VA Palliative Care Consult Team (PCCT) and Inpatient Palliative Care Unit (PCU): Fellows will spend three months out of the year working on a unit with 10 dedicated palliative care beds, and also performing consultations on inpatients throughout the hospital. The fellowship program director is the leader of the PCCT and also is the attending overseeing the inpatient floor with palliative care beds. Fellows are expected to see initial consults and conduct follow-up visits with the supervision of the program director. They will also work with the RN, MSW and chaplain who are part of the PCCT. Fellows will also be required to rotate with the oncology service at the VA for one month.
Center for Hospice and Palliative Care (CHPC) Inpatient Hospice Unit (HIU): Trainees will spend two months out of the year working on this 22-bed inpatient hospice unit. The hospice medical director and other staff hospice physicians will supervise. Fellows will participate in patient rounds, daily care, as well as family and interdisciplinary team meetings. The hospice inpatient experience also includes consultative service rotation at hospitals with 12 hospice swing beds, and 10 hospice residence beds.
Roswell Park Comprehensive Cancer Center Pain & Palliative Care Service: The rotation will take place one month out of the year at the comprehensive clinical and research cancer center affiliated with UB. Fellows will perform palliative care consults for inpatient and outpatient cancer patients supervised by an attending trained in both palliative medicine and interventional pain management.
Length: Six months
CHPC Hospice Home Care: Trainees will spend two months out of the year visiting patients in the home with members of the interdisciplinary team. The fellows will make visits with and be supervised by the Hospice medical director, staff physician, nurse, social worker, and pastoral care. They will be expected to maintain continuity of care and see at least 25 home care patients during the course of one year and keep a log of how many visits and patients are seen. Hospice Buffalo is affiliated with 40 regional nursing homes where home care visits will also be done.
Trainees will be expected to attend interdisciplinary team meetings while in this setting. The patient population served by Hospice Buffalo is diverse in age, gender, and diagnosis, living in urban, suburban, and rural settings. The average daily patient census is 360 patients.
Length: Two months
Fellows will work with a geriatrics attending physician for one month out of the year in a long-term care nursing home facility providing palliative care to this population. They will learn about topics such as delirium, polypharmacy, falls, incontinence and wound care.
Length: One month
VA Chronic Pain Multidisciplinary Outpatient Clinic: Fellows will have a panel of continuity outpatients experiencing chronic pain. The care is organized in the setting of a multidisciplinary clinic with exposure to medical pain management, pain management in patients with substance abuse, acupuncture, psychological approaches, procedures, and interventions. The required ambulatory chronic pain clinic is where fellows will work one half-day per week for the entire year. An attending physician on faculty who practices pain management will supervise.
Trainees are expected to carry a panel of patients that they follow up with and manage throughout the year. The clinic is interdisciplinary with medical, interventional, alternative and psychological approaches to pain management and outpatient palliative care.
Length: One half-day per week for one year
Elective time in a clinically relevant field will be offered two months during the year. Available electives are ethics consultations, geriatric medicine, interventional pain management, psychiatry, HIV clinic, pediatrics, radiation oncology, pulmonary, cardiology, neurology or other experiences determined to be appropriate by the program director.
Fellows will be responsible for choosing the elective and the fellow and program director will arrange the rotation at one of the participating institutions. Each elective experience will have written competency-based goals and objectives that will be distributed to the fellows and the supervising physician prior to starting the elective rotation.
Length: Two months
Fellows will have a scheduled month of scholarly activity during the course of the year. They must complete a scholarly project by the completion of the fellowship. Examples may include starting or helping work on an existing academic research project, presentation of a poster/abstract at a national meeting, or publication of a case report, review article or book chapter. Fellows will be asked to keep a portfolio documenting their scholarly activities.
Length: One month
Trainees are expected to gain experience working with interdisciplinary teams. The palliative medicine fellowship will provide the opportunity to work with IDTs, which potentially include a physician, nurse, social worker, chaplain, dietitian, volunteer, pharmacist, physical therapist, occupational therapist and recreational therapist.