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Graduate Medical Education at NewYork-Presbyterian/Queens | Salary and Benefits | Policies and Procedures | Graduate Staff Agreement | Patient Simulation Center | Lang Research Center | Queens: Our Community
The NewYork-Presbyterian/Queens Hospice and Palliative Medicine Program (HPM) is a 1 year, multi-site program, with rotations at NYP/Queens, Silvercrest Center for Nursing and Rehabilitation and the Visiting Nurse Service of New York. The program accepts 2 fellows each year. The HPM Fellowship is one of the 6 fellowships at NYP/Queens. NYP/Queens is an affiliated teaching hospital of Weill Cornell Medical College, and offers fellowships in Cardiology, Pulmonary/Critical Care, GI, Renal and Infectious Disease. Our Program aim is to train strong clinician educators that will become future leaders in the field. Fellows will work closely with our Interdisciplinary faculty in an academically strong learning environment. Fellows will also have the opportunity to attend monthly Interdisciplinary Conferences at the Liz Claiborne Center for Humanism in Medicine at New York Hospital/ Weill Cornell Medical College. An elective 1 month Pain and Palliative Medicine Rotation will also be offered at Memorial Sloan Kettering Cancer Center.
Goals of the Program
The primary goal of this one-year Hospice and Palliative Medicine Program is to train future clinical palliative care physicians with an interest in academic medicine, especially clinician educators. This program is outstanding in its breadth and diversity of its educational experiences, training sites, and faculty.
1. Clinical: Fellows are expected to acquire clinical expertise in providing patient centered care for patients who are seriously and/or at the end of life, and their family/caregivers. With supervision from dedicated interdisciplinary preceptors in multiple clinical settings, fellows will acquire skills that span the continuum of care for seriously ill patients: acute care hospital (Inpatient Palliative Care Consults Service and ICU rotation), skilled nursing facility/ Nursing home with ventilator unit (Silvercrest Center for Nursing and Rehabilitation), outpatient practice (Palliative Care Clinic and Oncology Clinic), the patient’s home (VNSNY home hospice rotation), and inpatient hospice unit (VNS Hospice). All settings are geographically convenient, yet set in ethnically distinct communities. Faculty members include Board Certified specialists in Palliative Care, Geriatrics, interdisciplinary faculty (Nursing, Social work, Speech and Swallow Therapy, and Chaplains) and subspecialties (Oncology, Pulmonary Medicine, Critical care).
2. Education/Teaching: Fellows will participate actively in a variety of educational experiences, including journal club, fellow-led presentations and conferences, didactic lectures and monthly conferences at the Liz Claiborne Center for Humanism in Medicine at New York Hospital/ Weill Cornell Medical College. The goal is to build on fellows’ knowledge and skills in disseminating knowledge about Hospice and Palliative Medicine, medical education, and community/public education. Fellows will take an active role teaching internal medicine residents, medical students, and interdisciplinary team members.
a. Hospice and Palliative Medicine (HPM) Fellows will actively supervise and teach all senior medical residents during their mandatory geriatrics/palliative care rotation (4 weeks).
b. HPM Fellows will provide noon conference presentations to medicine residents through a faculty-fellow co-teaching model.
c. HPM Fellows will have the opportunity to provide community education about Hospice and Palliative Medicine topics to local residents.
3. Research/Performance Improvement: The fellow will participate in research and performance improvement projects. All fellows are expected to participate in a research project related to their area of interest, and present an abstract at the Annual meeting of the American Academy of Hospice and Palliative Medicine (AAHPM) or a similar meeting. Fellows will actively participate in unit-based performance improvement projects both at NYP/Queens and Silvercrest.
Training Sites and rotations:
1. NewYork-Presbyterian/Queens: NYP/Queens is one of the major teaching hospitals of Weill Medical College of Cornell University and a member of the NewYork-Presbyterian Health System. It has 519 beds and annual discharges of 24,000 in the Dept of Medicine (DOM). Our Hospice and Palliative Medicine fellowship will be part of an ethnically and socioeconomically diverse community that NYP/Queens serves. NYP/Queens has achieved a standard of excellence by The Joint Commission (TJC) for cultural competence. Queens is one of the most diverse communities in the US. Racial and ethnic minority groups, e.g. African American or Black, Asian, Hispanic, account for 60% of the total population. Approximately 2 out of 5 patients are foreign-born. They come from 100 countries and speak more than 120 languages and dialects. The fellow will participate in interdisciplinary team rounds and provide palliative care consultation to patients of other services under the supervision of palliative care and geriatrics attendings. Fellows will learn how to evaluate and manage common medical and psychosocial problems of acutely hospitalized patients, to coordinate the care and plan the discharge of complicated seriously ill patients, to provide optimal pain management and communicate effectively with the patients, families and other teams involved in the patient’s care, and other aspects in Inpatient Palliative Medicine. During the NYP/Queens rotation, fellows also conduct journal clubs and teach housestaff about Hospice and Palliative Medicine topics during noon conferences. Fellows will also rotate in the Intensive Care Unit (ICU), participating in ICU interdisciplinary rounds and providing Palliative Medicine consults to critically ill patients under the supervision of an attending physician.
2. Visiting Nurse Service of New York (VNSNY) Home Care and Hospice: The HPM Fellows will have experience in both inpatient and home hospice through our affiliation with the Visiting Nurse Service of New York (VNSNY) Home Care and Hospice. Fellows will participate in home visits and interdisciplinary team (IDT) meetings at the VNSNY Hospice. At these IDT meetings, each patient’s individualized care plan is reviewed and revised. The fellows will participate in supervised home visits with a hospice physician and/or other interdisciplinary team members, including registered nurses who are certified in hospice and palliative care, medical social workers and chaplains. Hospice home care patients are located in private houses and apartments as well as senior independent living and assisted living facilities, lending exposure to varied populations and pathology. Fellows will do home visits and participate in IDT meetings at the VNSNY Pediatric Palliative Care service, providing exposure and experience in the interdisciplinary care of seriously ill children. HPM fellows will also rotate in the 25-bed inpatient hospice unit at VNSNY Hospice (Haven Unit - Bellevue Hospital), where they will participate actively in patient assessment and management, family education and IDT meetings.
3. Silvercrest Center for Nursing and Rehabilitation (SCNR): The 320 bed Silvercrest Center for Nursing and Rehabilitation (SCNR) (www.silvercrest.org), located approximately 3 miles from the NYP/Queens main campus, provides the HPM Fellow with ample exposure to all facets of geriatric skilled nursing care. SCNR provides multiple services, including subacute rehabilitation, an 80 bed ventilator program, dementia unit, and long term care for elderly and functionally dependent persons. Fellows activities will include Palliative Care consults, rounds with an attending physician, interdisciplinary rounds and meetings, and patient and family meetings. All aspects of this long term care rotation will be mentored by an attending physician and the long term care facility team, which includes Social Worker with ethics expertise, Speech and Swallowing Therapist, RN's. The teaching will be focused on identifying and transitioning appropriate patients to palliative and/or hospice care, as well as symptom control and psychosocial support.
4. Ambulatory care: We will have a palliative medicine ambulatory care clinic at NYP/Queens’s Ambulatory Care Center. Patients can be referred for Outpatient Palliative Care Consultations from other services, and patients who are discharged from the hospital. The diagnoses of patients referred and followed in the clinic will include: advanced heart failure, a variety of cancer diagnoses, neurodegenerative diseases, advanced lung disease, and end-stage renal / liver failure. HPM fellows will be supervised by an attending physician and will learn the treatment of symptoms that are prevalent in the above life-threatening medical conditions. In this clinic the fellows will learn about communication strategies, outpatient symptom management, and community resources.
5. Memorial Sloan Kettering Cancer Center (MSKCC): Elective rotations will be offered in Pain Medicine/Palliative Medicine at the internationally renowned Memorial Sloan Kettering Cancer Center (MSKCC), which is the world's oldest and largest private cancer center, having devoted more than 130 years to exceptional patient care, innovative research, and outstanding educational programs. MSKCC is one of 41 National Cancer Institute–designated Comprehensive Cancer Centers.
6. Oncology Clinic/ Queens Medical Associates: Queens Medical Associates (QMA) is a large Hematology and Oncology Center affiliated with NYP/Queens serving an ethnically diverse patient population. QMA communicates with patients in five official languages: English, Spanish, Chinese, Korean and Russian. Beyond their official languages, over 50 languages and dialects are spoken by their staff. The fellow will interact with several disciplines while evaluating patients at the medical oncology clinic: genetic counselor, pharmacy, research, social work, and MD Nutritionist. The fellow with evaluate patients with the supervision of the Oncology attending and will participate in educational case discussions with the other disciplines.
7. Additional elective rotation opportunities: Additional NYP/Queens elective opportunities that will be offered include rotations in Oncology, Radiation Oncology, Neurology, Geriatrics, Long term Care, Ethics, Physical Medicine and Rehabilitation, Critical Care, Addiction Clinic, Research and Quality Improvement, depending on availability of each service.
8. Clinical Research experiences: Our division actively participates in clinical research. Examples of our studies include effect of a unit based interdisciplinary pain improvement team on HCAP scores and patient experience, survival time and mortality of ventilator dependent patients who undergo palliative extubation, educational needs and outcomes of house staff and nursing in discussing preferences for cardiopulmonary resuscitation, effect of a palliative care program on tracheostomy volume, and others. Fellows will have the opportunity to help write protocols, enroll patients/subjects for human research, develop and maintain databases, and study the patients from the beginning to the end of the protocol with mentorship by an attending physician.
In summary, we will provide a well-rounded Hospice and Palliative Medicine fellowship experience, with strong palliative care training and exposure to Geriatrics, with a full spectrum of clinical sites, diverse patient populations, and team based approach. In addition, we support fellows in their research and teaching activities. We are fully invested in the success of our Hospice and Palliative Medicine fellows.