clinic. The interdisciplinary team consists of 3 physicians, 5 advanced practice providers, social worker, chaplain, case manager, pharmacist and clinical dietitian. Novant Health Forsyth Medical center was the first hospital in NC to achieve Advanced Certification in Palliative Care through Joint Commission and is also a Charter member Global Palliative Care Quality Alliance. The fellow will develop skills in consultative palliative care, symptom management, communication, inter-disciplinary care, transition management and end-of-life care.

Inpatient Palliative Care Unit (1 month)

This is a 19 bed acute inpatient palliative care unit. It was started in 2001. The fellow will develop skills in complex symptom management, communication, inter-disciplinary care, transition management and end-of-life care in an acute inpatient palliative care unit.

Hospice and Palliative Care Center (HPCC)

Long-term care Service

HPCC cares for 100+ long-term care patients daily, spread throughout multiple facilities in the region, both in assisted-living and skilled nursing facilities. The fellow will spend part of their LTC rotation rounding on patients in various LTC settings with supervision provided by a HPM physician. 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.

Inpatient Hospice Home (8-12 weeks)

HPCC is a large, not-for-profit, Medicare-certified, hospice with an average daily census of 500+ patients. It has a 40-bed inpatient facility that provides acute and residential care to hospice patients. The fellow will be responsible for rounding on patients’ daily, attending IDT meetings and participating in family discussions to provide high-quality patient care.

Home Hospice Service (6 weeks)

Fellows will gain extensive experience managing hospice patients in home care 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. 

Hospice of Davidson County (0.5 months optional)

Fellows will have an option to rotate at Hospice of Davidson County in the Hinkle Hospice house as part of their inpatient hospice experience. This is a 12 bed inpatient unit.  The fellow will be responsible for rounding on patients’ daily, attending IDT meetings and participating in family discussions to provide high-quality patient care. 

Bermuda Commons Retirement Community

Long Term Care Rotation: Bermuda Commons provides a complete continuum of care including short term rehabilitation, long term care, and out-patient therapy.  They offer Skilled nursing care, Physical therapy, occupational therapy, speech therapy, wound care, hospice and respite care. 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.

W.G. (Bill) Hefner VA Medical Center (VAMC)

Long Term Care Rotation: The Geriatrics and Extended Care (G&EC) Program at Hefner VAMC provides care and support to veterans and their families with a goal of maximizing function and independence. An interdisciplinary team – comprised of registered nurses, nurse practitioners, social workers, nutritionists, clinical pharmacists, occupational and physical therapists, psychologists, and physicians – work together with the veteran to determine goals and needs. Fellows will rotate in the community living center (CLC) which provides Short term rehabilitation (wound care, occupational therapy, kinesiotherapy, physical therapy, speech therapy, skilled nursing, and restorative care), Long term maintenance (skilled nursing, dementia, psychiatric, and maintenance care), Respite care, and Palliative & Hospice Care. 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.

Outpatient Supportive Care Oncology Clinic

Longitudinal care of hospice and palliative care patients is provided in the WFBMC Supportive Care Oncology Clinic where the fellow will spend one half-day every 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 

Interventional Pain Rotation (2 weeks)

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. The purpose of this rotation is to have fellows learn when referral to an interventional pain specialist is appropriate and how these techniques can be used in the management of palliative care patients.


Scholarly Activity rotation  (1 month)

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 (0.5-1 month)

Several elective opportunities are open to the fellow based upon interests. 

Electives:

  • Interventional Pain Management 
  • Interventional Radiology
  • Clinical Oncology 
  • Geriatric Medicine 
  • Critical Care Medicine 
  • Pediatric Palliative Care
  • Surg-Onc
  • Geripsych
  • Integrative Medicine
  • PACE medicine rotation
  • Transitional Care
  • Pain Management

Research:

Participation in scholarly activities in expected during the fellowship year. Time is set aside in the curriculum to develop and conduct scholarly work based upon the fellow’s interests. As a large academic medical center, the fellow will have many opportunities to strengthen research skills through a lecture series and participation in ongoing research projects.

 

 

 

Quick Reference

Gerontology and Geriatric Medicine

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Last Updated: 07-27-2017
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