Residents will spend two to four weeks at the Branford Hospice in Branford, CT. There, under the supervision of a hospice physician, they will see, evaluate, and manage symptoms in patients (new to the hospice and ongoing patients), participate in multidisciplinary rounds, engage in educational activities and learn the skills required to care for patients at end of life.
Goals and Objectives:
The fellow will apply what he/she has learned regarding the care at end of life to patients in a hospice setting.
Evaluation:
At the end of the rotation, the fellow will be evaluated utilizing the locally adapted evaluation form available electronically on MEC. This will be a composite evaluation completed by the director of the elective. Additionally, the elective director will discuss the evaluation with the fellow.
Competencies:
I. Patient Care
A.
The resident will be able to educate patients and their families/friends with regard to the appropriateness of palliative care vs. other more aggressive/invasive therapies for incurable diseases.
B.
The fellow will be able to effectively acquire patient data using history and physical examination and use these data to create plans which maximize patients’ physical and emotional comfort while minimizing toxicities and psychosocial stressors.
C.
The fellow will recognize the patients’ needs for emotional palliation, and spiritual connection.
D.
The fellow will become familiar with other forms of therapy such as art therapy, spiritual counseling, spirituality and relaxation techniques.
E.
The fellow will learn to offer appropriate emotional support to patients and families/friends during the dying process.
F.
The fellow will learn to conduct family meetings at the end of life.
G.
The fellow will learn to effectively choose and titrate various analgesics, anti-emetics, anti-cholinergics, anxiolytics and psychoactive agents for the relief of pain, dyspnea, nausea/vomiting, respiratory/oral secretions, anxiety and fatigue.
II. Medical Knowledge
A.
The fellow will understand the physiologic process of dying.
B.
The fellow will understand the natural history of end stage cancer so they can educate patients and families/friends with regards to expectations.
C.
The fellow will become aware of the need for bereavement support for families and friends.
D.
The fellow will learn the pharmacology of common drugs used in the hospice setting.
III. Problem Based Learning and Improvement
A.
The fellow will legibly and clearly chart patient information, response to therapy, and prognosis in the patient record.
B.
The fellow will participate in multidisciplinary rounds where their skills, knowledge and attitudes with regard to the dying patient can be evaluated and modified as need be.
C.
The fellow will understand the depth of knowledge required for hospice care and will respect the knowledge and information of their colleagues.
D.
The fellow will recognize the need for personal support to deal with the loss of patients.
IV. Interpersonal and Communication Skills
A.
The fellow will be sensitive to the needs of patients and families/friends for shared decision making with providers.
B.
The fellow will display appropriate empathy towards the patients, family members, friends and staff.
C.
The fellow will be sensitive to and respectful of the physical, emotional, social, and spiritual needs of patients and their families.
D.
The fellow will be sensitive to cultural diversity and respect he patients’ (and families) views of health, illness, cancer, dying, death, and the role of hospice care.
V. Professionalism
A.
The fellow will work collaboratively with other members of the palliative care/hospice team.
B.
The fellow will respect the rights of other caregivers to grieve and support others in their grief.
VI. Systems Based Practice
A.
The fellow will understand the roles of all members of the multidisciplinary team in the management of hospice patients and learn to interact with those members in a way that promotes the best possible care for patients.
B.
The fellow will participate in multidisciplinary care rounds in the care of patients.
C.
The fellow will become familiar with all the modalities in the medical/psycho- social sphere of hospice care management.
