As a pediatric palliative care fellow, you will be given the opportunity to provide ongoing care with the responsibility for decision-making and management, as well as consultative care for patients in all settings. This will foster the acquisition of assessment and management skills necessary for the evaluation and care of patients with complex palliative care needs. 

You will see at least 100 new patients during the yearlong training, and will follow at least half of these patients longitudinally across all settings.

Our program includes a didactic component focused on the epidemiology and pathophysiology of progressive chronic illnesses in pediatric patients, the management of these diseases in all settings, and the multiple issues associated with death and dying.

We will attend to the physical, behavioral, psychological, social and spiritual aspects of illness. We will emphasize communication and team-building skills. We will address all issues routinely covered by an interdisciplinary team, such as socioeconomic factors, cultural and ethical diversity, religious background, and ethical and legal implications of practice decisions.

Your training will cover issues of regulatory compliance and quality improvement, as well as awareness of the potential for personal and family growth at the time of terminal illness.

We encourage and facilitate professional self-care. We also address basic concepts of program management, financing for different care settings, and public policy/advocacy.

Inpatient Setting

• Consultative service and principal care management, including longitudinal follow-up
• Interdisciplinary team management approach to patients with acute medical and/or psychosocial problems
• Home visits to see patients in the palliative care program (personal transportation and up-to-date insurance coverage mandatory)
• Phone calls taken from home on a rotating basis with an exception of the need to provide in-hospital consultation and services as requested

Hospice/Home Care

• Meaningful participation in patient care at one or more Medicare-certified hospice programs with hospice medical directors certified by the American Board of Hospice and Palliative Medicine
• Provision of care to patients who may require the services of multiple disciplines, including nursing, social work, pastoral care and bereavement counseling
• Provision of continuing care and coordination to implement recommendations from the interdisciplinary team
• Involvement in hospice interdisciplinary team meetings
• Exposure to organizational and administrative aspects of home health care and/or hospice programs
• Minimum of 25 home visits required through the hospital program, hospice home care or home health care

 Long-Term Care

• One month minimum is spent in one or more long-term care institutions, such as a skilled nursing facility or chronic care hospital
• You will contribute to the care of the institution’s residents through the provision of principal care or involvement in a consultative team, specialty clinic or dedicated unit

Emphasis during this longitudinal experience focuses on:

• Approach to diagnosis and treatment of the chronically ill patient (including acute care needs) in a less technologically sophisticated environment than the acute-care hospital
• Working within the limits of a decreased staff-to-patient ratio compared with acute-care hospitals
• Greater awareness of and familiarity with hospice and palliative medicine in this setting
• The challenge of the clinical and ethical dilemmas that occur when caring for children with life-threatening illness

Outpatient Care

• Provide relevant palliative intervention in outpatient care setting
• Participate in the care of a panel of patients, following them across multiple care settings
• Home visits to see patients in the palliative care program (personal transportation and up-to-date insurance coverage mandatory)

Electives

• You may spend at least o4 weeks of elective time in a clinically relevant field, including experiences in ethics consultations, pulmonary, cardiology or neurology clinics, etc.

Conferences

• You will participate as both a learner and teacher in conferences or seminars/workshops in palliative medicine to augment your clinical experience, foster interaction, and develop skills in interpreting medical literature. As you progress through your training, opportunities will arise to teach staff such as nurses, allied health professionals, medical students and/or other residents.

Research and Quality Improvement

Palliative care research spans a broad spectrum, from molecular biology to health and social policy. Our research capabilities and resources are broad as well as our connections with others performing research.

Fellows are expected to perform scholarly activity which could include a research project or quality improvement project during the 1-year training program. We also encourage you to participate in ongoing research and/or develop an independent research project in some aspect of clinical care or education related to palliative care.

Specific Responsibilities

In addition to serving patients and families in the above areas and taking rotating call with an attending palliative medicine physician, the fellows are expected to participle in:

• Interdisciplinary palliative care conferences
• Interdisciplinary conference with other divisions in the hospital
• Hospice interdisciplinary team rounds
• Monthly fetal anomalies interdisciplinary conference
• At least one children's grief series
• Hospital remembrance services 

Fellows will be required to teach:

• Medical students at local medical schools
• 4th-year medical students during their palliative care elective
• Residents taking an elective in pediatric palliative care
• House staff education in pediatric palliative care