Hospice and Palliative Care
Rotation Schedule – Block Diagram
The typical block rotations for the year are described below.
Inpatient palliative care
Inpatient palliative care
Long Term Care
Pediatric palliative care
Anesthesia pain medicine
Palliative Care Consult Service (2-3 months)
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
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
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.
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
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 Unit (1 month)
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
Inpatient Hospice Home (8-12 weeks)
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)
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.
Long Term Care Rotation (1 month)
During this rotation, fellows will spend 100 hours rotating in various long
term care settings. This will entail palliative care consults in LTC settings,
along with subacute and long term care experiences at Winston Salem
rehabilitation, Peace heaven, Brookridge, and Bermuda Village. Fellows will
also get wound care training during this rotation. This experience will allow the fellow to gain valuable
insight into the needs of the geriatric population and the barriers to
providing hospice and symptom management in a long term care setting.
Outpatient Supportive Care Oncology Clinic
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
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)
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)
elective opportunities are open to the fellow based upon interests.
- Interventional Pain Management
- Interventional Radiology
- Clinical Oncology
- Geriatric Medicine
- Critical Care Medicine
- Pediatric Palliative Care
- Integrative Medicine
- PACE medicine rotation
- Transitional Care
- Pain Management
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.