Our Palliative Medicine team
Dartmouth Hitchcock Medical Center is a rural academic 396-bed tertiary care referral center attracting patients from Vermont, New Hampshire, Western Massachusetts, and parts of Maine. Our patient population is predominantly low socioeconomic status, Caucasian, non-religious, uninsured/underinsured, and have challenges with healthcare access.
Our palliative care team sees a wide variety of patients, such as those cared for by hematology-oncology (including hematological malignancy and transplant patients), hospital medicine, cardiology, neurology, surgical specialties, and the intensive care unit. Our team consists of physicians, nurse practitioners, nurses, a clinical pharmacist lead, social workers, healing arts practitioners, volunteers, creative arts specialists and chaplains.
We have outpatient and inpatient services as well as a primary service at the Jack Byrne Center for Palliative & Hospice Care serving our community. Rotations include 2 local home hospice programs with Visiting Nurse and Hospice for New Hampshire and Vermont as well as Bayada, long-term care facility experiences at a few Dartmouth Health affiliated sites representing a socioeconomic range, pediatric palliative care at our own Dartmouth Health Children's, spirituality, social work, the local Veterans Affairs Medical Center at White River Junction, and interventional pain. Our faculty are nationally recognized for communication education, substance use disorder in palliative care populations, narrative medicine, and healthcare delivery science research in end-of-life care.
Interprofessional Fellowship Model
Our program has been Accreditation Council for Graduate Medical Education (ACGME)-accredited since 2008, and has grown over the years from one fellow to five fellows representing physicians and nurse practitioners.
We are one of nine sites nationally offering an interdisciplinary training program for advance practice nurses. The Palliative Care Program is offering a 1-year APRN fellowship in Hospice and Palliative Care. The APRN fellow(s) will train with physicians in the Palliative Interprofessional Care Fellowship Program during the academic year. The NP fellow(s) will work closely with the physician fellows and be fully integrated into this nationally recognized palliative care service.
Interprofessional training is an ideal, but real-world challenges impact its actualization. We are pioneering a side-by-side interprofessional training experience and leadership model between physician and nurse practitioner in a way that is completely compliant with ACGME regulations, but utilizes clinicians based on their skills and attitudes instead of solely by their profession. The result has been a fellowship class of equally skilled independent hospice and palliative medicine clinicians who can serve as agents of change for our vision of interprofessional equity in the care of seriously ill patients.
Read more about the Interprofessional Fellowship Model on page 6 of our Department of Medicine newsletter where it was celebrated as an innovative training model.
Leadership and Preventative Medicine Track
Our program offers fellows the opportunity to train in Dartmouth Hitchcock Medical Center's unique Leadership Preventive Medicine Residency (LPMR), a fully-funded 2-year training program. LPMR graduates earn either an MPH or MS from The Dartmouth Institute for Health Policy and Clinical Practice (TDI). See an example of the work one of our previous fellows, Travis Austin, did as part of this program.
There are 2 options for participating in this additional leadership training:
- Apply to our 3-year HPM/LPMR combined track (either alone or in addition to our 1-year HPM clinical fellowship). Use the same materials for both tracks, but highlight your leadership and system change interests.
- After matching and starting in our 1-year HPM clinical fellowship, any fellow can apply to the LPMR program.
Both tracks lead to the following structure of training:
|Year 1||Year 2||Year 3|
|Clinical Hospice and Palliative Medicine Training||Leadership Preventive Medicine Residency, Year 1||Leadership Preventive Medicine Residency, Year 2|
Our graduates will be skilled clinicians in managing complex symptoms, discussing what matters most to patients and families, and providing team-based interdisciplinary care. In addition to this, they will be able to teach others how to add primary palliative care skills to their practice to increase the reach to rural and vulnerable patients, families, and communities.
Our fellows will learn symptom management during interactive faculty-led local and regional sessions throughout the year and use that learning to manage complex symptoms in a variety of contexts including patients with co-morbid substance use disorder. They will be mentored to teach these skills to medical school and GME learners at the bedside and in the classroom.
Our fellows will practice communication frameworks and associated skills that build over the year in complexity while receiving bedside coaching from our faculty in a progressively independent way over the year. They will be mentored in how to provide bedside feedback to colleagues to spread skills.
Our fellows will be taught and mentored by interprofessional faculty, experience interprofessional education with nurse practitioners and physicians trained side-by-side, and gain competency to leverage an interdisciplinary team for patient and family care.
- Graduate fellows who feel confident and are competent to manage complex symptoms in seriously ill patients, including being waivered to prescribe suboxone for SUD.
- Graduate fellows who feel confident and are competent in having serious illness conversations with patients and families, including completion of a 2-part communication training curriculum.
- Graduate fellows who are assessed by interprofessional faculty members to be competent in interdisciplinary teamwork and have experience of leading interdisciplinary team meetings.
- Read more about our team culture and daily work in Joy in Practice (PDF), a JAMA-published paper by Section Chief Kathryn Kirkland, MD.
- Visit the Palliative Care department website for information about our full team.
- Find regular communication training options for EARLY and LATE goals of care conversations on the Continuing Education website.
Diversity, equity, inclusion, and belonging
We understand that diversity fosters innovation and creates a welcoming and inclusive environment for our patients, colleagues, and communities.
Graduate Medical Education at Dartmouth Hitchcock Medical Center is committed to recruiting underrepresented minorities and physicians with diverse backgrounds to our residency and fellowship programs.