Palliative medicine consult service, Henry Ford Hospital
The inpatient service was established in 2000 and is an active teaching/consultative service. As part of an interdisciplinary team, fellows will provide comprehensive palliative medicine consults for patients with diverse diagnoses and across multiple clinical settings, including the ICU, general inpatient floors, and emergency department. Fellows take a leading role in teaching medical students, residents, and other trainees rotating on service.
Hospice Unit, Henry Ford Hospital
Fellows gain direct management experience in caring for hospice patients admitted from the hospital or from the community hospice teams with complex symptoms requiring general inpatient (GIP) hospice management. Fellows work with the hospice interdisciplinary team to provide comprehensive care and gain experience caring for imminently dying patients.
VA Medical Center, Detroit
Fellows gain direct management experience in caring for patients nearing the end-of-life by working as part of an interdisciplinary team to provide comprehensive care for veterans in the VA long-term care hospice unit. Fellows also provide inpatient palliative medicine consultation and may help transition veterans from the inpatient to the hospice setting. Fellows take a leading role in teaching medical students, residents, and other trainees rotating on service.
Hospice of Michigan:
Hospice of Michigan is a non-profit hospice agency serving greater than 1700 patients per day. Fellows work with interdisciplinary teams to provide end-of-life care to adult patients receiving home hospice services. Fellows do home visits with all members of the interdisciplinary team to learn about each team member’s role and expertise. Fellows also spend time working with the hospice medical director to learn about the clinical and administrative roles of the hospice physician.
Fellows work with a pediatric palliative medicine interdisciplinary team to see inpatient and outpatient palliative medicine consults, primarily at Children’s Hospital of Michigan. Fellows may also do home visits for pediatric palliative medicine patients.
Fellows provide care in the Henry Ford Cancer Institute ambulatory palliative medicine clinic.. Fellows work with an interdisciplinary team to provide symptom management, exploration of understanding and education about illness and prognosis, assessment and support of coping needs, and clarification of treatment goals and advance care planning for patients with cancer. Fellows have the opportunity to follow patients longitudinally and across clinical settings.
Fellows have 4-weeks of clinical elective time.. Elective choices include pain medicine, radiation oncology, health psychology, clinical ethics, neurology, heart failure, advanced pulmonary disease, and HIV medicine. Other electives can be accommodated based on fellow interest.
Structured learning occurs for 2 hours every week.. In July and August, didactics and accompanying reading focus on the core topics in clinical palliative medicine to give fellows a solid foundation. During the remainder of the year, structured learning include sjournal club, complex case conferences, morbidity and mortality conferences,and didactic presentations.
Fellows also participate in a structured communication skills curriculum, CLEAR Conversations, which was developed at Henry Ford and has roots in the national VitalTalk organization. Fellows attend communication skills workshops throughout the year, which utilize improvisational actors to allow fellows to practice skills in a safe environment. Fellows also learn and practice a framework for teaching communication skills. Fellows consistently receive structured feedback on their communication skills in real clinical encounters.
National and regional meetings:
Fellows have protected time and financial support to attend the Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA).. Fellows may also attend other local, regional, or national conferences depending on interest.
Interactive didactic presentations are given on research methodology in hospice and palliative medicine as well as quality improvement. Fellows have protected time to complete a scholarly project and work on a quality improvement project with faculty mentorship.