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Hospice and Palliative Medicine Interprofessional Fellowship

Our Palliative Medicine Team

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.

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!

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

Interprofessional Fellowship Model

Our program has been 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 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.

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 in July. 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. At DH, 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.

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

Leadership and Preventative Medicine Track

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 (TD1). 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).

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

Vision

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.

Mission

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.

Aims

  • 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.
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