Hospice & Palliative Medicine In the Division of General Medical Disciplines

Rotation & Objectives

Stanford Hospital & Clinics (SHC)
OVERVIEW

The Stanford Hospital Palliative Care in-patient consult service provides consultation on acute in-patients in Stanford Hospital, a large academic teaching hospital that serves both as a local community hospital as well as a tertiary care center for the surrounding counties. During this rotation the fellow will work with an inter-disciplinary palliative care team in providing such consultation under the supervision of an attending hospice and palliative medicine physician. Approximately 40-50 new patients are seen each month. This rotation provides HPM fellows with ample opportunity to deliver medical care for palliative care patients of both genders from a diverse milieu of cultural, economical, and social background, which complements their in-patient palliative care consult experience based at the VA Palo Alto.

Care Team

Attending Physicians:

ACGME Domains

Patient Care

Medical Knowledge

Problem-Based Learning & Improvement (PBLI)

Interpersonal & Communication

Professionalism

System-Based Practice (SBP)

Teaching Methods

The primary vehicle for learning during this rotation will be through the direct provision of care under supervision by the Attending Physician of the Stanford Palliative Care Service in the context of an interdisciplinary team. This experiential learning will be supplemented by:

  1. Formal ongoing weekly fellowship didactic sessions.
  2. Observation of and participation in daily interdisciplinary palliative care clinical meetings, weekly Stanford Intensive Care Unit multi-disciplinary clinical rounds, bi-monthly Stanford Palliative Care Administrative Advisory Group meetings, monthly Ethics committee meetings.
  3. Ad hoc instruction by the supervising Attending Physician and other inter-disciplinary members of the care team in the context of daily work, which may include but is not limited to mini-didactic sessions, formal and in-formal case-presentations.
  4. Direct observation of clinical care modeled by other clinicians, including the supervising physician and other inter-disciplinary clinicians doing consults.
  5. In addition this rotation will also include fiscal aspects of running a palliative care service including learning to bill and code for clinical services by observation of the Attending Physician (please note that our first year clinical fellows cannot bill for patient care services).
  6. Directed reading, both self-directed and reading as suggested by the Attending Physician. In such reading the emphasis will be on reviewing literature that discusses the evidence base for care options as relate to palliative care patients in an Intensive Care Setting and in an acute care ward setting.
Level of Supervision
Assessment Methods

Initial meeting to determine training goals:

  • The fellow will have an initial meeting with the supervising attending physician during which both programmatic competency goals and self-directed learner goals will be discussed.
  • End-of-rotation de-brief (formative feedback and block rotation evaluation):

    The supervising attending will meet with the fellow at the end of the rotation to provide formative and summative feedback, review the evaluation form with the fellow, and discuss to what extent programmatic and self-directed learning goals were obtained. Informally, the supervising physician will solicit feedback regarding the fellow's performance from Stanford Hospital patients, families, Stanford house-staff and other clinicians, as deemed appropriate. During this feedback session the Attending Physician will solicit fellow feedback regarding the rotation. Fellow evaluation process and follow-up: At the end of the Stanford block rotation (duration = one month), Med Hub sends an automated reminder to the Stanford Attending Physician to evaluate the fellow (using a global rating scale) who worked in that particular rotation. The evaluations are captured and collated by the system and aggregate data for individual fellows across various block rotations is available to the program director and will be used for both formative and summative fellow evaluation. When a fellow receives a sub-par evaluation on the rotation an automated trigger will send an alert to the program director who will immediately take necessary remedial action as appropriate.

    Specific evaluation methods used in this block rotation are:

    Direct observation: Fellow competency in will be evaluated using direct observation during patient care, and the results of direct questioning during clinical care and both bedside (at the patient's home setting) and clinical rounds based teaching experiences. Fellows will be observed by faculty during a clinical interaction and their skills will be evaluated by faculty using global rating scales and specific in-patient consult competency assessment checklists (attached).The supervising attending will directly observe the fellow performing at least one major patient care intervention such conducting a family meeting during the month and will observe the fellow’s presentation of recommendations to the Stanford interdisciplinary care team, referring house-staff and other sub-specialty attendings.

    Global rating scales:

    Stanford has a Med Hub online evaluation system which is specifically designed to evaluate fellows and faculty using a survey questions with ordinal responses.

    Rotation specific assessment checklists:

    The in-patient consult competency assessment rotation specific checklist is specifically designed to evaluate specific competencies related to this rotation. Attending physician will use this checklist to evaluate fellows at the end of each block rotation. These evaluations will be captured using an online database and collated and used to provide formative and summative feedback to the fellow.

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