Structure of Fellowship
The fellowship will be of one-year duration, beginning in July or August of each year. A minimum of two physician fellows will be chosen. The physician fellowship is part of a broader interdisciplinary fellowship program in palliative care. Physician fellows will work and train with fellows in other disciplines. In recent years we have had psychology, nurse, social work and chaplaincy fellows. In pursuing an interdisciplinary approach to training and work, our goal is to respect the expertise and unique training requirements of individual disciplines, while at the same time pursuing a common foundation in palliative care knowledge and skills. Fellows will gain clinical experience in a variety of venues appropriate for the established curricular goals. Time estimates for each venue and activity given below:
Inpatient Palliative Care Ward: The VA Palo Alto HCS Hospice Care Center is a 25 bed unit serving veterans and non-veterans. Currently, approximately 300 patients per year are admitted to the unit, ~5- 10% of them as non-veterans. Fellows will provide hands-on care for patients on the unit. They will in turn be supervised by the Medical Director, Dr. James Hallenbeck and other attending physicians, Dr VJ Periyakoil, Associate Director and Dr. Gary Hsin. Fellows will in turn supervise residents and students rotating through the unit. Approximate time spent: 30%.
Consultation: Fellows will also rotate onto the palliative care consultation team at VA Palo Alto HCS and will be first-call for consultations, under attending supervision. This will allow fellows to develop necessary palliative care consultation skills. Approximate time spent: 25%.
Home Care- Hospice and Home Based Primary Care: Two home care experiences will be offered. Because of the dominance of Medicare certified hospices in the provision of hospice and palliative care, all fellows will spend a minimum of one month with a community home hospice agency, Pathways Hospice. The major curricular goals of this experience are to expose fellows to hospice care in the home and community environment and to familiar fellows with Medical Director responsibilities.
Home Based Primary Care (HBPC) is a home care program for veterans which provides palliative care for those veterans seeking a palliative approach to care at home, but who either do not meet formal Medicare hospice criteria or elect not to receive care from a home hospice agency. A particular strength of HBPC is primary care of enrolled patients is taken over by either a nurse practitioner or physician within HBPC. Primary care providers routinely make home visits. Fellows will become primary care providers for a panel of 5 such patients under the supervision of an HBPC attending physician and will be available to assist nurse practitioners in the palliative care of their patients. Approximate time spent: 15%.
Elective Time: Fellows will have protected time to pursue independent study - both to allow completion of scholarly projects and to pursue other interests. Fellows may wish to spend more time in one of the venues of care discussed above or may wish clinical experience elsewhere. A variety of different clinical experiences may be available. Fellows may wish exposure to sub-acute, rehabilitation, nursing home care or pediatric palliative care at Stanford's Lucille Packard Children's Hospital. Opportunities exist for outpatient experience in a variety of clinics addressing specific palliative care issues. Some possibilities include: Rheumatology, Rehabilitative Medicine, Cardiology Clinic, HIV Clinic and Neurology Clinic. Approximate time: 25%
Fellows will be expected to rotate taking telephone back-up call for the
