Hospice and Palliative Medicine Fellowship

Education and research | Fellowship training
Contact information | Application

Education and research

The Department of Hematology/Oncology and Palliative Medicine at the Virginia Commonwealth University School of Medicine offers a one-year fellowship training program in Hospice and Palliative Medicine. Our fellowship program is fully accredited by the American Board of Hospice and Palliative Care.

The Palliative Medicine fellow will learn palliative care techniques through direct patient care on the Thomas Palliative Care Unit, an 11-bed unit dedicated to providing state-of-the-art palliative care to patients with needs for pain and symptom control and end-of-life care. Home and nursing home hospice experience occurs on a regular basis through the area’s local hospices.

The Thomas Palliative Care Program, one of six national RWJ Palliative Care Leadership Centers, includes multiple interdisciplinary national experts, including three board certified Palliative Care Physicians. Thomas Smith, MD and Patrick Coyne, RN MSN, are Faculty Scholars in the Project on Death in America and experts in the fields of Pain and Symptom Management and Palliative Care. Laurie Lyckholm, MD, also a Faculty Scholar in the Project on Death in America, is the Fellowship Program Director, attends and provides didactic lectures and case discussions for the fellows on a regular basis. Cathy Kelso, MD is a geriatrician with a special interest in communication and will also attend and mentor the fellow. Sarah Beth Harrington MD is a general internist trained in Palliative Care, and has special interests in communication, outpatient Palliative Care, and chronic pain education. Bart Bobb, RN, ANP, is an accomplished clinician who provides ongoing instruction in patient consultation for pain and symptom managment. The Palliative Care fellows are taught not only by physicians and advanced practice nurses, but by nurses, social workers, pharmacists, physical and occupational therapists, chaplains, psychologists, pet and music therapists, volunteers from all walks of life, and ESPECIALLY by our patients. The Palliative Care fellows play a central role on this cohesive team that is defined by common goals and values and esprit' de corps.

The Palliative Medicine fellow will be involved in the Palliative Care Consultation Service and the Pain and Symptom Management Outpatient Clinic, which is staffed by the Palliative Care faculty as well as physicians specializing in pain management from Physical Medicine and Rehabilitation, who are experts in pain control, including physical interventions such as nerve blocks.

Each fellow spends 3 weeks/month at the medical center and one week/month participating in research and providing hospice care. Currently, the fellows work with Crater Hospice in Petersburg, VA, attending Interdisciplinary Team conferences, making home and nursing home visits, and providing care as the primary hospice physician for many patients in several Central Virginia hospice programs. Our hope is to expand to the McGuire Veterans Administration inpatient and home hospice programs.

The fellow is required to participate in a research project in the area of his/her choice, with mentoring by Palliative Care faculty and others in the Massey Cancer Center and Quality Medicine Division. Harrington. The fellow is provided with administrative support and protected time for these projects. The Palliative Care fellow will also be expected to educate Internal Medicine, Psychiatry and Geriatrics housestaff as well as medical students and other trainees.

Fellowship training

The VCU Hospice and Palliative Medicine Fellowship curriculum is focused on two domains that are involved in improving the quality of life for all patients, not just those at the end of life: (1) interpersonal communication and (2) pain and symptom management. The two domains are completely interdependent. Without interpersonal communication with regard to a patient’s goals, values and plans, excellent symptom management is not possible. And without optimum symptom management, the patient’s goals cannot be realized.

The palliative care curriculum at VCU is distinguished by several unique features:

1. The faculty consists of an internationally recognized leader in oncology and palliative care, Tom Smith MD, a world renowned pain specialist, Patrick Coyne RN MSN, as well as, geriatrics expert Cathy Kelso, MD and educational and ethics specialist, Laurie Lyckholm, MD
2. All medical faculty, Smith, Lyckholm and Kelso, are board certified (ABHPM) in Hospice and Palliative Medicine.
3. The VCU Palliative Medicine Fellowship Program is one of only 17 ABHPM accredited fellowship programs.
4. Smith, Lyckholm and Coyne are all Faculty Scholars in the Project on Death in America.
5. The Thomas Palliative Care Program is one of the initial 10 Millbank Pioneer Palliative Care programs in the country.
6. The Thomas Palliative Care Program is one of six RWJ funded Palliative Care Leadership Centers of the Center for the Advancement of Palliative Care (CAPC).
7. The Thomas Palliative Care Program is the recipient of the prestigious 2005 Circle of Life Award.
8. The VCU MCV campus launched a major “POUNCE ON PAIN” initiative during National Pain Awareness Week, Sept 19-23 in which hundreds of clinicians, patients and visitors alike were educated on multiple aspects of pain management.
9. The Palliative Care program provides the fellow with experience in continuity of care for patients across the continuum, from home to outpatient clinic to inpatient palliative care unit.
10. Pain management in the Thomas Palliative Care unit is interdisciplinary, including MD, MSN, Pharm D, RN, PT/OT, MSW, psychological counseling and pastoral care. It is at the cutting edge of technology, with multiple physicians and nurses trained in the use of epidural trials, ketamine, intravenous lidocaine infusions, use of the Medtronic Pump for intrathecal infusion of opioids, local anesthetic, clonidine and now ziconitide. Fellows are given intensive hands-on training in all these techniques and provide direct inpatient and outpatient care for patients managed by these techniques, as well as more conventional approaches with the use of a significant armamentarium of opioids and adjunctive therapies.
11. The fellow also participates in multiple patient and family encounters in which he/she directs discussions regarding goal clarification and end of life decision making.

Fellowship contact information

Program director

Laurel J. Lyckholm, M.D.
P.O. Box 980230
Richmond, Virginia 23298-0230
Phone: (804) 828-9723
E-mail: lyckholm@vcu.edu

Application

The fellow should be a MD or DO who has 3 or more years of residency training in an ACGME-accredited Internal Medicine training program. Applicants from neurology and PM&R may also be considered. Salary is commensurate with that of a PGY4 at our institution.

Please submit an application, CV, personal statement, and three letters of reference, including one from your residency program director. The application may be downloaded and printed out:

http://www.intmed.vcu.edu/home/images/fellowship_app.pdf

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2008/04/17