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Palliative Care

Overview | Application Information | Program Educational Goals | Program Leadership and Core Faculty | Clinical Training Sites | Educational Experience Description | Sample Fellow Rotations | Current Palliative Medicine Fellows | Hospice and Palliative Medicine Fellow Compensation and Benefits

Educational Experience Description


Combined Palliative Care -Geriatrics Consult Service

Location: VA Hospital
Experience: The combined consultation service is a program at the ALM Veterans Hospital. This program receives approximately 150+ consults per month, serving inpatient and outpatient populations. This program receives referrals from several programs, and learners are involved in the following:


a) Extended Care (San Antonio and Kerrville): To screen appropriate patients to be referred to short-term nursing home care aimed at restoring function and returning the patient to independent living.


b) Palliative and Hospice Care: Patients with severe chronic diseases and difficulty in managing symptoms who require palliation and/or end-of-life care will receive consultation in special medical care from a multidisciplinary team. Patients receive comprehensive management of their multiple symptoms, family meetings to explore goals of care and advance care planning and expertise in discharge planning to the most appropriate setting, either home with hospice arrangements or a special inpatient hospice located in extended care at San Antonio VA.


c) Geriatrics: This service is provided to inpatients admitted to other services such as vascular surgery, orthopedics, and surgery, among others. This consultative service helps primary care teams to manage geriatric syndromes such as delirium, multiple medications interactions, incontinence, pain control, wound care, among others. This service also provides a comprehensive geriatric assessment including functional assessment, memory tests and depression screening.


This consultation service provides medical care, nursing case management, interdisciplinary approach and patient/caregiver education. The consultation service staff consists of two faculty physicians, a program coordinator, two nurses (one is a care coordinator for geriatrics and the other is a hospice palliative care coordinator), one social worker, one administrative assistant, a consultant physician and the learners. One of the goals of our program is to teach outstanding and compassionate interdisciplinary palliative care in the medical intensive care unit (MICU). HPM fellows on the combined geriatric and palliative care consultation rotation will gain the necessary experience to assist patients and their families in the MICU.


Outpatient Palliative Medicine Clinic at the GEM Clinic

Goal: To expose fellows to a diverse population of older adults ranging from robust to end-of-life care on an outpatient basis, both in the role of primary care physician and as a palliative medicine /Hospice consultant. Fellows will acquire the skills needed to care for older outpatients and develop a detailed working knowledge of the issues involved in caring for this population.


Location: The Geriatric Evaluation and Management clinic (GEM) at the VA Medical Center San Antonio.


Experience: Each fellow is assigned to the GEM-PC clinic for the purpose of developing a panel of continuity clinic patients for whom they will care over the course of their fellowship training. In addition fellows will see patients referred for outpatient palliative care consultation.The fellow will work with interdisciplinary team members at the GEM-PC clinic (nurses, nurse practitioner, Social worker, dietician, psychology, speech therapy). All fellows are responsible for answering phone messages, refilling prescriptions, entering consultations, reviewing labs/imaging results and following up on lab/imaging results that requires action such as notifying the patient, scheduling a follow-up visit, signing home health orders etc.


University Hospital Palliative Care Consult Service and Outpatient clinic

Location: University Hospital


Experience: The University consultation service is a new consultation service started to provide compassionate, comprehensive, and culturally sensitive palliative care to UHS patients. This programs beginning goal is to receive approximately 25+ consults per month but the number of consults is projected to increase dramatically over the first year. Palliative Medicine Consultations of the diverse population of patients seen at San Antonio's University Hospital. These consultations will include working with an interdisciplinary team to provide patients with expert palliation of symptoms, intensive communication for patients and their families, end of life goal-centered care, and appropriate spiritual and psychosocial care for patients and their families.


Inpatient Hospice and Palliative Medicine VA Hospital

Location: University Hospital


Goal: The fellow will develop proficiency in the assessment and management of pain and other symptoms in patients with late stage cancer and other terminal conditions, the assessment and management of changing nutritional needs and goals, will understand the implications of treating the family as the unit of care, will be able to work productively with hospice nurses, social workers, psychologists, pharmacists and chaplains to treat the patient and family, and will understand the grief process and the ways that grieving families can be supported by the hospice team.


PEDIATRIC PALLIATIVE CARE

Location: Christus Santa Rosa Hospital and Home Care Team


Goals:

1. Principles Of Pediatric Palliative Medicine: Learn to introduce palliative care into the mainstream of medical therapy of seriously ill children.
2.Pain Assessment And Management: Apply key principles of pain assessment and knowledge about child development to decisions about pain assessment and treatment.
3. Advanced Illness Care Planning. Learn to communicate prognosis, goals and plan of care for children with advanced illness and their families.

Rural Palliative Care: KTCC

Location: Kerrville Veterans Hospital


Goal:

To provide the opportunity for the fellow to learn about caring for patients in a rural environment, 60 miles away from San Antonio .


Experience: The fellow will work closely with Dr Martin and participate of team rounds for the KTC3 hospice ward, and for the KTC1 Dementia ward. Fellows will also have the opportunity of working with the palliative care geropsychologist Allegro Johnson Ph.D. and her pet visitation dog, Inook.


Pain Management Clinic

Location: University Hospital


Goal: To provide the opportunity for the fellow to learn about chronic pain evaluation and management


Location: The Pain Medicine Clinic is a interdisciplinary clinic dedicated to the treatment of persistent pain. Physicians, Nurses, Psychologists, Physical and Occupational Therapists provide pain rehabilitation programs. Treatment is both interventional and conservative. Close cooperation between disciplines is used to educate the patient and re-conceptualize their attitude to the management of pain.


HOME HOSPICE AND PALLIATIVE CARE

Goal:To provide the opportunity for the fellow to learn and practice the essence of providing comprehensive palliative care in an interdisciplinary home hospice setting.


Location: The physician fellow will have 2 outpatient hospice experiences throughout the year (2 months) with one or more of the home hospice agencies with which the fellowship has a memorandum of understanding.


ELECTIVE ROTATIONS

1)Medical Oncology: Through attendance in medical oncology clinic and consultation service, fellows acquire knowledge of the natural history of cancer, life expectancy, cancer treatments and their side effects. Sites include STVHCS and the Cancer Therapy and Research Center (CTRC) at the University.
2) Surgical Oncology: In addition to augmenting the fellow's achievement of the goals set out for Medical Oncology, fellows will gain additional experience in assisting patients living with alterations in gastrointestinal functioning, including ostomies. Fellows may also understand the nature and sequelae of the surgical treatment of cancer.
3) Radiation Oncology: Through attendance in clinic, observation at treatment facilities, and continuing care with patients undergoing and who have undergone radiation treatment, fellows will gain experience in the nature and experience of radiation treatment. Gain some basic knowledge on the Indications for and benefits of radiation treatment, including external beam and other modalities. Acquire knowledge of the adverse effects of radiation therapy and skill in its treatment.
4) ENT: Fellows become familiar with the natural history, progression, treatment, and complications of head and neck cancer.
5) ISC (Immunosupressed Service Clinic): Through attendance in the ISC clinic, fellows acquire knowledge and skills to deal with the natural history and complications of HIV infection, understanding of its psychosocial sequelae. Understand basic principles of antiretroviral therapy and adverse effects.
6) Urology: Fellows achieve mastery of the natural history, treatment, progression, and complications of prostate cancer; the treatment of urinary obstruction and dysfunction and the unique issues in the psychosocial adjustment to urologic cancer.
7) Memory Clinic/ Dementia Unit: Through attendance in memory clinic and Kerrville dementia unit (KTCC-1), fellows become skilled in the evaluation, diagnosis and treatment of dementia and related memory and cognitive disorders.
8) Rural Community Hospice: this experience would be in Victoria Texas working closely with the Hospice Medical Director Dr Tyson Meyer. Fellows will participate of clinical and administrative activities of the hospice and learn about the practice of palliative care in a rural setting.
9) Research:This course effectively engages fellows in an intense 2-week learning experience that focuses their attention on research as a potential career path. Fellow have one month to pursue research. Goal: To introduce fellows to basic principles, study designs, and laboratory methodology employed in patient-oriented research. To be able to interpret fundamental statistical tests and analyses in published research reports.


To develop linkages with research mentors within the Hospice and palliative fellowship faculty and other mentors.