Hospice & Palliative Medicine Curriculum

Inpatient Palliative Medicine blocks will be spent on the main Gundersen Health System Campus in La Crosse, Wis. As part of an interdisciplinary team providing consultative services and primary end-of-life care, you will: 

• Gain autonomy and demonstrate competence in patient and family-centered care; 
• Accept new consults from our referral sources and discuss them with the interdisciplinary team; 
• Participate in care conferences, lead family meetings, assist with advance care planning documentation and provide symptom management for our patients; 
• Work closely with the intensive care team to perform palliative extubations, both in the ICU and the OR for potential organ donation; 
• Provide comfort-focused care at the end of life for those patients who have symptom-management needs that preclude them from leaving the hospital; 
• Care for hospice patients that meet the General Inpatient or Respite levels of care; and 
• Perform telemedicine consultations to Gundersen Health System’s critical access hospitals in the tri-state area.

The Palliative Clinic blocks and the continuity clinic will be spent at the Palliative Clinic on Gundersen Health System’s main campus in La Crosse, Wis. You will: 

• Provide consultative services for patients with a broad range of medical backgrounds who are in various stages of their disease processes;  
• Assist with goals of care discussions, advance care planning documentation completion and symptom management; 
• Work as part of an interdisciplinary team that provides patient and family-centered care;  
• Perform co-visits with medical oncology, telemedicine visits and virtual visits; and  
• Develop a panel of patients that you will follow throughout the year in your half-day continuity clinic.

The Hospice block will be spent with a community-based hospice program at Gundersen Health System’s main campus in La Crosse, Wis. You will:  

• Work closely with the medical director to learn the roles and responsibilities of a hospice medical director; 
• Work as part of an interdisciplinary team, including RN (registered nurse), hospice aide, chaplain, SW (social worker), Music Therapy and Massage Therapy, to ensure excellent patient care at the end of life; 
• Provide symptom management, family support and family education throughout the dying process; and 
• See patients in their homes, at assisting living facilities, at nursing facilities and in the hospital to address symptom management needs, develop treatment plans and participate in family conferences.  

You will spend 1 block with the Adult Hematology & Oncology team. This will be a blended rotation where you will spend 2 weeks in the hospital on a consultative service and 2 weeks in the clinic setting, where you will: 

• See new and established patients alongside the attending physician; 
• Learn the presentation, prognostication, treatment options and their side effects for common malignancies;  
• Learn how to work as part of a multidisciplinary care team to ensure excellent patient and family-centered care; and  
• Participate in multiple tumor board discussions.  

• Work alongside their attendings to learn the presentation, prognostication, treatment options and their side effects for common childhood malignancies; 
• Develop the skills necessary to include the pediatric patient and their surrogate decision-maker in conversation and decision-making; 
• Learn about concurrent palliative and life-sustaining treatment and the unique aspects of hospice in the pediatric population; and 
• Gain experience in managing pain and other non-pain symptoms in the pediatric population.

• Receive a well-rounded education focused on common severe pediatric conditions; 
• Receive didactics on common pediatric hospice and palliative medicine conditions; 
• Attend rounds and participate in family conversations alongside their attendings; 
• Work alongside the child-life specialists; and 
• Gain experience in providing life support to critically ill pediatric patients and having difficult conversations with the patient’s surrogate decision-makers.

You will spend 1 month in community nursing facilities, where you will: 

• Gain experience in caring for geriatric patients; 
• Spend 2 weeks with the geriatrician where you will round on patients, discuss and develop treatment plans, and learn the policies/procedures/regulations unique to nursing facility care; 
• Gain a greater understanding of geriatric syndromes, including delirium, cognitive impairment and dementia, gait disorders, falls and polypharmacy; 
• Learn how to distinguish frail from healthy older adults and their differing levels of vulnerability;  
• Learn how the care of older adults evolves from an intent that is curative to a strictly palliative intent;  
• Spend 2 weeks with the interdisciplinary hospice team where you will participate in the care of hospice patients who reside in a nursing facility; and 
• Gain experience in symptom management, end-of-life care and the education of the patient, family and staff on what to expect in the dying process.

You will be expected to complete at least 1 academic project during your fellowship training.

You will have 2 blocks of elective time that can be spent doing a research project or spending time in a department that will help you achieve your goals and objectives. Options for electives include, but are not limited to, clinical ethics, physical medicine & rehab, and pain clinic where you learn more about interventional pain management.