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Clinical Rotations

Blocks

  • Inpatient (5 month consult including ICU)
  • Home Hospice (1.5 months with Visiting Nurses of NH and VT)
  • Inpatient Hospice Unit (2 months at Jack Byrne Center for Palliative and Hospice Care)
  • Long-term Care (1 month at Kendal at Hanover, but four different weeks)
  • Spirituality (0.5 month)
  • Pain/Interventional (0.5 month)
  • Pediatrics (0.5 month at Boston Children's Hospital with the Pediatric Advanced Care Team)
  • CME/Vacation (one week/three weeks)

Inpatient Block

The consult service sees patients in various inpatient settings at Dartmouth-Hitchcock Medical Center (DHMC) including medical, oncology, cardiology, pediatric, surgical floor and critical care units. Daily Inter-Disciplinary Team (IDT) meetings are held with:

  • Chaplaincy
  • social work
  • healing arts
  • creative arts
  • volunteer services
  • bereavement
  • physicians, including faculty and fellows
  • nursing, including advanced practice nurses, inpatient and outpatient nurses
  • between one and six learners on rotation

IDT meetings are held to comprehensively review each patient and family being followed by the palliative care team.

Fellows will spend about one weekend per month, either at the Jack Byrne Center for Palliative & Hospice Care (JBC) or at DHMC, working for the consult service with direct and indirect supervision from physician faculty. Additionally, fellows will cover night home pager call for about one week per month to gain experience in responding to palliative care emergencies.

Jack Byrne Center for Palliative & Hospice Care (JBC) Block

Fellows will spend 4 weeks working with JBC patients admitted for intensive palliative and end-of-life care. JBC patients come from several departments, including the hospitalist service, ICU, neurology, oncology, and surgical services.

Hospice Block

Palliative Care fellows will spend a total of 2.5 months on the Hospice Block rotation.

  • 6 weeks will be spent with a local non-profit home hospice, Visiting Nurses of NH/VT
  • 4 weeks will be spent at the Jack Byrne Center for Palliative & Hospice Care, with a focus on Visiting Nurses of NH/VT hospice GIP patients admitted because they can’t be managed at home due to acuity and complexity of symptom management. Hospice Inter-Disciplinary Team (IDT) meetings will be attended on a regular basis during this rotation.

Long-term Care Facility at Kendal Block

Palliative Care fellows will spend time at local nursing facility Kendal at Hanover, under the supervision of Dr. Linda Dacey, and should expect the following clinical flow:

  • 25% time with consults (symptom based in patients with life-limiting illness or coping with serious illness), including bereavement.
  • 50% time with residents in palliative care or hospice type units. These are in our assisted living and skilled nursing unit.
  • 10% time with residents who now have home hospice care. Most people move to assisted living for final care.
  • 15% time other, including acute illness, chronic pain and all geriatric issues.

Spirituality Block

Spiritual assessment, along with managing spiritual or existential distress, is essential in hospice and palliative medicine.

The spirituality block, led by our palliative care team chaplain, will include:

  • shadowing chaplain providers of various faith backgrounds
  • didactic sessions on clinically pertinent topics for a fellow
  • incorporation with the Chaplain Pastoral Education program.

With guidance from our Bereavement Coordinator, fellows will be responsible for planning one Service of Remembrance, a quarterly service for families of the bereaved.

Pain/Interventional Block

This required, important block includes outpatient pain clinic, procedures and inpatient consultation.

Pediatrics Block

Fellows will stay in Boston in order to rotate at Boston Children's Hospital with the Pediatric Advanced Care Team (PACT). This is an interdisciplinary pediatric palliative care specialty consult service where fellows can experience a well-integrated and high functioning team caring for a broad array of pediatric patients with serious illness.

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