EXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE IN PALLIATIVE MEDICINE

1. EXPERIENCE BASED CURRICULUM TO ACHIEVE COMPETENCE IN PALLIATIVE MEDICINE RODNEY TUCKER, MD PALLIATIVE MEDICINE FELLOWSHIP DIRECTOR UAB CENTER FOR PALLIATIVE CARE

2. OBJECTIVES • Introduce the evolved process of developing a traditional experience-based curriculum to achieve competence in palliative medicine • Review a tailored training sequence for a 12 month fellowship emphasizing increasing autonomy • Description of UAB site specific rotations and subsequent assessment methods • Future challenges

3. History of the UAB PMFTP • First fellow completed training in 2000 • Currently training 9th and 10th fellows • 100% ABHPM pass rate (6/8 have taken) • 9/10 faculty are ABHPM certified (6/10 faculty also boarded in Geriatrics) • Received 2 year AAHPM and NHF award in 2005 • ABHPM voluntary accred in 2006

4. Christine Ritchie, MD Director of Center for Palliative Care Rodney Tucker, MD Medical Director- UAB PM Programs Amos Bailey, MD Medical Director- BVAMC Safe Harbor Elizabeth Kvale, MD Out-patient Medical Director Cynthia Baker, MD Charlotte Williams, MD Carol Griffin, MD Tracey Humbert, MD Sandra Broeren, MD Heather Herrington, MD Palliative Care Section

5. Experience Based- What does that mean to us? • Rotational, didactic, and special seminars designed to expose fellows to a wide variety and mixture of clinical and classroom experiences necessary to achieve competence in palliative medicine domains

6. STEP ONE Determine core experiences to provide clinical opportunities for training purposes

7. In-patient PM consultation UAB PM Consult Service BVAMC PM Consult Service Children’s Hospital of Alabama PM consultation In-patient care UAB Palliative and Comfort Care Unit BVAMC Safe Harbor Unit 6-8 months per year Interdisciplinary team focus Rotational experiences

8. Out-patient Continuity clinics (Average one clinic per week) UAB Supportive and Palliative Care Clinic 2 sessions per month UAB HIV/AIDS Treatment Clinic 2 sessions per month BVAMC clinic consultation service 12 months continuity experience Development of own patient population Multi-disciplinary team Rotational Experiences

9. Rotational Experiences • Out-patient/ Home Hospice • Community Based Hospice Organizations with educational agreements • 2-3 months/year- Focused rotation • Ongoing Hospice Patient management by fellows with 12 month continuity • IDT focus • Majority observed home visits done during these months

10. Rotational Experiences • Pain management rotation • Out-patient and in-patient interventional focus • 1 month per year • Undisciplinary with some IDT component in out-patient section

11. Rotational Experiences • Elective • Fellow specific depending on area of interest • Can be Heme/Onc consult, Geriatric Psychiatry, long term care setting, Neurology, clinical visitorship to another institution, research and writing, etc. • Specific career objectives • One month/year

12. STEP TWO Determine core subject matter and format in which to cover topic areas in palliative medicine knowledge domain

13. Core Didactics • UNIPAC “Crash Course”- Covered by program director in July- Tucker • Classic article readings- Discussion lead by faculty and guests • Once weekly/ led by Fordham, et al • Directed readings- Assigned text readings (Oxford and Palliative Care & Supportive Oncology) and discussion with attendings • Once weekly/ led by Bailey, et al

14. Core Didactics • Fellows Case Conference- Case presentations with pertinent article centered on symptom managment, ethics, or self care • Once monthly, Interdisciplinary • Palliative Medicine Journal Club- Critical review of current literature articles using standard review instruments (Consort, etc.) • Once monthly, casual setting- Led by Kvale, et al • Interdisciplinary

15. STEP THREE Determine supplemental activities to cover gaps or expanded topics in palliative medicine

16. Palliative Care Research Forum • Discussion time for PM faculty, visitors, fellows, and other housestaff to discuss potential or ongoing research topics • Twice monthly, optional for palliative care fellows • Multidisciplinary

17. 2-3 hour focused seminars/workshops Mandatory attendance Topics: Communication Style Preference and How to Adapt Academic Presentation Skills Topics: Hospice Financing and Administration Building the Case for a Palliative Care Program Research Funding and Grants 101 Media Relations & Advocacy Special Seminars

18. STEP FOUR Match each activity with ACGME Competency Domain

19. Curriculum & Competency Cross Checklist • Matches each activity/topic/seminar with ACGME competency domain • Defines global objectives for each activity • See attached example

20. STEP FIVE Determine appropriate training sequence progression

21. Training Sequence for progressive fellow autonomy and responsibility • See attached training sequence • Divided into three sections to assist in providing theoretical structure to training experience • 1st sequence: Months 1-2 (Observe and question) • 2nd sequence: Months 3-6 (Observe, question, initiate) • 3rd sequence: Months 7-12 (Initiate, question, complete) • Reviewed with fellows at onset of program and at each quarterly review

22. STEP SIX Determine and Refine evaluation processes and assessment tools

23. Monthly fellowship & education committee meeting that reviews fellow progress Monthly Preceptor evals- All faculty Monthly Rotation evals- All fellows Quarterly documentation review- Program Director Seminar evals Filmed media interview Procedure logs for home visits, IDT leadership, first 25 consults and family meetings, vent withdrawals, palliative sedation, paracentesis In-service exam at 6 & 12 months Grand Rounds presentation-Once year End of year global program evaluation Evaluation/Assessment Tools Current status

24. STEP SEVEN Pray that all this will satisfy ACGME requirements

25. Evaluations and Assessements for the future • 360 degree evaluation to include members of IDT • Direct observation exercise (CEX) • Filmed mock patient • Selection of two assessment methods for each domain