The University of Miami Miller School of Medicine Palm Beach Regional Campus Hospice and Palliative Medicine Fellowship at JFK Medical Center, WPB VAMC, and HPBC prepare the selected physician for board certification in hospice and palliative medicine. The University of Miami Miller School of Medicine Palm Beach Regional Campus Graduate Medical Education Committee selects one fellow each year for participation in the program. The program gained ACGME accreditation under the JFK Internal Medicine Program in May of 2010. The participating institutions provide the clinical base for the separately accredited Allopathic and Osteopathic fellowships.
The program embraces the following ACGME-specified objectives for the selected fellow:
Patient Care: Demonstrate compassionate, appropriate, effective care for treating health problems and promoting well-being in a palliative care setting.
Medical Knowledge: Relate empirical medical knowledge and apply it to patient care.
Practice-based Learning: Analyze practice experience and perform practice-based improvement activities using systematic knowledge.
Interpersonal and Communication Skills: Create and sustain a therapeutic and ethically sound relationship with patients, families and other healthcare professionals.
Professionalism: Demonstrate professionalism that supersedes self-interest through care, compassion, integrity and responsiveness to the needs of patients and society.
Systems-based Practice: Practice cost-effective healthcare and resource allocation that does not compromise quality of care; advocate for quality patient care and assist patients in dealing with system complexities.
The palliative medicine fellow will gain clinical expertise through a variety of patient care experiences in a range of settings.
The fellow will undergo and extensive orientation program conducted by the University of Miami Miller School of Medicine Palm Beach Regional Campus, JFK Medical Center, VAMC, and Hospice of Palm Beach County. This orientation will include HR policies and procedures, benefits, EMR training, University of Miami Calder Library training to name just a few of the topics covered.
Hospice/Palliative Medicine Core Inpatient
The fellow begins his or her course of study on the inpatient unit at the Jay Robert Lauer Hospice and Palliative Care Unit at JFK Medical Center. The objective of the first month rotation is to provide the Fellow core concepts in both the medical and psychosocial aspects of palliative care. The Fellow will be expected to attend morning report with the Internal Medicine Residents and pre- round on the patients admitted to the inpatient unit. Teaching Rounds follow working rounds with the Faculty concludes the morning patient care. Noon time lecture is followed by didactic lectures on core concepts and articles, new patient consults, and other clinically relevant activities.
The outpatient homecare assignment will be a four-week rotation. Subsequent to the intense four-week rotation the fellow will continue to follow a small cohort of patients for 20 weeks. The focus of this experience is to allow the fellow to follow patients with a prognosis of six months or less throughout the trajectory of their terminal illness. The homecare team carries an average daily census of 60-80 patients. This patient population provides a strong mix of ethnicities and culture, as well as the opportunity to provide generational care. This experience will allow the fellow to participate in care planning from time of terminal diagnosis through difficult decision-making options, and allow for critical interactions with patient/family and other support systems. This rotation will allow the fellow an opportunity to develop the skills needed to function in an outpatient setting and experience the unique challenges of caring for patients in the home. The fellow will attend weekly interdisciplinary team meetings and visit patients in their home with various members of the team.
Ambulatory Care/Medical Oncology/Radiation Oncology
The fellow will attend the outpatient oncology clinic at the Palm Beach Cancer Institute (PBCI) ½-1 day week for at least six months. The fellow will attend clinic one morning/afternoon a week at the PBCI at JFK Medical Center in Lantana, Florida. The PBCI is led by a distinguished team of board certified oncologists, certified oncology nurses, and ancillary staff, committed to providing their patients with the finest cancer care available. The fellow will participate in the delivery of high-quality medical care and interventions to palliative care patients. Care is delivered in a warm, compassionate, and comfortable setting. The fellow will perform a thorough assessment of the referred patient, and participate in the initial and subsequent plan of care. The fellow will spend two weeks at the JFK Comprehensive Cancer Center learning the indications, benefits, and complications of radiation treatment.
Long Term Care (LTC)
The Community Living Center (CLC) at the West Palm Beach Veterans Administration Medical Center will be the designated site for the LTC experience. The CLC provides an excellent site for meaningful longitudinal care of patients. The CLC contains a 60-bed LTC facility, as well as a 10-bed palliative care and 10-bed hospice unit. The fellow will assume responsibility for evaluation of the LTC residents' daily medical needs, as well as following patients as they transition to the palliative and hospice units. This experience will allow the fellow to gain valuable insight into the needs of the geriatric population. Fellows are also afforded the opportunity to follow patients longitudinally through the experience at the VAMC. Fellow may follow patients in the LTC setting and subsequently as they are transitioned to a hospice or palliative care unit.
Inpatient Palliative/Hospice Consult/Service
The Inpatient acute care experience will provide day-to-day management of hospice patients who are admitted for symptom management, as well as consultative services for palliative care within the hospital. The four-month experience will take place on a dedicated 12-bed hospital-based inpatient unit located at JFK Medical Center. Fellow reports to the Unit at 7:30am to meet with rotating University of Miami residents and attending physician. Teaching Rounds will be completed with the interdisciplinary team. Upon completion of rounds, fellow will dictate progress notes. Fellow, with the assistance of the social worker and attending physician, will arrange for family conferences as needed. Fellow will cover assigned didactic topic with resident. Fellow will be notified by palliative care coordinator of pending palliative or hospice consults and complete in timely manner. Fellow will attend extubations and learn through mentoring the art of delivering bad news to families. Fellow will attend pertinent resident noon conferences and present at least two during the course of the fellowship. Fellow will work under the supervision of the attending, and maintain telephone communication with attending when not on the unit. Two months will be spent at on the WPB VAMC Palliative Care Unit as well as the LTC Center.
Hospice of Palm Beach County provides care to patients of all ages. A two week rotation with the Palm Beach Pediatric Hematology Oncology office will be required. Additionally, time will be spent in an outpatient experience with the Pediatric Oncology Support Team (POST) at the Parent Child Center. This experience will provide an opportunity for the fellow to follow children who are chronically as well as terminally ill. The Pediatric Oncology Support Team Program is a comprehensive psychosocial program utilizing a specialized team to provide longitudinal care to patients and their families. The fellow will work with the interdisciplinary team to evaluate and establish a plan of care for chronically ill children with conditions such as cystic fibrosis, cerebral palsy, leukemia, etc.
The fellow will select a one-month elective which will be subject to the approval of the Program Director. Opportunities available, but not limited to:
In addition to clinical training, the fellow will be required to attend scheduled didactic lectures and monthly journal club meetings. The fellow will be expected to assist with topic selection and moderate discussions during the meetings.
The fellow will also learn the art of mentoring while working with medical students, Internal Medicine Residents, and other clinical staff. One-on-one mentoring in hospice regulations, documentation and billing will take place with the fellow by either the Program Director or one of the senior faculty members. Although research is not a required component of the program, the fellow will be expected to complete a scholarly project or presentation prior to the end of the fellowship.
The fellow will receive a competitive salary and benefits package from the University of Miami Miller School of Medicine Palm Beach Regional Campus.