Hospice and Palliative Medicine

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Overview

The newly ACGME accredited Hospice and Palliative Medicine Fellowship Program at Jackson Health System/University of Miami Miller School of Medicine offers a well-rounded clinical training experience in hospice and palliative medicine, caring for a diverse patient population under the mentorship of experienced, board certified faculty. Fellows are exposed to all sectors of healthcare system throughout the fellowship. Our participating institutions include: Jackson Memorial Hospital, a large urban teaching hospital; Holtz Children's Hospital, the pediatric hospital for the Jackson Health System; the Miami VA Medical Center; the University of Miami Hospital; Sylvester Comprehensive Cancer Center; and Vilas Innovative Hospice Care, all conveniently located in walking distance within our health district.

Rotations are structured and balanced encompassing various clinical settings inpatient hospice arid palliative care unit management, inpatient palliative care consultation, outpatient palliative care clinic, home hospice care, long term care, specialized cancer care and pediatric hospital and home care. In addition to a rich clinical experience, fellows will have a wide variety of specialty and subspecialty elective options including pain medicine/interventional pain service, hematology and oncology with various site disease groups, supportive and integrative cancer care, radiation oncology, and heart transplant program.

Fellows will learn to conduct domain-based, comprehensive, whole-person assessment and to provide goal-directed, individualized treatment and care plan recommendations. Our hospice and palliative care team works closely and collaboratively with interdisciplinary team members including social workers, rehabilitation and recreational therapists, chaplains, and volunteers to achieve the best possible clinical outcomes for our patients and families. Fellows will learn to engage and work effectively with the interdisciplinary team in all settings as well as to provide recommendations on care plan development, care coordination and care transition.

Our fertile academic environment is very conducive to conduct clinical and education research projects and offers excellent opportunities for various scholarly activities to promote career development.

ACGME Accredited: Yes
Residents or Fellows per year:  Four
Duration:  One year
Postgraduate Training Required: Yes
U.S. Citizenship Required:   Preferred

Application Deadline
The fellowship program currently does not participate in the match program.

Rotations and Sample Block Schedule

Block12345678910111213
Site Site 1, Site 7 Site 1, Site 7 Site 1 Site 6 Site 2 Site 2 Site 2   Site 3, Site 4 Site 3, Site 4 Site 5, Site 4   Site 1
Rotation Name IP, LTC PCHU, LTG PCHU, LTC HHC PCHU, HHC IP, HHC IP, HHG VAG PCHU, AC PCHU, AC IP, AC Elect PEO
% Outpatient 10 10 10 100 10 10 10   10 10 10   10
% Research 0 0 0 0 0 0 0   0 0 0   0

 

Summary of Didactic Activities

Didactic Content Description Schedule Total Hours
Geri/Palliative Care Immersion Core topics in palliative medicine, essential for daily clinical practice in PC Every Monday during the first 8 weeks of fellowship 16 hours
Case Presentation PC case presentation and discussion Weekly didactic session on Wednesday afternoons from October onwards 40 hours
Geri/Palliative Care Core Curriculum PC and related topics primarily in lecture format Weekly didactic session on Wednesday afternoons 40 hours
Grand Round Selected PC topics by guest lecturers; each fellow to present 2 topics of interest Family Medicine Grand Rounds 10 hours
Journal Club Selected articles- by fellows and faculty Monthly on Wednesday mornings 10 hours

Educational & Other Experience
Each block rotation offers unique experiential learning experience in addition to didactic activities.

Summary of Experiential Educational Experience

Training Site Number* 1 2 3 4 5 6 7
Institution Name* JMH VA UMH UMHC SCCC Vilas JHS/LTC
Inpatient PC Consultation x x x   x   x
Inpatient Care (Palliative) x x x   x    
Inpatient Care (Hospice) x x x     x  
Ambulatory Care x x   x      
Home Hospice Care           x  
Hospice Administration           x  
Pediatric Palliative Care x            
Long Term Care Experience   x       x x

* See table above rotation and sample block schedule
Each training site offers unique learning environment- system differences, practice variation, disease complexities,and cultural, psychosocial, and ethnic diversities. Fellows will learn and overcome these challenges while preparing them to work and pursue career growth for future.

Jackson Memorial Hospital and Holtz Children's Hospital
Growing palliative care program offers a wide variety of referral bases- cancer and non-cancer patients from a very diverse population with ethnic,cultural,and socio-economic backgrounds. Fellows attend and conduct the weekly IDT care plan meeting and interact with members of various disciplines.
Fellows will rotate 4-week block of pediatric palliative care rotation at the site 1 - Holtz Children's Hospital (under Jackson Memorial Hospital/Jackson Health System). The Holtz Pediatric Palliative Care Program is a well-established program and is registered in the National Palliative Care Registry. During this rotation, the fellow will be exposed to an experiential learning in pediatric palliative care. The fellow will be under direct supervision of the PC program director Dr. G. Patti Cantwell, MD, an experienced Pediatrician specialized in critical care and palliative medicine. Fellows will also see pediatric patients in home care setting- the TiLLi (terminal illness or life limiting illness} Kids Program. The fellows will attend IDT meeting and spend time with child psychologists,child life specialists, chaplains and social workers.

Miami VA Healthcare System (MVAHS)
Established palliative care program which consists of: (1) Palliative Care Consult Team (PCCT); (2) Hospice and Palliative Care Unit (HPCU);(3) Outpatient Palliative Care inclusive of Palliative Care Clinic (PCC) and Clinical Video TeleHealth (CVT); and (4) Bereavement Care Service. There are 3 full-time PC board-certified attending physicians, one ANP,and the dedicated members of IDT including PC trained nurses,a social worker,a psychologist/bereavement care specialist,a chaplain,a recreational therapist and volunteers.

Fellows work with other IDT members,attend weekly IDT meeting and participate in care planning and care transition into various settings after successful management of acute needs. Fellows will learn veteran-specific EOL needs including PTSD,substance abuse,and homelessness.

Outpatient PC services utilize both office visit and TeleHealth encounter for the veterans residing in remote areas.

Bereavement team provides anticipatory grief counseling, bedside ritual, debriefing (for staff and trainees), post-death and bereavement phone calls and mailing,and semi-annual memorial services­ has been well-established.

University of Miami Hospital (UMH)
Growing palliative care consult team (PCCT) provides consultative and co-managed care in in the private, tertiary hospital teaching hospital setting. Fellows will interact with faculty experts from various specialties and subspecialties during the rotation. The UMH, UMHC and SCCC are robust academically and conducive for learning and research activities.
The inpatient hospice unit (IPU) operated by Vitas Innovative Hospice Care provides inpatient level of hospice care. Annually,there are approximately 500-600 new admissions and average LOS of 7 days. Fellows provide inpatient hospice care under direct supervision of experienced, board certified attending physicians.

University of Miami Hospital and Clinic (UMHC)
Palliative care clinic at UMHC provides non-hospice palliative care for patients with advanced, incurable illnesses in ambulatory care setting. The clinic hours are from 1:00 p.m. to 4:00p.m. and it runs four days per week except Wednesday. The PC clinic works.closely with the cancer survivor support group which consists of mental health providers (psychiatrists and psychologists),social workers, a chaplain, integrative medicine physician, rehabilitation and restorative physician, and an acupuncturist. Fellows will learn these integrated support services available to cancer survivors. Elective options are also available to rotate with these experts.

Sylvester Comprehensive Cancer Center (SCCC)
SCCC is a renowned tertiary cancer center,offers comprehensive cancer care and is a referral hub for cancer patients from the Caribbean and other South American countries. Various site-disease groups (SDG), bone marrow transplant and stem cell transplant services are available. A well-established pain fellowship program and radiation oncology residency training program will work closely with HPM fellowship program as elective options. The UM PC faculty offers Inpatient PC consult for the patients admitted at SCCC. A large variety of cancer patients at their different stages will enrich fellows' experience and foster learning by participating in various SDG tumor boards.

Vitas Innovative Hospice Care
For-profit community hospice agency with average daily census of around 1600-1700 patients in South Florida, provides home hospice care. Fellows learn both clinical and administrative aspects of home hospice agency. Vilas medical director supervise and educate the fellows during the rotation. Fellows make home visits with various lOT members including nurses,social workers, chaplain in addition to medical visits with the attending physician. Fellows participate in the weekly lOT meeting. Fellows learn the role of hospice medical director and required skills such as eligibility and recertification visits, medical visits, and communication skills with other lOT members in home setting.

Jackson Memorial Long Term Care Center
Fellows provide consultation and co-management care for palliative care patients in long-term care setting at the Jackson Memorial Long Term Care Center under direct supervision of attending physician. This rotation offers palliative care experience in the long term care setting and in care transitioning from acute inpatient to long term care. Fellows will also interface with hospice care provided by community hospice agency in this setting.

Faculty Supervision
At each training site, faculty closely supervises the fellows and provides feedback. Faculty ensures that the fellows receive appropriate levels of supervision,and establishes supervisory lines of responsibility and clear lines of communication while advancing the fellows' privilege of progressive authority and responsibility, and conditional independence.

Research
Both clinical and educational research opportunities are available to interested candidates. Using mobile phone technology application,we are exploring research in supportive services for breast cancer care. Additional one or two years of research fellowship opportunity is available to the interested candidates. Fellows devote to research activities with defined numbers of clinical block annually.

Call
The program follows strictly to the Fellow Duty Hours/Fatigue Mitigation Policy. On-call activities are generally at-home call only. Fellows do one weekend of in-house call along with supervising attending physician.

Teaching Hospitals

  1. Jackson Memorial Hospital
  2. Holtz Children's Hospital
  3. Miami Veteran Administration Hospital
  4. University of Miami Hospital
  5. University of Miami Hospital and Clinic
  6. Sylvester Comprehensive Cancer Center

Program Directors,Preceptors, Medical Student Clerkship Directors, or Contacts

  • Khin Zaw,MD: Program Director,University of Miami
  • G. Patricia Cantwell, MD: Chief,Division of Pediatric Critical Care Medicine, Holtz Children's Hospital
  • Cyrus Meshkin,MD: Staff Physician, Jackson Memorial Hospital
  • Aguilar Enrique, MD: Associate Chief of Staff,Geriatric and Extended Care, MVAHS
  • Juan Palacios, MD: Medical Director,Hospice and Palliative Care Program, MVAHS
  • Osvaldo Rodriguez,MD: Medical Director, Home Based Primary Care,MVAHS
  • Paul Pugliese, MD: Medical Director, Vitas Innovative Hospice Care,Miami Dade County
  • Elizabeth Schultz, MD: Associate Medical Director, Vitas Innovative Hospice Care, Miami-Dade County
  • USMLE 1, 2, and 3
  • Completion of residency from one of the following ACGME-accredited residency programs: anesthesiology, emergency  medicine, family medicine, internal medicine, neurology, psychiatry, pediatrics, physical medicine and rehabilitation, radiation oncology, surgery.

 

Shelley Manning, Program Coordinator
Phone: 30S-243-1245
Fax: 305-243-6871
Email: SManning2@med.miami.edu

Prospective Residents

Physicians Services / Housestaff Office
Jackson Memorial Hospital
East Tower Room 1004
1611 NW 12th Avenue, Miami, Florida 33136
Phone: 305-355-1122
Fax: 305-355-1123

Graduate Medical Education Office
Jackson Memorial Hospital
Institute 118B
1611 NW 12th Avenue, Miami, Florida 33136
Phone: 305-585-4310
Fax: 305-585-4309

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