PEDIATRIC FOCUSED TRAINING OVERVIEW 

Pediatric Palliative Care Inpatient (5-6 months)

• Rotation site: Children’s Hospital and Medical Center- Hand in Hand/Palliative Care Team
• Site Director: Dr. Hema Navaneethan
• Team structure
  • 3 Physicians
  • 2 Social workers
  • 1 Nurse case manager
  • Close relationships with
    • Integrative therapists in massage and healing touch
    • Child life
    • Chaplains

• Rotation experience: Fellows will work closely with the interdisciplinary team seeing new consults and established pediatric patients. The fellow will staff directly with the palliative medicine attending. Learning goals over this rotation are largely related to perspectives around:
  
  • Working as a consultant
  • Comprehensive symptom assessment and management
  • Family systems with coping with serious illness
  • Family systems with medical decision making
  • The varying scope of practice of palliative medicine in the pediatric patient population
  • Special considerations around the hospice benefit in the pediatric patient population
  • Pediatric end of life care
  • Education of residents and medical students

AmbulatoryPediatric Palliative Care Experience (Third Thursday and Friday AMs of each month) 

• Rotation site: Children’s Hospital and Medical Center- Hand in Hand/Palliative Care Team
• Site Director: Dr. Hema Navaneethan
• Rotation experience: Fellows will participate in monthly interdisciplinary Hand in Hand Clinic with the goal of following patients longitudinally in the ambulatory setting. Fellows will work closely with the interdisciplinary team. Skills learned over this longitudinal experience will include:
  • Comprehensive symptom assessment and management
  • Providing support and coping strategies for patients and families
  • Eliciting the values and preferences of patients and families
  • Making recommendations based on patient preferences
  • Eliciting preferences around prognostic disclosure and helping patients and families develop prognostic awareness 
  • Discussing advance care planning
• Fellows will also have the opportunity to see pediatric patients in the outpatient setting throughout their pediatric palliative care inpatient months.

Home Hospice (2.5 months) 

• Rotation site:
  • Hillcrest Home Hospice(2 months)
  • Children’s Hospital & Medical Center Hand in Hand Team (2 weeks)
• Site Director: Dr. Natalie Manley (Hillcrest) and Dr. Hema Navaneethan (Hand in Hand Team)
• Team structure
  • Medical director
  • Case managers
  • Social workers
  • Chaplaincy
  • Home health aids
  • Pharmacists
  • Bereavement counselors
    
    
• Rotation experience: Fellows will perform home visits with various members of the hospice team and attend weekly IDT meetings. Fellows will work in an observational role, and over time, will start to make the plan of care for patients.
• Skills learned over the rotation will include:
  • Working with an interdisciplinary team
  • Comprehensive symptom assessment and management
  • Assessment and management of issues around capacity for medical decision making
  • Hospice qualifications for initial admission and subsequent recertification
  • Regulatory issues around hospice compliance and payment structure
• Fellows will spend an additional 2 weeks working with the Children's Hospital & Medical Center Hand in Hand Team on the management and care of pediatric hospice patients.

Acute and Chronic Pain with Adult Acute Pain Service (2-4 weeks) 

• Rotation site: UNMC inpatient consult service and outpatient cancer pain clinic
• Site Director: Dr. Madhuri Are
• Rotation experience: Fellows will work with the acute pain team in the inpatient setting and also see patients in the ambulatory setting. The experience may start with observation with the expectation of seeing patients directly and staffing with the attending. Skills learned over this rotation will include:
  
  • Comprehensive pain assessment
  • Understanding various modalities for managing pain, including medications, procedures, and referral to other services as applicable (eg. physical therapy, substance use disorders clinic, psychiatry, psychology)
  • Criteria and eligibility for procedural pain management strategies, particularly intrathecal pain pumps

Inpatient VA Palliative Care Consults (2-4 weeks) 

• Rotation site: Omaha Veteran Administration Hospital
• Site Director: Dr. Lou Lukas
• Team structure
  • 2 Physicians
  • 1 APRN, 1 PA
  • 1 Social worker
  • 1 Case manager
    
    
• Rotation experience: Fellows will see patients admitted to the VA with palliative care consults. The fellow may begin in an observational role but should anticipate transitioning into seeing patients directly and staffing with the attending. Skills learned over the rotation will include:
  • Working as a consultant
  • Comprehensive symptom assessment and management
  • Assessment and management of issues around capacity for medical decision making
  • Helping patients and families develop prognostic awareness
  • Eliciting the values and preferences of patients and families
  • Making recommendations based on patient preferences
  • Discussing advance care planning and recommending completion of forms such as advance directives and POLST as applicable
  • Discussing and recommending a transition to hospice when applicable

Long Term Care Experience (1 month- divided into 2-week blocks) 

• Rotation site: St. Jo Villa Nursing Home and Ambassador Health
• Site Director: Dr. Mandy Byers
• Team Structure
  • Medical director
  • Nursing
  • Social work
    
    
• Rotation experience: Fellows will see patients in a primarily observational role. Skills learned over this longitudinal experience will include:
  • Working with an interdisciplinary team to provide patient care
  • Assessment and management of issues around capacity for medical decision making
  • Working with families to provide support, elicit values and preferences, and make personalized recommendations on patient care
  • Discussing advance care planning and recommending completion of forms such as advance directives and POLST as applicable
• Fellows may also work to meet long term care requirement hours in caring for pediatric patients residing at Ambassador Health

Elective (1 month)