Program Overview

Hospice and Palliative Medicine Fellowship

Core Rotations

• Adult Inpatient Palliative Care Consult Service
• Pediatric Palliative Care Consult Service (inpatient and outpatient)
• Long-term Care
• Home Hospice
• Inpatient Hospice
• Elective Rotations
• Addiction Medicine
• Oncology-embedded 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
One block will allow fellows the opportunity to complete their required long-term care visits through Bluegrass Palliative Care and Bluegrass Hospice. Additionally, fellows may have the opportunity to provide Community-based Palliative Care visits in the home. Notably Bluegrass Palliative Care provides specialty palliative care to more than 16 facilities in Fayette County.

Inpatient Hospice
Fellows rotate at the Hospice Care Center (HCC) located within UK Good Samaritan Hospital. The UK HCC is a dedicated inpatient hospice unit with 11 beds, staffed by an interdisciplinary team through Bluegrass Care Navigators.

Fellows will also have exposure to the scatter bed model of inpatient hospice care at UK Good Samaritan and Albert B. Chandler Hospitals; dedicated interdisciplinary hospice teams provide end-of-life care to eligible hospitalized patients. Fellows will have the opportunity to provide withdrawal of life-sustaining interventions, including mechanical ventilation, VAD, CRRT, ECMO, vasopressors, and high-flow nasal cannula oxygen.

Additionally, fellows have the option to rotate at the Greg and Noreen Wells Bluegrass Hospice Care Center, a 12-bed, freestanding hospice facility, located in Hazard, Ky., where patients, families and friends take advantage of a a home-like setting with private patient suites and outdoor patios.

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 Golisano Children’s at UK, 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, one half-day per week in July, given by nationwide experts and leaders in hospice and palliative medicine. Weekly core conferences are held throughout the academic year which cover various HPM topics. 

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
Fellows are expected to attend Ethics meetings or conferences as assigned to ensure they have exposure to ethical frameworks and dilemmas in healthcare. Priority for enhanced experiences will be provided for fellows with a particular interest in this field.

Guided Self Study
Fellows are expected to study independently outside of clinical rotations and structured didactics. Physical and online resources are provided and recommended alongside rotations to align with specific topics in hospice and palliative medicine.

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

Grand Rounds Presentation
Fellows will present an end-of-year presentation of their scholarly project to the UK Division of Palliative & Supportive Care Educational Grand Rounds.

Scholarly Activity Requirement
Fellows will complete a scholarly activity, research, or quality improvement project of their choice. Structured guidance with a designated faculty member ensures mentorship, support, and project completion in a short, one-year fellowship. This project may be used for poster presentations throughout the year and will form the basis of an end-of-year presentation to the division.

Professional Conferences
The program sends the fellow to AAHPM Annual Assembly and the annual state conference KAHPC. 

Lectures and Presentations
Fellows are expected to present on topics of their choosing throughout the year as assigned, including but not limited to formal presentations in the Core Conference series for pertinent hospice and palliative medicine topics, case discussions, informal discussions on-service, chalk talks with learners, and interdisciplinary conferences.

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 use an interdisciplinary interview approach. 
• We incorporate lectures and workshops to address cultural competence as it relates to patient care.
• We are increasing our recruitment efforts at the undergraduate, medical student, and resident levels.  

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 check-in throughout the year. The wellness check-ins are built into the schedule to ensure they are prioritized.

Other wellness opportunities include:

• Schwartz Rounds at BCN
• Schwartz Rounds at UK Chandler 
• Fellows have access to a wide variety of resources through GME