• Curriculum and Rotations

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    StarShine Pediatric Hospice (SH) is based out of the home care division at Cincinnati Children's. SH comprises an interdisciplinary team including physicians, social workers, nurses, case managers, nurse practitioners, bereavement coordinators, expressive therapists, spiritual care providers, volunteers, nursing assistants and allied health/rehabilitation professionals focused on quality of life, optimal pain and symptom management, guidance in medical and legal decisions, skilled nursing, counseling and bereavement support, and spiritual care for patients. As an integral part of Cincinnati Children's, the pediatric palliative care program provides hospice and palliative care to patients in their individual homes. The fellow spends 4 weeks with the Pediatric Team of StarShine visiting patients in multiple settings as a member of the hospice IDT. The fellow develops increasing comfort as a hospice team physician/member of the IDT by attending weekly hospice IDT meetings and seeing patients daily with IDT members. Initially an observer early in the rotation, the fellow becomes an integral member of the IDT during this rotation. The fellow gains increasing skill in interacting with a large IDT, recognizing and managing conflict, building relationships, exchanging relevant information efficiently and nonjudgmentally, providing and receiving constructive feedback, negotiating resource-based care decisions as a team, determining appropriate settings for patient care, making shared decisions with professional colleagues, and identifying caregivers at high risk for complicated grief and bereavement.

    Christ Hospital Palliative Care Consult Team is an interdisciplinary team which sees adults with a wide variety of patient diagnoses and clinical circumstances in all areas of the hospital (ICU, oncology, heart failure, pulmonary, geriatrics, inpatient family medicine service, and nephrology). Consults range from patients who are relatively stable but coping with a new diagnosis, to patients who are very ill in the ICU and close to dying. Consulted patients and families are from a wide variety of racial, ethnic, cultural, and socioeconomic backgrounds. The fellow will function at the appropriate developmental level as a team member. The fellow will obtain information, examine the patient, and participate in meetings with the patient/family and team; including eliciting the patient’s goals for care and delivering prognostic information.

    The fellow is involved in developing a treatment plan. The fellow will convey these recommendations to the primary team caring for the patient. The fellow communicates with the receiving clinician or program regarding palliative care plans when the patient is discharged. Fellows will participate in daily interdisciplinary team meetings to discuss all patients on the consult census. In addition, fellows participate in a weekly 90-minute team meeting focused on team building, continuing education, planning, and administration. One afternoon every week will be devoted to a variety of workshops and didactic teaching sessions for fellows and other learners on the service.

    Vitas Hospice is an adult home hospice organization that cares for adults with a wide range of life-limiting illnesses, including cancer, stroke, heart disease, lung disease, liver disease, kidney disease, multiple sclerosis, ALS, Alzheimer’s and AIDS.

    The fellow will function at the appropriate developmental level as a team member. The fellow will participate in the interdisciplinary team meetings and go on home visits with the supervising physician and/or hospice interdisciplinary team member (nurse or chaplain). The rotation will involve two half days per month during the course of the fellowship.

    Pediatric Special Needs Service (PSNS) at Cincinnati Children’s Hospital is a division within pediatrics that focuses on children experiencing complex, life-threatening medical conditions that require the coordinated care of many specialties and disciplines. The core healthcare team consists of an attending physician from the Division of General Pediatrics, a nurse practitioner, a social worker, a case manager, and floor nurses, all working with the patient and family to optimize the patient’s health status and quality of life. The responsibilities and experiences of the team typically involve diagnostic evaluation within the context of established chronic illness, the development and implementation of comprehensive care plans within the context of family and home capacity, and the assessment of treatment within the context of patient comfort and quality of life.

    The fellow will provide patient care, family counseling, and residency training under the direct supervision of the PSNS attending physician. The fellow will participate in daily interdisciplinary bedside rounds with the full PSNS team and care coordination rounds with the social worker, nurse educator, and case manager. The fellow will also participate in the outpatient management of these children approximately one half day per week bringing an opportunity to follow them longitudinally.

    The fellow works directly with social work, child life, music therapy, chaplaincy, and family advisory faculty of PACT. This rotation includes direct patient care and informal discussions of the goals for patient interactions. This rotation occurs while the fellow is on the PACT service.

    • The social worker works directly with families as well as with healthcare workers and school systems in coordinating psychosocial services, providing psychosocial and emotional support for patients, families, and healthcare workers working with dying children.
    • The child life specialist and music therapist provide social, emotional, and developmental support to children and families by utilizing developmentally appropriate play, art, music, education, counseling, and legacy building activities while creating opportunities for memory making.
    • The chaplain assigned to the patient floor provides pastoral services for families from a diverse group of spiritual beliefs and religions, including spiritual interventions, support, prayer, and sacraments. The chaplain coordinates spiritual care with communities of faith and arranges any special spiritual needs of a patient and family.
    • The family advisory faculty brings a family perspective to committees. As an advisor to PACT, they collaborate in patient care and strategic planning.

    Similar to StarShine Pediatric Hospice (SH), Daniel’s Care (DC) provides pediatric Home Hospice services to children with life-threatening illness and their families. Unlike SH, Daniel’s care does not have a perinatal hospice. While SH serves the Southwest Region of Ohio, Daniel’s care serves families residing in Northern Kentucky. The fellow will participate in the home management of patients served by Daniel’s care. The fellow will serve as a member of the interdisciplinary team of Daniel’s care and participate in home visits under the supervision of the medical director.

    Hospice of Cincinnati is a dedicated Palliative / Hospice free standing hospice in-patient facility for adults suffering from a terminal illness who have accepted hospice as a managed care benefit. Hospice of Cincinnati provides acute symptom management, respite and residential care for adult hospice patients.

    The fellow will function at the appropriate developmental level as a team member. The fellow will participate in the weekly interdisciplinary care meetings. The fellow will also have an opportunity to experience grief and bereavement counseling at the Adult Grief Center and Fernside Center for Grieving Children.

    Maple Knoll Village (MKV) is a continuing care retirement community in Cincinnati with support for seniors ranging from independent living to nursing home care. During the two week rotation, pediatric palliative care fellows will work with geriatric medicine physicians and the IDT at Maple Knoll Village to learn principles of caring for end stage dementia and other chronic diseases in the elderly, and to understand policies and procedures for integrating hospice care into the nursing home setting. As pediatricians in a geriatric care environment, the level of responsibility for participating in patient care activities will be tailored to each fellow’s level of experience and comfort working with seniors, but will be focused primarily on direct observation of patient care, and communicating with patients and families with one-on-one precepting from geriatric medicine or adult palliative care faculty. Learning activities will include participation in:

    • Weekly palliative care IDT meetings
    • Daily patient care rounds in the nursing home
    • A Geriatric Evaluation Center patient evaluation
    • Direct observation of outpatient geriatric patient visits
    • Direct observation of hospice nursing visits in the nursing home
    • Family care conferences

    St. Joseph Home for Children is a residential intermediate care facility (long-term care) serving children and adults with severe disabilities. There are 48 children and adults who live in this facility with varying medical and developmental concerns and varied quality of life issues. Approximately 75% have advanced directives with do not resuscitate orders.

    This clinical rotation would provide a community-based experience that allows fellows to learn more about quality of life, functional capacity, psychosocial, and emotional supports faced by children and young adults with severe disabilities and their families. It also provides a forum to understand inter-disciplinary models of care (direct care staff, nursing, OT, PT, speech/pathology, nutrition, psychology, and medicine) and how the effective communication among disciplines can enhance the quality of life of children with complex needs. This rotation will involve two half days per month and occur over the course of the fellowship to provide a longitudinal/continuity experience.