Vanderbilt University Medical Center (VUMC):

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Under the supervision of Drs. Mohana Karlekar, MD, Sumi Misra, MD, MPH, Sara Martin MD,  Maie El-Sourady MD, Andrew Wooldridge MD, Tiffany Hines, MD and Matt Peachey MD,  Stacey Tillman MD, Ricky Shinall MDVUMC provides the fellow with a consultative experience for adults in a university/tertiary care/urban environment including a variety of inpatient experiences with a well-established IDT, including consults to oncology, medicine, intensive care, surgery, neurology, and psychiatry.

The Palliative Care (PC) Clinical Program, established in 2005, includes 9 HPM board-certified physicians, three NP’s and an experienced interdisciplinary team.  Consulting on over 1,500 patients a year, the consult service is a robust clinical site for trainees to receive an interdisciplinary, in-depth exposure to palliative medicine.  The service collaborates with oncology, geriatrics, critical-care, trauma and surgery.  VUMC service has been a training site for over 250 multidisciplinary trainees since 2008.  Outpatient PC clinics began in 2011 and have served over 200 patients affording fellows with a continuity experience, for symptom management and goals of care. The 12 bed Inpatient Palliative Care Unit (PCU) was initiated in September 2012 and serves as a unique multidisciplinary site for learning. Strongly supportive of the program, the institution commits faculty time and physical space for administrative, clinical and education-related activities and experiences.

  • Key Learning Opportunities
    • Care of medically complex patients with a variety of chronic, life limiting medical conditions
    • Opportunity to teach and mentor residents/students
    • Opportunity to work with expert IDT to promote continuity of care following hospital discharge
    • Ability to co-manage with staff from many community hospice organizations
    • Excellent case mix from ICU to general medicine
    • Many ethics based  and pain management consults
    • Cultural diversity especially African American patients
    • Strong exposure to community setting
    • Opportunity to learn about the systems based approach to the  business of palliative medicine

The Nashville Veterans Affairs Medical Center (NVAMC)

VA-20140717JR001-r_400x237.jpgThe Nashville Veterans Affairs Medical Center, under the supervision of Drs. Sumi Misra, MD, Martha Leonard MD and Deborah Unger MD, Carol Nestler NP, provides the fellow a consultative experience for veterans of all ages, including both outpatient patient experiences and a variety of inpatient experiences, including consults to oncology, medicine, intensive care, surgery, neurology, and psychiatry.

The Tennessee Valley Health Care Systems, Veterans Affairs Medical Center, Nashville (TVHS VAMC) Palliative Program, founded in 2006, serves over 800 patients a year (600 inpatient and 200 outpatients’ consults) and oversees a seven bed palliative care unit, managed by the interdisciplinary PC team. Four board-certified HPM physicians, one nurse practitioner and a knowledgeable interdisciplinary team cares for veterans with life-limiting illnesses including cancer, congestive heart failure, dementia, chronic obstructive pulmonary disease, end-stage renal disease, agent-orange related conditions and  coronary artery disease.  Strongly supportive of the program, the institution commits faculty time and physical space for administrative, clinical and education-related activities and experiences.

  • Key Learning Opportunities
    • Focus on specific veteran needs near end of life, including PTSD and challenges of substance abuse in pain management
    • Care of medically complex patients with a variety of chronic, life limiting medical conditions
    • Ability to co-manage with staff from many community hospice organizations
    • Opportunity to teach and mentor residents/students
    • Excellent case mix from ICU to general medicine
    • Cultural diversity especially African American patients
    • Pain management consults
    • Strong exposure to community setting
    • Opportunity to learn about the systems based approach to the  business of palliative medicine

The Monroe Carell Jr. Children’s Hospital18496483382_6908e510a9_z.jpg

The Monroe Carrell Jr. Children’s Hospital provides the fellow a unique experience in comprehensive pediatric palliative care consultation under the supervision of Pediatrics Palliative Care physicians and NP and IDT

  •  Key Learning Opportunities.
    • Opportunity to learn about Pediatric patients
    • Strong exposure to oncology
    • PACT teams  (will teach fellow about grief and bereavement and support systems for family with children)
    • Outpatient palliative care clinic with opportunity to follow hospital patients longitudinally
    • Many academic conferences
    • Pediatric exposure

Community Based Hospice Experience:

Alive Hospice, founded in 1975, is the oldest and largest nonprofit hospice agency in the Nashville area, having cared for 3,304 patients and families in 2010. It accommodates patients with a wide variety of ethnicities, socioeconomic backgrounds, ages and diagnoses (52% cancer, 48% non-cancer).  Fellows train at The Residence, a 30-bed free-standing facility, as well at two inpatient hospice units, long-term care facilities, and at patients' home, under the supervision of the CMO, Dr. Robert Bercompas MD. The Team of full-time and part time board-certified HPM medical supervise an average daily census of 420 patients throughout its 12 county service area. In the mission to provide education to the medical community at large, Alive has trained over 300 learners, since 2007, and participating in bereavement programs and Quality Improvement (QI) meetings. The VUMC Palliative Medicine fellow works together with the Alive faculty and staff as part of a strong interdisciplinary team (IDT) and participates in inpatient admission assessments, follow-up care, patient and family meetings and IDT meetings. Fellows begin to develop the mastery of the core knowledge, attitudes and behaviors of a palliative medicine physician. The Alive Residence is a busy teaching site for residents, students and other health professions learners from academic programs throughout the Greater Tennessee Area. When possible, fellows continue to follow patients at home in conjunction with the team Fellows are active teachers and mentors for other learners. Fellows attend regular weekly conferences.

  • Key Learning Opportunities
    • Large hospice population
    • Variety of issues to manage
    • Committed Interdisciplinary team
    • Expert palliative nursing resources
    • Many opportunities to use patient controlled analgesia
    • Many opportunities to use methadone
    • Many different medical directors and thus the opportunity to learn from a variety of mentors
    • Opportunity to have some practice autonomy
    • Opportunity to bond with another palliative medicine learners
    • Music therapy department and recreational therapy services integrated with palliative care plans

In addition Alive Hospice has three General inpatient Units (GIP) located in the community setting

  •  Learning Opportunities
    • Small intimate unit setting
    • Restricted formulary
    • One-on-one education
    • Opportunities to learn methadone usage
    • Opportunities to learn and avoid opioid toxicities
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Home and Community Based Palliative Care and Hospice Care:

Gentiva/Kindred Palliative Care is a unique and innovative learning environment that is a collaboration between Vanderbilt University Faculty and a community hospice agency that has incubated one of the most well established community based palliative care programs in the State, since 2008. Home Care Teams offers the fellows an opportunity to follow patients longitudinally and see new patients in their homes.

  • Key Learning Opportunities
    • Large and strong interdisciplinary team
    • Broad case mix and economic diversity
    • Opportunity to contribute to decisions
    • Opportunity to work with Hospice Pharmacia

Palliative care in long Term Care settings:

The experiences are provided to the fellow at The Tennessee Valley Health Care Systems (TVHS) Nashville and Murfreesboro VA Medical Center and at VUMC affiliated Trevecca and Bethany Nursing Homes in the community.  Fellows work with IDT’s in various aspects of consultation, facilitating transitions, and working with patients and families to make care plans.