Fox Chase Cancer Center/Temple Hospice & Palliative Medicine Curriculum
2018-2019
Teaching Method Key:
- Clinical: Milestone will be achieved through clinical rotations, IDT, and faculty/IDT member direct feedback.
- Lecture: Milestone will be addressed through a didactic lecture.
- Interactive teaching session (ITS): Milestone will be addressed through interactive teaching session, fellow responsible for bringing questions/cases/reviewing educational materials beforehand. Examples include case conference, faculty-led session, flipped classroom.
- Mentoring: Milestone will be addressed through one-on-one mentoring sessions with core faculty.
- Fellow teaching session (FTS): Milestone will be addressed through the fellow developing a teaching session or journal club.
- CAPC: Milestone will be addressed through completion of CAPC modules.
- Independent reading (IR): Key journal articles, core readings (Demystifying opioid conversions, Mastering communication with seriously ill patients, Fast Facts, HPM Essentials).
- Debriefing: Milestone will be addressed through debriefing with psychologist.
- Orientation: Milestone addressed through formal Temple orientation (e.g. safety event/error reporting/fatigue mitigation).
- GME: Milestone addressed through FCCC-wide sessions (usually lectures) for all GME programs.
- Collaboration: Milestone addressed through local collaboration with other HPM fellowships.
Evaluation Method Key:
- Observation and feedback (OF): Observation and direct, timely feedback provided at the time of a clinical encounter and/or during precepting.
- Fellow self-evaluation (FSE): Fellow evaluates progress, identifies competency/knowledge gap, develops an action plan.
- Faculty evaluation (FE): Faculty completes milestones-based evaluation.
- HPM PASS: HPM practice board exam.
- Specific evaluation tools (SET): Examples include small group teaching checklist, 360 degree evaluation, chart abstraction and chart review, patient evaluation, SECURE framework.
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Patient Care
CM #1: Knowledge of Serious and Complex Illness
A. Knowledge of disease trajectories (eg, pathophysiology, differential diagnosis, complications)
Teaching method(s): Clinical, IREvaluation method: OF, FSE, FE
B. Prognostication
Teaching method(s): Clinical, ITS, CAPC, IR
Teaching sessions:
Prognosis for Heme-Onc and Rad Onc Trainees – Molly Collins
Evaluation method: OF, FE
C. Scope of palliative treatments for different serious and complex illnesses (eg, surgery, radiation therapy)Teaching method(s): Clinical, ITS, lecture, IR
Teaching sessions:
“How to sound like you know what you’re talking about when you’re talking to an oncologist” – Angela Jain
Date TBD “How to talk like a radiation oncologist” – Dr. Josh Meyer
Malignant Bowel Obstructions – Jeff Farma, Gabrielle Gauvin, Molly Collins
Evaluation method: OF, FSE, FE
D. Assessment of benefits and burdens of treatments on the seriously ill patient and family
Teaching method(s): Clinical, mentoringEvaluation method: OF, FE
E. Pharmacology of essential palliative symptom management
Teaching method(s): Clinical, lecture, ITS, FTS, CAPC, IRTeaching sessions:
Neuropathic pain – Marcin Chwistek
Medical marijuana for trainees – Marcin Chwistek and Molly Collins
Depression, anxiety and adjustment reactions – Emmie Chen
Delirium – Beth Corcoran
Evaluation method: OF, FSE, FE, HPM PASS, SET (chart abstraction/review)
F. Advance care planning for specific illnesses and potential advanced therapies (eg, mechanical ventilation, implantable defibrillator, ventricular assist device) across the age spectrum
Teaching method(s): Clinical, ITS, CAPC
Teaching sessions:
Advance Care Planning for Heme-Onc Fellows – Sheila and Molly
Temple Team: Advance care planning for specific illnesses (Mary Kraemer –
LVAD/Transplant/ECMO; Stan Savinese – Renal, SICU)
Evaluation method: OF, FE, SET (SECURE framework)
CM #2: Comprehensive Whole-Patient Assessment
A. Assess pain and nonpain symptoms
Teaching method(s): Clinical, CAPCTeaching sessions:
Dyspnea – Kate Murphy
Nausea, vomiting, constipation and mirtazapine – Molly
Fatigue – Leigh
Pain management 101, 102, 103, 104 – Marcin and Molly
Depression, anxiety and adjustment reactions – Emmie Chen
Delirium – Beth Corcoran
Cognition – Beth Corcoran and Paula Finestone
Evaluation method: OF, FE, HPM PASS, SET (chart abstraction/review)
B. Assess decisional capacity and/or developmental stage (eg, cognitive, behavioral, emotional)
Teaching method(s): Clinical, ITS, orientation (ELM education training for house staff/onboarding)
Evaluation method: OF
Teaching sessions:
Decisional capacity – Emmie Chen
D. Identify supports and stressors (eg, psychological, psychiatric, spiritual, social, financial)
Teaching method(s): Clinical, ITS
Teaching sessions:
Communication Curriculum: Coping – Molly
Coping with pain – Paula Finestone
Evaluation method: OF, FE
CM #3: Addressing Suffering/Distress
A. Manage pain and nonpain symptoms using pharmacologic strategies
Teaching method(s): Clinical, lecture, ITS, FTS, CAPC, IRTeaching sessions:
Dyspnea – Kate Murphy
Nausea, vomiting, constipation and mirtazapine – Molly
Fatigue – Leigh
Fun with Opioid Math! For Heme-Onc and Rad onc Trainees – Molly
Methadone – Tara Friedman
Pain management 101, 102, 103, 104 – Marcin and Molly
Depression, anxiety and adjustment reactions – Emmie Chen
Delirium – Beth Corcoran
Evaluation method: OF, FE
B. Manage pain and nonpain symptoms using nonpharmacologic strategies (eg, integrative, interventional, surgical)
Teaching method(s): Clinical (pain rotation, Scrambler therapy, radiation oncology rotation), FTS, IR
Teaching sessions:
Dyspnea – Kate Murphy
Fatigue – Leigh
“How to talk like a radiation oncologist” – Dr. Josh Meyer
Coping with pain – Paula Finestone
Relaxation and mindfulness techniques – Paula Finestone
Evaluation method: OF, FE
C. Manage basic psychosocial/spiritual distress
Teaching method(s): Clinical, debriefing
Teaching sessions:
Depression, anxiety and adjustment reactions – Emmie Chen
Communication Curriculum: Coping – Molly Collins
Evaluation method: OF, FE, FSE
CM #4: Palliative Care Emergencies and Refractory Symptoms
A. Identify common palliative care emergencies
Teaching method(s): Clinical, IREvaluation method: OF, FE
B. Anticipate, triage, assess, and manage palliative care emergencies
Teaching method(s): Clinical
Evaluation method: OF, FE
C. Manage proportional sedation for refractory symptoms
Teaching method(s): Clinical
Evaluation method: OF, FE
CM #5: Withholding/Withdrawal of Life-Sustaining Therapies
A. Counsel patient, family, and providers about the process of withdrawal (eg, prognosticate, attend to psychosocial, spiritual, cultural needs of patient/families, promote shared decision-making for goals of care, utilize interdisciplinary team)
Teaching method(s): Clinical
Evaluation method: OF, FE
B. Manage physical symptoms before, during, and after withdrawal
Teaching method(s): Clinical, IR
Evaluation method: OF, FE
C. Orchestrate the technical withdrawal
Teaching method(s): Clinical
Evaluation method: OF, FE
D. Consider issues related to withholding/withdrawal of artificial nutrition and hydration that may differ from advanced life-sustaining therapies
Teaching method(s): Clinical, lecture
Teaching sessions:
Anorexia & feeding at EOL for heme onc fellows – Marcin Chwistek
Evaluation method:
E. Attend to personal, team, and other provider reactions (eg, values, emotions)
Teaching method(s): Clinical, mentoring, debriefing, attend a debriefing session with the Temple team
Evaluation method: OF, FE
F. Apply ethical and legal standards and institutional culture and policies related to withdrawal of life-sustaining therapies
Teaching method(s): Clinical, observe an ethics consult with Mary Kraemer
Evaluation method: OF, FE
CM #6: Care of the Imminently Dying
A. Manage physical symptoms during the dying process
Teaching method(s): Clinical, ITS, CAPC, IRTeaching sessions:
Imminently dying patient & anticipatory guidance for heme-onc fellows – Molly Collins
Evaluation method: OF, FE, FSE, HPM PASS, SET (360 degree evaluation)
B. Attend to psychosocial, spiritual, cultural needs of patient/family
Teaching method(s): Clinical, ITS, debriefingTeaching sessions:
Temple Team: Spiritual and emotional care in palliative settings – Rev. Jim
Ingalls
Evaluation method: OF, FE, FSE
C. Collaborate effectively within own and across other interdisciplinary teams
Teaching method(s): Clinical, mentoring, debriefing, attend a debriefing session with the Temple team
Evaluation method: OF, FE, SET (360 degree evaluation)
D. Communicate around the time of death (eg, empathic presence, preparing family)
Teaching method(s): Clinical, ITSTeaching sessions:
Imminently dying patient & anticipatory guidance for heme-onc fellows – Molly Collins
Managing the Death Event – Stan Savinese
Evaluation method: OF, FE
E. Attend to self-awareness and self-care
Teaching method(s): Clinical, ITS, mentoring, debriefingTeaching sessions:
Temple Team: Coping strategies for moral distress and vicarious trauma – Emily Browning
Evaluation method: OF
F. Attend to post-death care (eg, death pronouncement, note, death certificate, communication with others)
Teaching method(s): Clinical
Teaching session:
Managing the Death Event – Stan Savinese
Evaluation method: OF, FE
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Communication
CM #7: Fundamental Communication Skills for Attending to Emotion
A. Build rapport
Teaching method(s): ClinicalEvaluation method: OF, FE
B. Acknowledge and respond to emotion (eg, listening vs hearing, compassionate presence and strategic silence, intuition around cues and guiding discussion)
Teaching method(s): Clinical, ITSTeaching sessions:
7/13 Communication Skill Bootcamp – Nemours/AI Dupont
Communication curriculum: Close Listening – Sheila Amrhein and Molly Collins
11/5-11/7 PalliTalk for Fellows
Serious Illness Conversation Guide Training – Molly Collins, PPCP Team
Evaluation method: OF, FE, SET (SECURE framework, 360 degree evaluation)
C. Acknowledge one’s own emotions and preconceptions (eg, implicit bias)
Teaching method(s): Clinical, ITS, debriefing
Teaching sessions:
Temple Team: Coping with Moral Distress – Emily Browning
Evaluation method: OF
D. Address conflict (eg, among patients, families, other care providers)
Teaching method(s): Clinical, mentoring, debriefing
Teaching sessions:
Personality disorders and how to maintain boundaries – Emily Chen
Temple Team: Keeping your cool when things get hot – Emily Browning
Evaluation method: OF
CM #8: Communication to Facilitate Complex Decision-Making
A. Deliver medical information (eg, serious news, prognosis)
Teaching method(s): Clinical, collaboration, CAPC
Teaching sessions:
7/13 Communication Skill Bootcamp – Nemours/AI Dupont
11/5-11/7 PalliTalk for Fellows
Evaluation method: OF, FE, SET (SECURE framework)
B. Elicit patient values and goals
Teaching method(s): Clinical, ITS, CAPCTeaching sessions:
Serious Illness Conversation Guide Training – Molly Collins, PPCP Team
Evaluation method:
C. Promote shared decision-making
Teaching method(s): Clinical, ITSTeaching sessions:
Serious Illness Conversation Guide Training – Molly Collins, PPCP Team
Temple Team: Communication to Facilitate Complex Decision-Making - Mary
Kraemer
Evaluation method: OF, FE, SET (360 degree evaluation, SECURE framework)
D. Facilitate a family meeting
Teaching method(s): Clinical, CAPC, ITS
Teaching sessions:
11/5-11/7 PalliTalk for Fellows
Evaluation method: OF, FE, SET (SECURE framework)
E. Foster adaptive coping (eg, reframe hope, promote resilience, legacy, humor, affiliation, anticipation)
Teaching method(s): Clinical, ITS
Teaching sessions:
Communication Curriculum: Coping – Molly Collins
Evaluation method: OF, FE
CM #9: Prognostication
Teaching method(s): Clinical, ITS, CAPC, IR
Teaching sessions:
Communication Curriculum: Close reading of: Mastering Communication with Seriously Ill Patients – Molly Collins
Serious Illness Conversation Guide Training – Molly Collins, PPCP Team
Prognosis for Heme-Onc and Rad Onc Trainees – Molly Collins
B. Possess knowledge of individual illness trajectories and potential responses to therapies
C. Formulate prognosis (eg, clinical assessment, utilization of tools, input from other healthcare providers, consequences of failure to prognosticate)
D. Communicate prognosis (eg, function, timeframe, quality of life, challenges of communication prognosis, promote prognostic awareness, acknowledge uncertainty)
CM #10: Documentation
A. Communicate treatment recommendations professionally and diplomatically to others
Teaching method(s): Clinical, ITS, mentoringTeaching session:
Consultation Etiquette/FCCC Culture – PPCP Team
Evaluation method: OF, FE
B. Understand the relationship between documentation and billing (eg, CPT requirements and ICD coding, medical complexity and time-based billing)
Teaching method(s): Lecture, mentoringTeaching session:
ICD 10 for Hospice & Palliative Care – Stan Savinese
Evaluation method: OF
C. Document comprehensive hospice and palliative medicine plans (eg, medical decision-making and rationale behind realistic treatment recommendations, patient and treatment goals, ethical and legal implications)
Teaching method(s): Clinical, mentoring
Evaluation method: OF, FE, SET (chart review)
CM #11: Grief, Loss, and Bereavement
Teaching method(s): Clinical, ITS, IR
Teaching sessions:
Temple Team: Grief, Loss and Bereavement across the Life Span - Katie Eaddy
Evaluation method: OF, FE, HPM PASS, SET (360 degree evaluation)
Milestone achieved:
A. Understand risk factors for and types of grief based on age and developmental stage (eg, anticipatory, normal, complicated grief)
B. Identify and assess individuals for grief and/or bereavement
C. Provide basic support for anticipatory grief and/or bereavement
D. Refer for grief and/or bereavement support and therapeutic interventions Collapse
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Hospice and Palliative Medicine Processes
CM #12: Interdisciplinary Teamwork
Teaching method(s): Clinical, mentoring, debriefing, ITS, FTS
Teaching session:
Temple Team: Interdisciplinary team communication - Mary Kraemer
Evaluation method: OF, FE, SET (360 degree evaluation)
B. Facilitate interdisciplinary team meetings (eg, understand team dynamics, elicit varied and unexpressed opinions)
C. Support team members (eg, provide and receive feedback, address conflict, educate)
D. Develop and demonstrate leadership skills
CM #13: Consultation
Teaching method(s): Clinical, ITS, mentoring, debriefing, attend a provider debriefing session with Temple Team
Teaching session:
Consultation Etiquette/FCCC Culture – PPCP Team
What is outpatient palliative care and how is it different from inpatient? - Molly
Evaluation method: OF, FE
B. Promote professional consultation etiquette (eg, negotiation with other providers around goals, respect for primary team relationships, diplomacy in advocacy)
C. Demonstrate empathy and respect toward other involved colleagues
CM #14: Transitions of Care
Teaching method(s): Clinical, mentoring
Teaching session:
Answering your questions about hospice (will cover levels of service, criteria) and approach to helping patients transition to comfort care – Marie Welsh
Evaluation method: OF, FE, SET (360 degree evaluation), faculty observation of at least one handoff to another site of care (e.g. inpatient to home hospice team)
Milestone achieved:
A. Practice safe handoffs across settings of care
B. Counsel patient, family, and teams about eligibility, capabilities, payer sources, expectations for next and alternative sites of care (eg, hospital, nursing facility, inpatient hospice, home hospice, long-term acute care facility, home-based palliative care)
C. Address medication management issues during transitions of care (eg, medication reconciliation, formularies, safety especially with controlled substances, rational de-prescribing)
CM #15: Safety and Risk Mitigation
A. Practice safe prescribing (eg, polypharmacy, medication reconciliation and disposal, legal and regulatory issues, Risk Evaluation and Mitigation Strategies, Prescription Drug Monitoring Program)
Teaching method(s): Clinical
Teaching session:
A rational approach to optimizing hospice patients’ medications – Stan Savinese
Evaluation method: OF, FE
B. Understand issues around comorbid substance use disorders (eg, diversion risk, addiction treatment)
Teaching method(s): Clinical, ITS, IR
Teaching sessions:
Assessment and approaching patients with substance use disorders – David O’Gurek
Medication assisted treatment in patients with substance use disorders and pain – David O’Gurek
Substance use disorder standardized patient encounters – David O’Gurek
Alcohol and benzodiazepine use disorders – Beth Corcoran
Evaluation method: OF
C. Understand processes to promote patient safety (eg, screening for safety risk factors, error reporting, handoff procedures, learner supervision, fatigue mitigation)
D. Identify safety events and participate in their investigation
E. Promote situational awareness and provider safety in different healthcare settings
C-E ABOVE:
Teaching method(s): Orientation: mandatory TUH/GME competencies, ELM education training for house staff (“onboarding”), AMA/GME competency education program
Evaluation method: OF
CM #16: Hospice Regulations and Administration
Teaching method(s): Clinical, mentoring (one on one sessions with Stan Savinese each hospice rotation)
Teaching session:
Answering your questions about hospice (will cover levels of service, criteria) and approach to helping patients transition to comfort care – Marie Welsh
Evaluation method: OF, FE, SET (360 degree evaluation), HPM PASS
B. Fulfill the role of a hospice team physician
C. Perform hospice-specific documentation that meets regulatory requirements (eg, physician visits, certification of terminal illness, face-to-face visits, interdisciplinary team input)
D. Understand the hospice business environment (eg, formularies, contracts, specific resources and policies)
Professional Development
CM #17: Ethics of Serious Illness
Teaching method(s): Clinical, mentoring, ITS, participating in at least one ethics consultation at TUH (Mary Kraemer), optional participation in the TUH ethics committee, completion of CITI training
Teaching sessions:
Decisional capacity – Emmie Chen
Anorexia & feeding at EOL for heme onc fellows – Marcin Chwistek
Advance Care Planning for Heme-Onc Fellows – Sheila and Molly
Evaluation method: OF, FE, HPM PASS
D. Ethical aspects of death definition and disorders of consciousness (eg, coma, persistent vegetative state, minimally conscious state)
E. Ethics of medically assisted nutrition and hydration
F. Ethics of withholding and withdrawing life-sustaining therapies
G. Ethics and legal theory of decision-making capacity and confidentiality (eg, assent, consent, dissent, emancipated minors, surrogacy)
CM #18: Self-Awareness Within the Training Experience
Teaching method(s): Clinical, mentoring, debriefing
Teaching sessions:
Personality disorders and how to maintain boundaries – Emmie Chen
Consultation Etiquette/FCCC Culture – PPCP Team
Temple Team: Keeping your cool when things get hot – Emily Browning
Evaluation method: OF, FE, FSE, SET (chart review, 360 degree evaluation, patient evaluation)
B. Demonstrate personal accountability in administrative tasks (eg, teaching organization and improvement, credentialing activities, assignment completion, committee work tasks and participation)
C. Identify conflicts of interests (eg, personal, professional, or corporate gains)
D. Display awareness of one’s role, identity, and boundaries in the private, professional, and public domains
E. Integrate past clinical and personal life experience into a therapeutic patient-provider relationship (eg, cultural, spiritual, emotional, cognitive, and implicit bias)
CM #19: Self-Care and Resilience
Teaching method(s): Clinical, ITS, mentoring, debriefing, GME, narrative medicine
Teaching sessions:
Temple Team: Coping strategies for moral distress and vicarious trauma – Emily Browning
Evaluation method: OF, FSE
B. Identify risk factors for burnout in self, others, and system (eg, high volume, high acuity, misaligned values and incentives, lack of transparency and recognition)
C. Identify strategies for cultivating self-care and resilience for self and others (eg, medical humanities, healthy boundaries and realistic expectations, physical health, recreation, engagement and receptivity with team and community)
D. Exhibit evolving self-reflection and conscious personal/professional identity formation (eg, loss and bereavement, insight around actions and consequences, mindfulness, compassion)
CM #20: Teaching
Teaching method(s): Clinical, mentoring, FTS
Evaluation method: OF, SET (small group teaching checklist)
B. Teach basic palliative care to other healthcare providers (eg, conducting learner needs assessment; defining learning goals and objectives; adjusting teaching content and methods to the setting and learners; recognizing teaching, coaching, and mentoring opportunities in every hospice and palliative medicine setting)
C. Share evidence-based hospice and palliative medicine literature with others Collapse
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Professional Development
CM #21: Scholarship, Quality Improvement, and Research
Teaching method(s): Mentoring, development and execution of a QI project, poster submission to AAHPM, FCCC GME-wide research series, FTS, optional participation in a research project, attend AAHPM assembly
Teaching sessions:
Quality Improvement – Mary Ellen Morba, Delinda Pendleton, Tricia Heinrichs
FCCC Research Series
Evaluation method: OF, SET (small group teaching checklist)
B. Recognize and participate in quality improvement methods and activities (eg, interpret quality data, distinguish between quality improvement and research)
C. Describe basic approaches and unique aspects of research in hospice and palliative medicine (eg, funding, ethics, vulnerable populations)
CM #22: Career Preparation
Teaching method(s): Clinical, mentoring, ITS, collaboration, participation in PEC, attend AAHPM assembly
Teaching sessions:
ICD 10 for Hospice & Palliative Care – Stan Savinese
A rational approach to optimizing hospice patients’ medications – Stan Savinese
Evaluation method: OF, SET (chart review)
B. Engage in leadership skill development and planning for career trajectory (eg, lifelong learning, advocacy)
C. Participate in elements of program development (eg, Program Evaluation Committee participation, quality metric identification)
D. Demonstrate billing fundamentals and delivery of cost-effective care in hospice and palliative medicine practice Collapse