Hospice and Palliative Medicine Fellowship

This one-year training program is designed to give Hospice and Palliative Medicine fellows a comprehensive experience. Fellows are exposed to patients in the inpatient, ambulatory, home/hospice and long-term care settings. They will interact with a variety of physicians in other specialties. In each setting, they will be a part of an interdisciplinary team.

The Hospice and Palliative Medicine Fellowship is comprised of 13 four-week blocks.

Inpatient Consult Service

There are six blocks required on the inpatient consult service at Carilion Roanoke Memorial Hospital (CRMH). During the Inpatient Consult Service rotations, the fellow will see and primarily manage patients on the 10-bed Palliative Care Unit as well be expected to perform palliative care consultations for those with serious illness throughout CRMH. Fellows are expected to see initial consults, including pediatric consults, and conduct follow-up visits with the supervision of the attending physician. They will be expected to become an essential part of the interdisciplinary care team, working with the nurse, social worker/case manager and chaplain.  

Home and Hospice Care

Two and a half blocks are dedicated exclusively to hospice, working with Carilion Clinic Hospice, a not-for-profit community-based hospice provider affiliated with Carilion Clinic, and Good Samaritan Hospice, a non-profit community-based hospice serving southwest Virginia. Fellows will participate in home visits with nurses and other members of the interdisciplinary team, and attend the interdisciplinary team (IDT) hospice meetings. Fellows will learn how a hospice is managed and meets regulatory requirements. Throughout the fellowship, a continuity hospice exposure will be provided by following patients across the care continuum with Carilion Clinic Hospice.

Long-Term Care Rotation

One block is dedicated to caring for a geriatric population. Through this rotation, fellows will learn geriatric principles and follow patients in their restoration to maximum function and independence and prevention of further decline.

Oncology

One block is dedicated to the study of oncology and latest practices through Blue Ridge Cancer Care to learn about medical oncology therapies. These consultations will occur in the inpatient and outpatient settings and include participation in the oncology IDT, as well as attendance of tumor boards and conferences throughout the fellowship year.

Special Populations

This one block rotation gives the fellow exposure to outpatient clinics in HIV, geriatric HIV care, inpatient and outpatient pain management (both medical and interventional), radiation oncology, gynecology-oncology and wound care. This rotation will be split between opportunities through Carilion Clinic and the Salem VAMC.

Addiction Medicine

A two-week block is dedicated to study of substance use disorder (SUD). The fellows will spend time with the interdisciplinary addictions medicine team in the Substance Abuse Residential Rehabilitation Treatment Program (SARRTP) at the Salem VAMC. This will include learning and exposure to inpatient and outpatient detoxification as well as cognitive behavioral therapies and pharmacological management strategies for SUD.

Continuity Clinic

Twice a month, fellows will participate in an outpatient continuity clinic to address palliative care needs of community-based patients living with chronic and possibly terminal illness (prior to eligibility for hospice enrollment). This will include symptom management as well as psychosocial and spiritual assessment and support.

Elective

The fellow will have the opportunity to select one elective block in a field of their choice such as: research, pediatrics, geriatrics, pulmonary critical care and pain management, among others. Fellows are able to return to any previous rotation to gain additional experience. Outside rotations are permitted if the discipline is not available through Carilion Clinic.

Didactic Sessions

Every Friday from 8 a.m. to noon will be designated as time for scholarly activity. One hour of didactics on a variety of topics required for palliative medicine education and board preparation will be provided every week. All fellows will be given the UNIPAC series—Essential Practices in Hospice and Palliative Medicine—and the ability to purchase the HPM FAST questions for board review. They will also have access to the Center to Advance Palliative Care for scholarly activities and other projects. All fellows will be expected to participate in a quality improvement project through their fellowship year as well. Journal Clubs will be offered during rotations on the Inpatient Consult Service at CRMH as well. Fellows will also be expected to serve on the Ethics Committee during their fellowship year.

Optional learning opportunities include:

• Oncology Tumor Boards
• Ethics Consults
• Carilion Clinic Spring Symposium
• VTCSOM Research Day