Overview:
Hospice is a two-week preceptorial required rotation in the HSM curriculum, and is also an elective rotation that can be taken during the second or third year of residency. Each resident spends a minimum of twenty-five hours per week in the office of the supervising Hospice physician (and/or staff at the Hospice facility), in Memorial Hospital attending to hospice patients and in other locations included in the Hospice physician’s usual practice.
Goals:
The Hospice curriculum experience shall:
- provide the resident with training in end of life care of patients in a variety of settings
- provide experience in providing and coordinating hospice/team care
- provide teaching and information on easing the pain and suffering of the patient and the family
- provide a positive training experience in care of terminally-ill patients that encourages resident participation in continuity of care of their terminally-ill patients in their practice
- Provide the resident with teaching and information on unique features of hospice care funding and administration
Objectives:
At the completion of this rotation, the resident will have demonstrated to the satisfaction of the Hospice preceptor:
- medical knowledge in Hospice pertinent to the practice of Family Medicine, including the appropriate evaluation and treatment of pain, the causes and treatment of non-pain symptoms and nutrition and hydration of the terminally ill (MK)
- the ability to perform an appropriate history and physical assessment with attention to common findings in the terminally-ill patient (PC)
- knowledge about compliance with regulations pertaining to the use of controlled substances in the terminally-ill patient in and outside of Hospice (MK)
- the ability to develop an initiate an ongoing analgesic regimen that includes the use of morphine-equivalent dosages and other narcotic equivalents, the effective use of alternative routes of analgesia, and the correct use of pain scales to adjust medication dosage (PC)
- effective referral of available social services for both patient and family (PC)
- effective communication and interpersonal skills, including counseling of and responsiveness to the patient, family and others with sensitivity to culture, age, gender and disabilities (ICS)
- a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality, informed consent and business practices (P)
- ability to work cooperatively with other health professionals as part of a healthcare team (PC)
Implementation:
This is a preceptorial rotation, so the resident is assigned to the Medical Director of the Hospice facility. The resident will accompany the Hospice Medical Director during his/her professional activities in Memorial Hospital, at the Hospice facility and in other locations involved in the preceptor’s usual practice. In the course of seeing patients, the Hospice Medical Director will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may be assigned to research specific topics in Hospice care. Also at the discretion of the preceptor, the resident may spend a portion of his/her time working alongside Hospice nurses or other members of the hospice team.
The family medicine resident considering a rotation in Hospice has the responsibility of contacting the Team Leader at the time when the rotation schedule for the academic year is being arranged. The resident is responsible for contacting the Hospice Medical Director and arranging a schedule for the rotation. The resident must continue to meet usual residency obligations to his/her patients in the Family Medicine Center including scheduled clinics, caring for continuity patients admitted to Memorial Hospital and rounding in the nursing home. The resident is expected to attend noon conferences and comply with all other general program policies. Upon completion of the rotation, the resident must complete the evaluation form provided by the program.
Evaluation:
The supervising physician preceptor will complete an evaluation form at the end of the rotation assessing the resident’s success in meeting the rotation objectives as outlined in the curriculum.
