Hospice & Palliative Medicine Fellowship

About the program

General description

The NewYork-Presbyterian Queens Hospice and Palliative Medicine Program (HPM) is a one-year fellowship, with rotations at New York-Presbyterian Queens, Silvercrest Center for Nursing and Rehabilitation, Calvary Hospital, and the Visiting Nurse Service of New York (VNSNY). A one-month pain and palliative medicine elective rotation is also offered at Memorial Sloan Kettering Cancer Center.

The program accepts three fellows each year. The HPM Fellowship is one of six fellowships — cardiology, pulmonary/critical care, GI, renal, and infectious disease — offered at NewYork-Presbyterian Queens. NewYork-Presbyterian Queens is an affiliated teaching hospital of Weill Cornell Medical College.

Our program aims to train strong clinician-educators who will become future leaders in the field. Fellows work closely with our Interdisciplinary faculty in an academically strong and clinically robust learning environment. Fellows also can attend educational programs at multiple institutions, including the Mt. Sinai Intensive Update with board review in geriatrics and palliative care, Memorial Sloan Kettering Cancer Center didactics, and VNSNY Board Review Sessions. Our fellows also receive program support to attend the Annual Assembly of the American Academy of Hospice and Palliative Medicine (AAHPM).

Goals of the program

The primary goal of this one-year Hospice and Palliative Medicine Program is to train future clinical palliative care physicians with interest in academic medicine, especially clinician-educators. This program is outstanding in the breadth and diversity of its educational experiences, training sites, and faculty.

Clinical

Fellows are expected to acquire clinical expertise in providing patient-centered care for seriously ill patients and at the end of life and their family/caregivers. With supervision from dedicated interdisciplinary preceptors in multiple clinical settings, fellows will acquire skills that span the continuum of care for seriously ill patients: acute care hospital (inpatient palliative care consults service and ICU rotation), skilled nursing facility with ventilator unit (Silvercrest Center for Nursing and Rehabilitation), outpatient practice (palliative care, pain, and NewYork-Presbyterian Queens oncology), home-based care (VNSNY home hospice rotation), and Calvary Hospital. All settings are geographically convenient yet set in ethnically distinct communities. Faculty members include board-certified specialists in palliative care, geriatrics, interdisciplinary faculty (nursing, social work, speech and swallow therapy, and chaplains), and subspecialties (oncology, pulmonary medicine, critical care).

Education/teaching

Fellows participate actively in various educational experiences, including journal club, fellow-led presentations, case conferences, and didactic lectures. Educational Opportunities include:

• Weekly didactics sessions and interdisciplinary team conferences that cover a core palliative care curriculum and sessions on self care and promoting resiliency.
• New York-Presbyterian Queens Palliative Care & Geriatrics Annual Symposium
• Mt. Sinai Intensive Update with board review in geriatric and palliative medicine course
• Full subscription to CAPC educational modules sponsored by NewYork-Presbyterian Queens

The goal is to build upon fellows' knowledge and skills in disseminating knowledge about hospice and palliative medicine, community outreach, and education. Fellows play an active role in teaching internal medicine residents, interdisciplinary team members, and international physician observers.

• HPM Fellows will provide HPM core lectures to our medicine residents and IDT team under the supervision of our faculty
• HPM Fellows will have the opportunity to provide community-based education about hospice and palliative medicine to residents.
• HPM Fellows will also have the opportunity to interact with all senior medical residents during their mandatory geriatrics/palliative care rotation and during the HPM/ ICU rotations
• Fellows will also have the opportunity to guide, mentor, and teach international physician observers

Research/performance improvement

The fellow will participate in research and performance or quality improvement (PI/QI) projects. All fellows are expected to participate in a research or QI project related to their area of interest and submit an abstract for presentation at the annual meeting of the American Academy of Hospice and Palliative Medicine (AAHPM) or a similar meeting.

This program expects HPM Fellows to gain skills in Practice-based Learning and Improvement by developing skills and habits to be able to meet the following goals:

• Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement and improving patient safety.
  • Fellows participate in introductory and regularly scheduled conferences about research, QI, and scholarly activities and the differences between these endeavors.
  • Fellows complete the IRB training modules, including research ethics, history, informed consent, and others.
  • Fellows complete the IHI modules on quality improvement principles
  • Each fellow participates actively in one or more interdisciplinary and multispecialty QI projects: examples include:
    • BIPAP appropriateness QI Project: HPM fellows work collaboratively with HPM faculty, Respiratory therapists, pulmonary/critical care fellows and faculty, medicine residents, and nursing leaders.
    • Improving Goals of Care discussions among Nursing Home Residents with ESRD who receive Hemodialysis: HPM fellows work collaboratively with HPM faculty, dialysis nurses, nephrology fellows and faculty, and medical residents.
    • Falls Committee to reduce falls with injuries: HPM fellows work collaboratively with HPM and Geriatrics faculty, nursing leaders and supervisors, pharmacists, and physical therapists.
    • HPM Fellows take an active role at the GME Housestaff Quality Council Committee
  • Fellows receive ongoing supportive feedback about their performance, with the goal for reflective practice and performance improvement.
• Locate, appraise, and assimilate evidence from scientific studies related to their patient's health problems. Fellows receive an introductory lecture about journal club reviews, principles of analyzing evidence-based medicine, and biostatistics
  • Fellows participate actively in reviewing and presenting journal club articles of import and impact in the palliative care field
  • New: Fellows will participate actively in regularly scheduled "writing clubs" -
• Teach personnel such as nurses, allied health personnel, medical students, residents, and other fellows.

HPM Fellows participate actively in teaching nurses, physician assistants, residents, students, and other allied health staff about palliative care topics and disseminating QI results and best practices (e.g., appropriate use of BIPAP, especially for end-of-life situations).

Training sites and rotations

NewYork-Presbyterian Queens

NewYork-Presbyterian Queens is one of the major teaching hospitals of Weill Medical College of Cornell University and a member of the New York-Presbyterian Health System. It has 519 beds and annual discharges of 24,000 in the Department of Medicine (DOM). Our Hospice and Palliative Medicine fellowship will be part of an ethnically and socioeconomically diverse community that NewYork-Presbyterian Queens serves. NewYork-Presbyterian Queens has achieved a standard of excellence by The Joint Commission (TJC) for cultural competence.

Queens is one of the most diverse communities in the US. For instance, racial and ethnic minority groups, e.g., African American or Black, Asian, Hispanic, account for 60% of the total population. Approximately 2 out of 5 patients are foreign-born. They come from 100 countries and speak more than 120 languages and dialects.

The fellow will participate in interdisciplinary team rounds and provide palliative care consultation to patients of other services under the supervision of palliative care and geriatrics attending. Fellows will learn how to evaluate and manage common medical and psychosocial problems of acutely hospitalized patients, coordinate care and discharge plans for complicated, seriously ill patients, provide optimal pain and symptom management, and communicate effectively with patients, families, and other teams involved in the patient's care.

During the NewYork-Presbyterian Queens rotation, fellows also conduct journal clubs and teach our IDT team, medicine residents, and International Physician Observers about Advanced Directives, core topics in Palliative Medicine and Hospice. Fellows will also rotate in the Intensive Care Unit (ICU), participating in ICU interdisciplinary rounds, working with medical residents and ICU fellows, and providing Palliative Medicine consultation to critically ill patients and their families under the supervision of an attending physician.

Visiting Nurse Service of New York (VNSNY) home care agency

The HPM Fellows will have home hospice experience through our affiliation with the Visiting Nurse Service of New York (VNSNY). Fellows will participate in-home visits and interdisciplinary team (IDT) meetings at the VNSNY Hospice. At these IDT meetings, each patient's individualized care plan is reviewed and revised. The fellows will participate in supervised home visits with a hospice physician and other interdisciplinary team members, including registered nurses certified in hospice and palliative care, medical social workers, and chaplains.

Hospice home care patients are located in a private residence and assisted living facilities and nursing facilities, lending exposure to varied populations and pathology. Fellows will also have the opportunity to do home visits and participate in IDT meetings at the VNSNY Pediatric Palliative Care Program, providing exposure and experience in the interdisciplinary care of seriously ill children.

Silvercrest Center for Nursing and Rehabilitation (SCNR)

The 320 bed Silvercrest Center for Nursing and Rehabilitation (SCNR), located approximately 3 miles from the NYP/Queens main campus, provides the HPM Fellow with ample exposure to all facets of geriatric skilled nursing care. SCNR provides multiple services and specialty care, including subacute rehabilitation, an 80-bed ventilator program, dementia unit, and long-term care for elderly and functionally dependent persons. Fellows' activities include Palliative Care consults, rounds with an attending physician, interdisciplinary rounds, and patient and family meetings. All aspects of this long-term care rotation will be mentored by an attending physician and the long-term care facility team, which includes social workers with ethics expertise, speech and swallowing therapists, registered nurses, and nurse practitioners. The teaching will be focused on identifying and transitioning appropriate patients to comfort or hospice care and symptom management and psychosocial support.

Memorial Sloan Kettering Cancer Center (MSKCC)

Elective rotations will be offered in Pain Medicine/Supportive Care (Palliative Medicine) at the internationally renowned Memorial Sloan Kettering Cancer Center (MSKCC), which is the world's oldest and largest private cancer center, having devoted more than 130 years to exceptional patient care, innovative research, and outstanding educational programs. MSKCC is one of 41 National Cancer Institute–designated Comprehensive Cancer Centers.

Palliative Care Clinic at Outpatient Oncology Center/Queens Medical Associates

Queens Medical Associates (QMA) is a large hematology and oncology center serving an ethnically diverse patient population. QMA communicates with patients in five official languages: English, Spanish, Chinese, Korean, and Russian. Beyond their official languages, over 50 languages and dialects are spoken by their staff. The fellow will work under the supervision of an HPM board-certified faculty member, providing outpatient Palliative Care Consults. They obtain training in complex pain and symptom management, outpatient advance directives discussions, and experience collaborating with a multidisciplinary outpatient oncology team.

Outpatient Pain Center

The fellows' can also have additional outpatient experiences at Dr. Damian Martino's office, a pain specialist affiliated with our institution. Dr. Martino is a graduate of the Memorial Sloan Kettering Palliative Care Fellowship program and has extensive experience in caring for complex pain syndromes. The fellows participate in the evaluation of patients with complex pain syndromes and learn a comprehensive curriculum of pain management topics which includes:

1. Opioid prescription and safety;
2. Medication management;
3. Physical Exam and workup for pain syndromes;
4. Types of pain, Pathophysiology of pain and the pain pathways;
5. Physical Therapy/Occupational Therapy;
6. Interventional Pain Management;
7. Regulatory requirements (Urine toxicology/Oral Swab, NYS Prescription Monitoring Program I-STOP, Opioid agreement/Contract, Documentation); 8) Substance Abuse (How to interact with difficult patients and drug-seeking patients)

Calvary Hospital

Calvary Hospital is the only fully accredited acute care specialty hospital in the US exclusively providing palliative care for adult patients with advanced cancer and other life-limiting illnesses. Calvary programs include inpatient care, pain management, complex wound management, hospice, bereavement services, and support programs for families and friends. During their rotation, fellows will be exposed to complex inpatient symptom management and end-of-life care, participating in a multidisciplinary treatment approach for terminally ill patients.

NewYork-Presbyterian Queens Cancer Center

The Cancer Center participates in multidisciplinary comprehensive cancer care, postgraduate medical education and offers the full range of diagnostic and treatment services either on-site or by referral. The integration of multispecialty cancer conferences helps guide treatment planning based on consensus after discussing all the data associated with a patient's condition to individualize and optimize patient care delivery. During their rotation, fellows work with medical oncology (inpatient and outpatient), gynecologic oncology (outpatient), and radiation oncology and participate in multidisciplinary tumor board meetings.

Additional elective rotation opportunities

Additional NewYork-Presbyterian Queens elective opportunities offered include rotations in oncology, radiation oncology, neurology, geriatrics, long term care, ethics, physical medicine and rehabilitation, critical care, pain clinic, research, and quality improvement, psycho-oncology depending on availability of each service.

Clinical research experiences

Our division actively participates in clinical research and scholarly activities. Fellows will have the opportunity to help write protocols, enroll patients/subjects for human research, develop and maintain databases, and study the patients from the beginning to the end of the protocol with mentorship by an attending physician. In addition, all fellows are expected to participate in a research project or scholarly activities related to their area of interest and present an abstract at the annual meeting of the American Academy of Hospice and Palliative Medicine (AAHPM) or a similar meeting. Examples of work presented by our former fellows include:

• Advanced Care Planning and End of Life Discussions Amongst Resident Physicians in the Primary Care Setting. Presented at the 2018 AAHPM Annual Meeting by fellow Dr. Suraj Tandon
• "Achieving Appropriate Utilization of Bi-level Positive Airway Pressure In Hospitalized Patients: Especially at the End of Life" Poster presented by fellow Dr. Hope Cassano at the 2018 AAHPM Annual Meeting
• "When Religion Clashes with Personal Values: Reconciling Religious and Medical Perspectives at the End of Life," Oral presentation by fellow Dr. Elina Yushuvayev at the 2017 AAHPM Annual Meeting
• "Withdrawal of Mechanical Ventilation: A Systematic Review and Approach Following Two Unusual Cases" Poster Presentation by fellow Dr. Michael Gale at the CHEST 2016 National Meeting
• "New Model: Integrating Palliative across Care Settings" Poster presented at the 2016 CAPC Annual Meeting, co-authored by fellows Dr. John Zaravinos and Michael Gale
• "How Do We Provide Optimal Palliative Care for Patients with Developmental Disabilities (DD)? Opportunities and Challenges" Poster presentation by fellow Dr. Michael Gale at the 2016 AAHPM Annual Meeting
• "Indecisive Surrogate Consenting for Organ Donation after Withdrawing Life Support: Ethical Challenges Requiring an Interdisciplinary Approach" Main Plenary presentation at the "Identity Agonies: Living Dyingly, International Conference at University of Padua" in Italy, presented by fellow Dr. Brigit Palathra (Nov 2017)

Summary

In summary, we provide a well-rounded Hospice and Palliative Medicine fellowship experience, with strong palliative care training and exposure to Geriatrics, with a full spectrum of clinical sites, diverse patient populations, and a team-based approach. In addition, we support fellows in their research and teaching activities. We are fully invested in the success of our Hospice and Palliative Medicine fellows.

Application

Applications are only accepted via ERAS.