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Hospice and Palliative Medicine Interprofessional Fellowship

A message from Interprofessional Program Director, Max Vergo, MD, FAAHPM and Interprofessional Associate Program Director, Lisa Stephens, APRN.

A video from recent fellow and current faculty members, Emily Kobin and Ember Moore.

Amber Barnato discusses the research mission and Meredith MacMartin provides an overview of Leadership Preventive Medicine Residency (LPMR) as a professional development tool.

Mission

Dartmouth-Hitchcock Medical Center (DHMC) 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 a local home hospice program with Visiting Nurses of NH and VT, long term care facility experiences at a few DH affiliated sites representing a socioeconomic range, and pediatric palliative care at our own Children’s Hospital at Dartmouth (ChaD). Electives include spirituality 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.

We are one of nine sites nationally offering an interdisciplinary training program for advance practice nurses. The Dartmouth-Hitchcock 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 D-H Palliative Interprofessional Care Fellowship Program during the academic year that begins July 1st. The NP fellow(s) will work closely with the physician fellows and be fully integrated into this nationally recognized palliative care service.

Our program offers fellows the opportunity to train in Dartmouth-Hitchcock's unique Leadership Preventative Medicine Residency (LPMR), a fully funded two-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 (scroll to the bottom of the page). Let us know before your interview if you are interested, and we will set up one-on-one time with LPMR leadership!

Aims

Our aim is to train well rounded clinicians who can manage the vulnerable populations in our region. This is obtained through interdisciplinary mentorship/education with a focus on advanced communication techniques, management of palliative care patients living with substance use disorder (SUD), collaborative interdisciplinary teamwork, the capacity for self-reflection and ability to value others’ perspectives.

Educators are social workers, chaplains, pharmacists, nurse practitioners, and physicians.

Advanced communication training consists of 14 2-hour interactive sessions throughout the year focused on skills required to achieve the hospice and palliative medicine core competencies.

Management of palliative care patients living with SUD is accomplished by 3 outpatient months with a nationally recognized faculty member using validated tools to assess for opioid use disorder and 3 dedicated case-based didactic sessions with completion of the buprenorphine waiver.

Collaborative interdisciplinary teamwork is achieved by daily interdisciplinary team meetings with mentoring for fellows to lead these meetings. In addition, on weekly ‘Wisdom Wednesdays’ the team discusses challenging cases to share interdisciplinary wisdom and observations. Fellows perform joint visits with social workers, chaplains and our Pharmacist.

Capacity for self-reflection and ability to value others’ perspectives is gained through monthly narrative medicine sessions (reading literature intentionally, writing to a prompt, and then intentionally reading fellows’ writing in a small group), small group sessions with our team Social Workers and Chaplains, quarterly sessions on family dynamics, and a communication feedback technique used by faculty at the bedside with fellows and later taught to fellows over 3 2-hour sessions.

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