Residents

There are three palliative care educational experiences available to residents at Mount Sinai.

Inpatient Palliative Care Unit

During this four-week rotation on 11 East, medicine residents provide care for patients admitted to the Palliative Care Unit as well as patients admitted to the HIV teaching service. Two attending physicians, one each from the Division of Infectious Diseases and the Palliative Care Service, round daily with the residents. Both attendings work closely with the residents to ensure they achieve their mutual educational goals during these four weeks.

The Palliative Care Service has developed a comprehensive curriculum in palliative care for residents on the in-patient rotation. This curriculum covers key topics relevant to caring for patients with serious, chronic, or life-limiting illness including: symptom assessment and management, physician communication skills, ethical and legal issues, and loss, grief and bereavement. This curriculum has been highly praised by the house staff for its ability both to advance knowledge and to promote the acquisition of valued patient management skills.

Patients admitted to the Palliative Care Unit require intensive palliative care interventions for one of two reasons:

1. To control refractory symptoms related to their advanced disease
2. To support patients and their families in coming to terms with a progressive illness and establishing appropriate goals of care.

Patients may be admitted from one of the hospital’s intensive care units, the Emergency Department, the floors, or directly from outside the hospital. Not all patients will be imminently dying or have a Do Not Resuscitate order. Many patients will continue to receive disease-modifying therapies concurrently with palliative care. One of the greatest challenges of providing care to seriously ill patients is determining and communicating the benefits and burdens of each medical intervention and providing only those interventions which have a realistic chance of forwarding the mutually agreed upon goals of care. Experience with this challenging task is a major educational objective of the rotation.

Patients on the Palliative Care Unit are also followed by an interdisciplinary team from the Palliative Care Service including a social worker, a nurse or nurse practitioner from the Palliative Care Service, and the Palliative Care teaching attending. The Palliative Care team works with the residents to develop a comprehensive palliative plan of care for their patients including a discharge plan when appropriate.

Palliative Care Service Rotation

House staff are invited to participate on our service through elective rotations on the Palliative Care Consultation Service. Rounds begin at 8:00am Monday-Friday in Annenberg 10-02. New patients are seen on the day of the request by the resident along with the palliative care attending and nurse. The resident will follow the patient daily with the palliative care team, and will present patients at the Tuesday Palliative Care inter-disciplinary team conference. Additionally, elective rotations in palliative care are available to a limited number of external trainees with advanced scheduling.

Elective rotations on the Palliative Care Service for 2-4 weeks can be scheduled by calling the palliative care administrative office at (212) 241- 1446.

Palliative Care Ambulatory Program

The Hertzberg Palliative Care Institute offers an out-patient teaching rotation for third-year medicine residents, as part of their outpatient clinic responsibilities. Following the Palliative Care Ambulatory Program clinical experience, house staff will become proficient in:

• Pain and symptom management related to serious, complex, or life-threatening illness
• Counseling/guidance about care options in the face of serious illness (e.g. discussions of goals of care, advance directives, or prognosis)
• Developing a palliative plan of care
• Providing loss, anticipatory grief, and bereavement support for patients and their families

Following the Palliative Care Ambulatory Program clinical experience, house staff will be able to:

• List the elements of a comprehensive palliative care assessment
• Perform a comprehensive palliative care assessment
• Demonstrate improved knowledge in the management of common physical and psychiatric symptoms