Non-Clinical Learning Experiences
The following describes the non-clinical learning experiences for fellows in the Mount Sinai Palliative Medicine Fellowship.
Palliative Medicine Journal Club
Fellows lead the monthly interdisciplinary palliative medicine journal club at Mount Sinai. Using clinical questions, fellows search the recent literature to choose an article that will influence their clinical practice. The journal club is led by a faculty member who meets with the fellow in the week prior to the session. The discussion not only covers the question posed by the fellow but also the research challenges inherent in studying a palliative care population. Fellows learn from and enjoy the challenge of having to engage team members from multiple disciplines in the discussion.
To supplement learning in the clinical settings, the fellowship has a schedule of didactic lectures to cover key topics in palliative care in a comprehensive fashion. Topics include: symptom management, functioning as a consultant, grief and bereavement, spiritual assessment, communication skills, pediatric palliative care, and cultural aspects of palliative care. These lectures are taught by experts in each field drawn from Mount Sinai, affiliated sites, and the New York City palliative care community at large. Each lecture is accompanied by a series of handouts which includes a power point presentation by the speaker as well as a series of manuscripts providing an evidence base (whenever possible) for the data presented.
Monthly Fellows Meetings
The fellows meet as a group on a monthly basis with the program leadership to discuss the fellowship and offer suggestions for improvement. The agenda includes time to discuss the rotation in which each fellow is currently participating as well as time to reflect on the fellowship experience in general. The fellows are free to discuss any changes they would like to see in the program, and the administrators use this as a time to "check-in" with the group to see if any improvements can be made. This allows the fellows to have a regularly scheduled yet informal session to provide feedback directly to the leadership of the program. In addition, fellows are encouraged to use this time to reflect on the emotional nature of their work and discuss any issues with which they might be struggling.
These sessions occur every other month and are solely for the fellows. Facilitated by a certified grief therapist, they allow the fellows a "safe space" in which they can reflect upon the loss of a particular patient or work as a group to process the feelings engendered by the complex nature of our work and its relationship to loss.
Weekly Palliative Care Meetings
Every week the fellows join the entire staff of the Hertzberg Institute for the following four types of meetings:
Clinical Interdisciplinary Conference
This weekly team discussion focuses on the care of inpatients who pose a clinical challenge to the team. Discussion encompasses assessment and management of symptoms and treatment side effects; interdisciplinary team function; management of psychological, social, and spiritual issues in palliative care; care of the actively dying; ethical, legal and cultural aspects of palliative care; consultation skills; and professional self-care.
Clinical Staff Meeting
This twice monthly meeting focuses on the clinical work of the palliative care team. Issues related to the structure and process of the team are discussed, protocols are developed, and discussions are held about how newly implemented processes and protocols are functioning. This allows fellows to be actively involved in the process of quality improvement for our clinical service.
This monthly meeting is for all staff of the Hertzberg Palliative Care Institute for purposes of discussion and exchange of updated information about a broad range of activities. These meetings provide leadership training through role-modeling the administration of a large interdisciplinary team engaged in administrative, clinical, educational, and research activities.
Palliative Care Continuing Education Meeting
These teaching conferences focus on reviewing current topics in palliative medicine and are taught by leaders in their respective field drawn from both Mount Sinai and throughout New York City. The majority of attendees state that these lectures are likely to change their clinical practice.
Thursday Academic Half-Day
Because of the integration between palliative care and geriatrics at Mount Sinai, fellows (regardless of specialty or background) participate in the department’s Academic Half-Day on Thursday afternoons. All fellows are excused from their clinical duties starting at noon on these days and participate in didactic and small group teaching sessions facilitated by both leading geriatric faculty as well as fellows. Didactic lectures cover basic geriatric principles which are fundamental to palliative care such as dementia, delirium, constipation, incontinence, and falls prevention. Small group teaching includes the geriatrics journal club, led by Drs. Rosanne Leipzig and Helen Fernandez who are leaders in evidence-based medicine, and a monthly morbidity and mortality conference led by fellows.
Master Geriatric Educator Program (MGEP)
Integrated into the Thursday Academic Half-day, MGEP is a certificate program to develop expert educators in geriatric medicine and other disciplines. This program covers teaching principles and skills, curriculum development, and evaluation/assessment techniques that focus on issues key to the care of older adults with chronic disease. Each fellow designs an educational intervention that they perform in the medical center to improve the care of adults with chronic disease. While the focus of this program is on geriatrics, these concepts and skills are clearly applicable to palliative care. For example, one fellow designed a survey to evaluate how staff in the surgical intensive care unit conceptualize palliative care activities such as withholding and withdrawing ventilators and artificial hydration/nutrition.
Medical Student Teaching
As part of the curriculum for third-year medical students, the palliative care fellows teach lectures on pain management and communicating bad news (co-taught with a PhD candidate in bioethics). The fellows use a curriculum provided by the division of palliative care. This series of lectures is repeated for the medical students on a monthly basis.
In addition, all third-year medical students complete a week-long rotation on the palliative care service as part of their clerkship in Medicine and Geriatrics. The palliative care fellows provide informal teaching for these medical students during their time on the palliative care service.
Palliative Care Grand Rounds
These teaching conferences focus on critical review of the palliative care literature, and academic research presentations by regional and national leaders in the field of palliative care. Recent topics include: Use of Adjuvant Therapies in the Treatment of Pain; Living with Head and Neck Cancer; Depression, Hopelessness, and the search for Meaning at the End of Life; Research Outcome Methods in Palliative Care; Treatment of Pain in the Emergency Room; and Palliative Care in the Home. There is also a complete series of geriatrics grand rounds which the palliative care fellows are encouraged to attend.