Clinical Training

Overall Program Goals

• To provide physicians the knowledge, skills, attitudes, and behaviors to integrate palliative approaches throughout the continuum of medical care and to qualify as subspecialists in palliative medicine.
• To cultivate interdisciplinary and multidisciplinary models of care for patients with advanced illness
• To foster the development of research and teaching skills to function as a clinician scientist and educator in palliative medicine.
• To create a supportive environment where professionalism, ethical principles, teamwork, and each physician’s potential are furthered.

• To promote the field through training future leaders in Hospice and Palliative Medicine

Description of Clinical Training Experiences

The one-year clinical fellowship program offers multiple block rotations with diverse experiences in inpatient palliative care consultation, home hospice and palliative care, pediatric hospice and palliative care, long term care, inpatient hospice care, and several electives.  Longitudinal clinical experiences are also stranded within a university-based palliative care clinic and community home palliative care and hospice program to provide fellows abundant opportunities to care for patients and families throughout the course of illness.  Fellows will care for patients with a broad range of diagnoses, from various socioeconomic and cultural backgrounds, and with diverse palliative care needs.  Goals and objectives of the rotation that address the 6 core competencies of the ACGME will be reviewed with the fellows prior to each clinical experience.

University of Chicago Adult Inpatient Palliative Care Consultation

Through this experience, trainees will be responsible for communicating with the primary team, running family meetings, discussing bad news, delineating goals of care near the end-of-life, advising on the care of the actively dying patient, coordinating care, transitioning care, and teaching other trainees.  The service functions as a dynamic team that represents one of the busiest and most valued inpatient consultative services at the University of Chicago Medical Center.

Pediatric Hospice and Palliative Care

This block combines inpatient pediatric palliative care consults at the University of Chicago Comer Children’s Hospital with home-based pediatric hospice and palliative care provided by Vitas Hospice and Palliative Care.

Vitas Healthcare: Hospice and Palliative Care

VITAS Hospice, the largest national provider of hospice services (established in 1978), is a Medicare-certified, free-standing, for-profit organization. It has been an integral site for training medical students, residents, fellows, attendings, social workers, chaplains, bereavement workers, and nurses in palliative care. Interdisciplinary team members include hospice physicians, RNs, LPNs, social workers, physical and occupational therapists, chaplains, dieticians, pharmacists, volunteers, bereavement counselors, and complementary alternative medicine (CAM) therapists. During this rotation, fellows will develop skills in assessing and treating patients at home, managing symptoms near the end of life, addressing goals of care, and identifying and communicating to families signs of impending death. Fellows will participate in weekly interdisciplinary team meetings, where they will take on a leadership role, by helping to develop a comprehensive care plan, appreciating the role of the team, and becoming familiar with Medicare hospice regulations

VITAS Inpatient Hospices at Mercy Hospital

VITAS has a dedicated inpatient hospice unit located at nearby Mercy Hospital, one of the UC community hospital affiliates. The inpatient unit provides opportunities for the fellow to aggressively manage pain and non-pain symptoms in a hospice unit, utilize resources in a cost-effective manner, and is an excellent learning environment for enhanced communication with family and caregivers to provide high-quality patient care.

Northshore University HealthSystem Palliative Care

NorthShore University HealthSystem, comprised of a group of 4 community hospitals on Chicago’s north side, is another primary educational partner with University of Chicago. Glenbrook and Evanston Hospitals are the primary training sites for fellows, offering a breath of clinical experiences in consultative medicine and the Inpatient Palliative Medicine Unit. The fellows also attend outpatient clinic at the Center for Integrative Medicine, and perform home hospice visits on Chicago’s north side.

Long-term Care and Skilled Nursing Facility

During this rotation, fellows learn the nuances of palliative care needs of the elderly, such as progression and management of neurologic illness (e.g. dementia, ALS, Parkinson’s), assessment and management of chronic non-cancer pain, wound care, geriatric syndromes (incontinence, delirium, non-cancer related functional decline, and frailty), advance care planning, and policies and regulations of long-term care settings.

Pediatric Hospice and Palliative Care

This rotation provides a breadth of clinical experiences including inpatient pediatric palliative care consults at UC Comer Children’s Hospital, chronic long-term assisted care at La Rabida Children’s Hospital, pediatric oncology clinic, and home-based pediatric hospice and palliative care provided by Horizon Hospice’s “All About Kids” Program. The fellow spends a week on each of these services with a dedicated attending specialist seeing a spectrum of childhood illnesses, such as cancer, muscular dystrophy, birth defects, and cystic fibrosis.

Longitudinal Clinic

The University of Chicago offers two established longitudinal clinic experiences where fellows care for patients under the direct supervision of an attending palliative care physician on average one-half day every other week for the entire year.

• Oncology Palliative Care Clinic.  This clinic provides supportive care (palliative care physician, social work, nursing, nutrition, and psychologist) concurrently with oncologists.  Fellows provide supervised consultations for, and co-management of, cancer patients undergoing aggressive chemotherapeutic regimens including management of physical and psychological symptoms, quality of life interventions, and redefining goals of care.
• Specialized Oncology Care and Research in the Elderly Clinic (SOCARE).  This multidisciplinary ambulatory training model combines resources from oncology, palliative medicine, and geriatrics to provide high-quality care for older adult patients with cancer.

Electives

Fellows have 4 weeks protected time to explore a variety of electives including, but not limited to, Memory Disorders, Anesthesia/Pain, Psychiatry, Geriatric Frailty, HIV, Neurology, and Medical Ethics.