Core Rotations

• 5 months – Adult Inpatient Palliative Care Consult Service
• 1 month – Pediatric Palliative Care Consult Service (inpatient and outpatient)
• 1 month – Long Term Care
• 1.5 months – Home Hospice
• 2 months – Inpatient Hospice
• 1.5 months – Elective Rotations
• 1 day per week continuity clinic throughout the year 
   

Inpatient Palliative Care
During the five months of this experience, the fellow works as a member of an interdisciplinary team providing inpatient palliative care consultation to patients with a variety of serious illnesses. The rotation takes place at the University of Kentucky Albert B. Chandler Hospital.

Continuity Clinic
The ambulatory experience takes place at the palliative care clinic embedded in Markey Cancer Center at UK HealthCare. Our fellows will also have dedicated clinic rotations to gain outpatient exposure to patients with advanced heart failure, end-stage liver disease, endocarditis, ILD, and those recovering from ICU care.

Long-Term Care
Two weeks in the fall and two weeks in the spring will be spent providing palliative care consultation to patients in the long-term care setting. Bluegrass Palliative Care provides specialty palliative care to more than 16 facilities in Fayette County. This care is largely provided in coordination with APRNs. Other long-term care experiences will be encountered on the home hospice rotation as well.

Inpatient Hospice
Fellows will rotate through the Hospice Care Center (HCC) located within UK Albert B. Chandler Hospital. The UK HCC is a 10-bed dedicated inpatient hospice unit with hospice services provided by Bluegrass Care Navigators. Fellows will also have exposure to the scatterbed model of inpatient hospice care, as there is a dedicated scatterbed interdisciplinary hospice team (APRN/SW/RN/CP) that sees eligible patients within the critical care settings at UK Chandler Hospital. This model of inpatient hospice care gives fellows exposure to providing end-of-life care for patients pursuing withdrawal of life-sustaining interventions, including mechanical ventilation, VAD, CRRT, ECMO, vasopressors, and high-flow nasal cannula oxygen. 

Home Hospice
Bluegrass Hospice Care provides end-of-life care to patients in 32 counties across Kentucky. The fellow’s exposure will be limited to patients in Central Kentucky. The fellow will go on home visits with various faculty, and toward the end of the academic year, will do home visits independently.

Pediatric Palliative Care
The fellow rotates with the Pediatric Advance Care Team at Kentucky Children’s Hospital, both in the inpatient and outpatient settings. During this month-long rotation, the fellow will gain knowledge and experience with prognostication and communication as it relates to the seriously ill pediatric population.

Electives
Previous fellows have chosen from a variety of electives. These include, but are not limited to: radiation oncology, addiction medicine, interventional pain, VA hospice and palliative care, advanced heart failure, integrative medicine, and additional time in Pediatric Palliative Care. The electives are evaluated annually and continue to be adjusted as needed to maximize the experience of the fellow.

Educational Lecture Series 
Our fellows join other hospice and palliative medicine fellows across the country for a July Bootcamp lecture series. This bootcamp is one day per week for four hours during July, and lectures are given by nationwide experts and leaders in hospice and palliative medicine. After July, weekly lectures are held throughout the academic year. The location and topic vary to ensure information is most relevant and least disruptive to the fellow’s current rotation and location. The lecture series incorporates speakers from various specialties providing the most up-to-date, evidence-based information. See the full list of lecture series.

Wellness
Throughout the year, the fellow will have opportunities to attend Schwartz Rounds at Chandler Medical Center, journaling workshops, and one-on-one narrative medicine sessions. Each year the fellow is also matched with someone for mentored wellness check-ins. These check-ins are built into the schedule, and the format is left up to the mentor and fellow. "Mindfulness Moments" is a weekly session led by BCN’s clinical psychologist, and the fellow is encouraged to attend these sessions regularly.

Addiction Medicine
Our program continues to strengthen relations and involvement with addiction medicine at UK, as we are seeing more crossover in our seriously ill patients with substance use disorders. Managing addiction, pain, and palliation interdisciplinary team (MAPPIT) meets monthly for journal article and case presentations. Specialists in pain management, addiction, and palliative care from across the state participate in these meetings, and the hospice and palliative medicine fellow is also highly involved.

Ethics
The fellow is required to attend three ethics meetings throughout the year. Additionally, the fellow attends the state bioethics conference, KYHEC.

Communication Skills Training
Providing a structured training experience in communication skills for hospice and palliative medicine fellows is essential, and we continue to prioritize it throughout the year. One of our faculty, Jessica McFarlin, MD, is also VitalTalk faculty. There are various opportunities throughout the year to attend a one-day VitalTalk training, and the fellows have previously participated in the VitalTalk pre-conference at the AAHPM Annual Assembly. We are working on something exciting for our fellows in the future. Stay tuned.

Hospice Medical Director
Providing the fellow with the skills necessary to become a hospice medical director (HMD) is a core objective for our program. As such, the fellow will spend the first half of the year participating in interdisciplinary team meetings for a designated home team and will be leading those meetings as the HMD for the second half of the year. Our fellow also participates in Bluegrass Hospice physician triage days throughout the year to gain a better understanding of the administrative and clinical duties, as well as regulatory information, required of an HMD. By the end of the year, the fellow should be well poised to complete the Hospice Medical Director Certification Exam, should they choose to take it.

Guided Self Study
Along with the fellow’s yearly rotation schedule, we provide recommended resources and a structured approach to self-study throughout the year. The resources match the rotation in which the fellow is currently rotating (ex., hospice medical director manual while on home hospice rotation). The fellow is provided with access to CAPC modules, AAHPM online resources, VitalTalk online modules, and more.

Patient Safety
All fellows are required to participate in a unit-level swarm, a root cause analysis patient safety event.

Grand Rounds Presentation
The fellow gives a lecture on desired HPM topic at the University of Kentucky Chandler Internal Medicine Grand Rounds.

Quality Improvement Project
In coordination with a designated faculty member, the fellow will participate in and complete a quality improvement project of their choice. At the end of the year, the fellow will give a presentation of their project to UK and BCN.

Professional Conferences
The program sends the fellow to multiple professional conferences, including the AAHPM Annual Assembly, the annual state conference KAHPC, and the annual state bioethics conference KYHEC.

Diversifying the field of HPM is essential. Our program is committed to ensuring our seriously ill patients in Kentucky are represented in the care we provide. Here are some things we have been working on to accomplish this:

• We utilize a holistic application review process. 
• We have revised how we evaluate candidates during the interview process.
• We use an interdisciplinary interview approach. 
• We incorporate lectures and workshops to address cultural competence (microaggression, use of stigmatizing language, LGBTQ+ topics, unconscious bias training).
• The program leadership completes unconscious bias training, and all faculty will receive this training regularly. 
• In coordination with UK GME, we track gender and ethnicity data for our program.
• We are increasing our recruitment efforts at the undergraduate, medical student, and resident levels.  
• Our program leadership continues to participate in faculty development opportunities offered by the University of Kentucky College of Medicine Office of Diversity, Equity, and Inclusion.
• Visit the Office of Diversity, Equity, and Inclusion to find out more about this area.

Our program values providing a safe space to process and debrief their experiences and grief. In addition to caring for seriously ill patients, we recognize many of our trainees are concurrently studying for board examinations and experiencing major life changes and milestones like welcoming a new child, getting married, searching for jobs, and experiencing their own health issues. Time for wellness is essential.

Trainees may take two wellness days per year to utilize as they choose and when needed.

Fellows are paired with a wellness mentor at the beginning of the year and meet monthly throughout their training. The wellness check-ins are built into the schedule to ensure they are prioritized. These check-ins are informal and typically take place over coffee or lunch. 

Other wellness opportunities include:

• Schwartz Rounds at BCN
• Schwartz Rounds at UK Chandler 
• Premium access to the Calm app 
• Mindfulness Mondays from 8 - 8:30 a.m. and noon - 12:30 p.m. led by our clinical psychologist, Dr. Lisa King
• Fellows have access to a wide variety of resources through GME

Our program director is on the Wellness In Training Committee through UK GME and has created a wellness committee for our fellowship program to ensure we continue to grow in this area and meet the needs of our fellows and faculty. We have some big things planned, including instituting Finding Meaning in Medicine gatherings and an annual faculty and fellow retreat.