Description of Program Objectives
Knowledge:

• Understand the general principles of hospice/palliative care.
• Learn the differences between hospital-based and home-based hospice care.
• Learn the diseases (and their pathophysiology) most likely to place a patient in need of palliative care.
• Learn the medical principles of palliative care.
• Learn the pharmacologic agents most frequently employed on the hospice unit.
• Become familiar with a variety of non-pharmacologic treatments for problems seen in the terminally ill, including family, individual, and spiritual counseling.
• Learn the psychotropic agents most frequently employed in the HIV population.

Skills:

• Learn to diagnose and assess pain.
• Learn to treat pain with a variety of therapeutic strategies (narcotics, steroids, antidepressants, palliative radiation, psychosocial).
• Learn to treat other common symptoms such as nausea and dyspnea, cachexia, agitation and depression.
• Learn to assess and treat common emotional and behavioral problems in HIV-positive patients.
• Learn to communicate empathetically with dying patients and their family members, taking into account cultural, religious, and educational differences.
• Learn to recognize and consider treatment for psychological distress.

Attitude:

• Become familiar with ethical and legal considerations in the practice of palliative care.
• Respect the roles of the multiple disciplines that participate in palliative care.
• Become familiar with the psychosocial, emotional, and spiritual issues associated with the end of life.
• Exhibit integrity, compassion, sensitivity, respect, and courtesy.
• Honor the wishes of patients and families.
• Appreciate the multi-faceted nature of suffering.
• Appreciate ethnic and religious contributions to end-of-life decisions.

Activities and Responsibilities:

• The student will spend at least one day per week with the VNA Hospice team and will attend interdisciplinary team meetings and make home visits with the nursing staff.  If there are patients who make the transition from the Palliative Care Unit to home or vice versa, the student will follow those patients through the transition.
• The student will make rounds with the Pharmacy Pain Control team in order to learn the process of pain assessment and the appropriate choice, dosage, and route for administration of narcotic and adjuvant analgesic therapies (steroids, NSAIDs, narcotics, antidepressants, neuropathic agents, palliative chemotherapeutic agents).
• The student will attend Interdisciplinary Palliative Care Unit (PCU) Team rounds every Wednesday morning in order to learn the role of the physician on a Palliative Care team and to observe the importance of the roles played by other team members.
• The student will participate in patient care and in clinical chart review to gain familiarity with palliative care admission criteria, assessment tools, and treatment plans.
• The student will schedule time to make rounds with the Pastoral Services staff and will make an effort, if comfortable with the religious content, to be present for specific religious rites (such as the Catholic Sacrament of the Sick).
• The student will consult to and follow patients with terminal illness who are being treated on Medical/Surgical Units by the Psychiatry Consultation/Liaison Service at Hartford Hospital.

Formal Teaching Activities:

The student will be assigned a faculty preceptor who will meet with him/her twice weekly and at the beginning and end of the rotation for discussion sessions.

The student will prepare a 20-30 minute presentation on a relevant topic of his/her choice, preferably one that is based upon a real case encountered during the rotation.  This presentation may be done at any time during the rotation that is mutually agreeable to the student and the preceptor.

Supervision:

Supervision will be provided by the Palliative Care Unit staff, including medical directors, nurses, psychiatrists, attending physicians in various medical disciplines (commonly hematology/oncology, infectious disease), pastoral services staff, anesthesiologists, and pharmacists.  The student will meet weekly with the preceptor for the rotation for on-going feedback and clarification of goals.  In addition, at the beginning and end of the rotation the preceptor will meet with the student for orientation and evaluation purposes.

Readings:

Each student will be provided with the HH Palliative Care Manual, which contains a broad overview of articles relevant to Palliative care.

Facilities:

Evaluation:

The Medical Director of the PCU will submit a brief narrative evaluation of each student that is based on input from the psychiatry service, the nursing staff, the pain control teams, the pastoral services staff, the preceptor, and the student.  Prior to this evaluation, the preceptor will have met with the student to discuss the student’s assessment of the rotation and performance in the rotation.  The evaluation will include verification of the student’s completion of the rotation, commentary on the student’s achievement of specified goals, and an assessment of the student’s performance in the final presentation.

Revised 8/04

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