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University of Nebraska Medical Center

Hospice and Palliative Medicine Rotations

Inpatient Palliative Care Consults (8 months)

  • Rotation site: Omaha Veteran Administration Hospital & Nebraska Medicine
  • Rotation experience: Fellows will see patients admitted to the VA with palliative care consults. The fellow will staff directly with the palliative medicine 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
    • With progressive responsibility, teaching residents and medical students

Home Hospice (2.5 months)

  • Rotation site: Hillcrest Home Hospice
  • 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 and field calls about patient care during normal business hours. 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

Pediatric Palliative Care Inpatient Consults (1 month)

  • Rotation site: Children’s Hospital and Medical Center “Hand in Hand” Team
  • Rotation experience: Fellows will largely serve in an observational role to better understand the similarities and differences between palliative medicine in the adult and pediatric patient populations. Learning goals over this rotation are largely related to perspectives around:
    • Family systems with coping with serious illness
    • Family systems with medical decision making
    • Explaining death to a child at various ages
    • The varying scope of practice of palliative medicine in the pediatric patient population
    • Special considerations around the hospice benefit in the pediatric patient population

Long Term Care Experience

  • Rotation site: St. Joseph Villa Nursing Home & Gretna Community Living
  • Rotation experience: Fellows will have a panel of patients that they follow longitudinally. Fellows will staff directly with the attending. 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
    • Assessing and adjusting goals of care over a longitudinal time period (eg decisions about going back to the hospital, when to transition to hospice)

Ambulatory Palliative Care Experience (alternating Tuesday afternoons)

  • Rotation site: Fred and Pamela Buffett Cancer Center Clinic at UNMC
  • Rotation experience: Fellows will have progressive responsibility in this experience, from observation to direct patient care with the goal of following patients longitudinally in the ambulatory setting. Fellows will staff directly with the attending. Skills learned over this longitudinal experience will include:
    • Working with referring providers in a co-management role
    • Comprehensive symptom assessment and management
    • Eliciting preferences around prognostic disclosure
    • Helping patients and families develop prognostic awareness
    • Providing support and coping strategies for patients and families
    • 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

Acute and Chronic Pain (1-2 weeks)

  • Rotation site: Nebraska Medicine Oncology (Inpatient & Outpatient)
  • 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

Oncology Inpatient Consults (2 weeks)

  • Rotation site: UNMC
  • Rotation experience: This rotation serves as a capstone clinical experience at the end of the fellowship year, as fellows will be nearly ready for independent palliative medicine practice. Fellows will work with the oncology consult team in the inpatient setting to see patients admitted with advanced cancers. Fellows will staff directly with the oncology attending with Dr. Melissa Teply available for indirect supervision. Skills learned over the rotation will include:
    • Serving as an embedded palliative medicine specialist on the oncology consult team
    • Coordination of communication between the inpatient and outpatient oncology providers and settings
    • Comprehensive symptom assessment and management
    • 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

Elective (1 month)

This experience will be scheduled toward the end of the fellowship year in order to allow fellows time to create a personalized learning experience. Elective opportunities are available in ethics, geriatrics, oncology, expanded time in any of the required rotations, or other learning experiences that the fellow identifies.