Nuvance Health Hospice and Palliative Care Fellowship at Vassar Brothers Medical Center

Thank you for exploring this rewarding field and a fellowship in Hospice & Palliative Medicine (HPM). Having been an HPM fellow myself, I’m passionate about creating a fantastic experience for our fellows. This field is continuing to experience rapid growth nationwide, with extremely high demand for new, board-certified Hospice & Palliative Medicine physicians, especially locally in the Hudson Valley and Western Connecticut. Now is certainly the time to explore this highly rewarding field, allowing the clinician to know patients and their families in unique detail and truly provide patient centered, high-quality, personal care. Meeting patients at often intense and emotional times in the course of serious illness can provide clinicians with personal meaning and career fulfillment.

The Fellowship is based out of Vassar Brothers Medical Center (VBMC) in Poughkeepsie, NY. A robust and busy inpatient Palliative Medicine Consult Service is already thriving at VBMC, meaning a fellow will drop into a strong and busy inpatient Palliative Medicine experience. With plenty of patients to learn from, VBMC provides an ideal site to learn the art and science of communication and pain and symptom management. The fellow will see patients with advanced, serious, chronic illness across a full and extremely diverse array of diseases. From medical and surgical floors to the intensive care unit, to the emergency department, fellows will greet patients across the hospital and have the potential to follow patients on their journey, also seeing patients in the outpatient setting and under hospice care.

Our outpatient Palliative Medicine experiences are also based at VBMC, with outpatient palliative care clinic time established in the Dyson Cancer Center and the Heart Center. These growing outpatient programs will offer fellows the opportunity to follow patients experience with illness over time, while managing pain and symptoms, improving quality of life, participating in advance care planning, and making referrals to hospice care. Partnering with Hudson Valley Hospice, a large local hospice of over 35 years, fellows will learn the ins and outs of hospice care. Fellows will see patients in the home setting and in a brand new, state-of-the-art, free standing hospice inpatient center. Caring for patients under hospice care provides fellows with an enriching experience in caring for the dying and making their final days better. Our pediatric and long-term care rotations are combined into one block at Elizabeth Seton Children’s Center in Yonkers, NY. Fellows will join the Palliative Care team at this beautiful rehabilitative facility, learning all aspects of pediatric palliative care as well as being exposed to palliative music therapy, art therapy, and so much more.

The Fellowship also provides opportunities to focus on palliative topics such as medical oncology, radiation therapy, interventional pain management, and geriatric psychiatry. Additional elective inpatient and outpatient palliative medicine experiences can be arranged through Nuvance Palliative Medicine Programs in Danbury and Norwalk, CT. Ample elective time is provided to give fellows the option of personalizing some of their time to best meet their personal interests and career needs.

We look forward to discussing this rewarding opportunity with you further!

Vassar Brothers Medical Center (VBMC) is a 350-bed facility that has served New York’s Mid-Hudson Valley since 1887. VBMC includes 294 private patient rooms, 13 surgical suites, and a 66-room emergency and trauma center. VBMC is part of the larger Nuvance Health system, a network of seven hospitals and numerous outpatient facilities throughout the Hudson Valley and across western Connecticut. Thus, our patients benefit from the various services and multispecialty groups across the health system. The Palliative Care team consists of expert physicians, advanced practice nurses, social workers, and chaplains who provide high-quality and compassionate care to patients.

As the primary clinical training site for the Hospice and Palliative Medicine (HPM) Fellowship Program, VBMC provides fellows with high quality training experiences and unique educational opportunities that will fully prepare them for independent practice upon graduation. The Program Director and clinical faculty will provide appropriate supervision for fellows in the Hospice and Palliative Medicine Fellowship Program. The Site Director and Program Director, Dr. Brian Murphy, is board certified in Family Medicine by the American Board of Family Medicine (ABFM) and Hospice and Palliative Medicine by the American Board of Family Medicine (ABFM).

During their inpatient rotations fellows will see patients across all hospital settings. Fellows have the opportunity for rotations in the following services at VBMC: Medical Oncology, Radiation Oncology, and Interventional Pain Management. Block rotations include time with Hudson Valley Hospice, a pediatric palliative care and rehabilitative care experience with Elizabeth Seton’s Children Center in Yonkers, NY, and an inpatient geriatric-psychiatry experience at Sharon Hospital in CT.

All participating sites for the Fellowship are located in the Hudson Valley region and offer a patient population that is diverse and representative of the diagnoses and palliative care needs for training, including patients with varied socioeconomic and cultural backgrounds. Fellows will rotate through multiple participating sites including adult, geriatric, and pediatric populations, offering a range of diagnoses and care needs. Our fellows will gain appropriate competency in caring for the broad range of patient populations and their common to complex diagnoses, including their palliative care needs associated with their advanced acute and chronic conditions. Nuvance Health operates within a growing community hospital system to provide patient-centered care and serve the diversified communities in the area. The Hospice and Palliative Medicine Fellowship Program allows fellows to experience the continuation of care provided in hospital, home hospice, and outpatient palliative care services in the area.  This provides a greater clinical and educational training experience for the fellows.

During these experiences, fellows will develop expert skills in planning and implementing care plans that are specific to each patient’s needs, as well as those of their families and caregivers. Fellows will elicit and then match a patient’s goals for their healthcare and life with an appropriate plan of care, accounting for social and family situation, disease burden, symptom management, and prognosis.  All participating sites will offer fellows uninhibited access to a diverse patient demographic. These various locations will provide ample clinical encounters where they will develop the ability to collaborate with other specialties through a variety of hands-on experiences.  All required rotations are fully offered including Inpatient Palliative Medicine Consult Service, Hospice Care, Pediatrics, Long-Term Care, and Continuity/Longitudinal Clinic.   In addition, focused experiences are offered, including Inpatient Geriatric-Psychiatry, Medical Oncology, Radiation Oncology, and Interventional Pain Management.  To ensure fellows can build expertise related to their own unique career needs, a full 8 weeks of elective time is offered.

SCHEDULE AT A GLANCE:

Thirteen 4-Week Blocks- Rotations

• 5 blocks – Inpatient Palliative Medicine Consult Service
• 3 blocks – Hospice
• 1 block – (of two 2-week sections) – Geriatric-Psychiatry & Interventional Pain Management
• 1 block – Pediatrics & Long-Term Care
• 1 block- Medical Oncology and Radiation Oncology
• 2 blocks – Elective Time

In the inpatient acute care setting, fellows will be provided with exposure to a patient population representing diverse cultures, backgrounds, socioeconomic statuses, and gender identities. During this rotation fellows will be able to expand their knowledge base and expertise in the management of patient symptoms, efficient communication, interdisciplinary teamwork, and teaching/mentorship. Fellows will have the following experiences while assigned to the Inpatient Palliative Medicine Consult Service at Vassar Brothers Medical Center:

1. Inpatient consults and follow-up for the palliative care patient
2. Inpatient hospice care
3. Participation on the Ethics Consult Service
4. Interdisciplinary, team-centered care
5. Transition of care coordination

On the Inpatient Palliative Medicine Consult Service, fellows will obtain consultative experience with all types of Palliative Medicine diseases and conditions: including pulmonology topics such as COPD and pulmonary fibrosis, neurologic conditions such as stroke, Parkinson’s Disease, dementia, ALS, and MS, a wide range of solid and hematologic malignancies, trauma, and post-operative patients, ESRD, cardiac and valvular diseases, as well as metabolic, endocrine, and geriatric illnesses. Fellows will see new consultations daily with responsibility for patient follow-up during hospitalization. Fellows will be responsible for directing all palliative endeavors, including but not limited to communication with primary care team and consultative care teams as appropriate. Fellows will be directly involved in goals of care and code status discussions, as well as pain and symptom management under faculty supervision. In addition, the fellows will participate in referrals to hospice and oversee the care of hospice patients on general inpatient level of hospice care. Additionally, fellows will take a leading role in teaching medical learners of all levels rotating on the service.  During this time, Fellows with be involved with the Ethics Consult Service and participate in didactics and their longitudinal care clinic.

The fellows will be assigned to spend twelve weeks with the Hudson Valley Hospice. Fellows will be assigned to an interdisciplinary team and support the patients under that team’s care for the duration of their hospice rotations. Fellows will have experience in home hospice care, working with the team’s medical director and an interdisciplinary clinical staff including chaplaincy, social work, and nursing. Fellows will provide pain and symptom management and gain knowledge through exposure to end-of-life care that occurs in patient’s homes and the stand-alone, brand new, state-of-the-art hospice inpatient unit. Fellows will be provided education on and experience with the Medicare Hospice Benefit including regulations that pertain to physicians. Rotations are completed under the supervision of board-certified Hospice and Palliative Medicine Physicians.

These two required rotations have been merged into one unique experience at Elizabeth Setons Children Center in Yonkers, NY. This beautiful 196-bed children’s rehabilitation center provides fellows with experience in providing palliative care to patients from not long after birth through to the teenage years.  Assigned to the facility’s palliative care team, the fellows see patients under the supervision of the medical director.  Patients at the facility have a wide range of illnesses and conditions, including patients with chronic ventilators, feeding tubes, and other complex therapeutic treatments.  Teaching at the facility will include patient care and didactics focused on working with pediatric patients with chronic, serious, debilitating diseases, and end-of-life care. This unique experience will include immersion into important adjuvant palliative care therapies such as music therapy, art therapy, spa therapy, and work with child life specialists and pediatric grief and bereavement.

The fellows will also have the opportunity to obtain more focused in-depth experience during other rotations.

The inpatient geriatric psychiatry rotation provides the fellow with significant experience managing and prescribing medication for agitation, delirium, and dementia patients with behavioral issues.  Focus will include behavioral and care techniques as well as medication to improve the quality of life and functioning for these patients.

During one block rotation, fellows will have more in-depth experiences in oncology and pain and symptom management.  Fellows can explore medical and radiological treatments, including efficacy and side effects by working with teams from Medical Oncology and Radiation Oncology. Fellows will experience diverse tumor board meetings to understand the proposal and review of treatment options for patients with diverse malignancies and also participate in discussions of high-risk oncologic patients.

The fellows will also work with a physiatrist who specializes in interventional pain management techniques.  Fellows will see patients in that office and see actual procedures in the operating room as well, to fully understand interventional options available to palliate various pain disorders that our palliative care patients experience.

Finally, the fellows are provided with 8 weeks of elective time to allow fellows to focus on their own unique educational and learning needs.  Electives can include time at other hospital inpatient palliative medicine consult services, time with hospice, and/or more time with any of the rotations.  Electives are open to the creativity of the fellow.  The elective’s goals and objectives and the elective itself must be reviewed and approved by the Program Director.

Throughout the fellowship program, fellows will be assigned to one half-day of ambulatory palliative clinic for a minimum of 6 months of the year. The ambulatory Palliative Care clinic is embedded in the Dyson Oncology Center. Fellows will have educational and clinical experiences in Palliative Care patients with oncological as well as other palliative conditions. Fellows will be responsible for seeing new and follow-up Palliative Medicine patients in the ambulatory palliative clinic, providing direct clinical care as an outpatient to ambulatory patients with a diverse grouping of oncologic, pulmonary, cardiac, and neurologic conditions, among others. The focus of the experience will be on pain and symptom management, as well as discussions of advance directives and goals of care.  A second palliative clinic experience is now being developed with The Heart Center for those with advanced cardiac illness.

Journal Club will occur every month during the Hospice and Palliative Medicine Fellowship. Faculty and fellows will choose an article relevant to current patient care scenarios and present this article to the group of fellows and faculty. The fellow will then guide a discussion regarding the merit of the research as well as potential implications for patient care.

Fellows will have dedicated time one-half day per week fully devoted to didactic learning sessions and time set aside for research, quality improvement projects, and publication interests.  Didactics will cover the gambit of palliative topics from pain management 101 to ketamine, from symptom management of nausea to constipation and pruritis, from communication 101 to evidence-based tips on managing conversations, and from self-care to compassion fatigue.  With this dedicated time, fellows can work on case reports or other publications, submissions of poster presentations or to speak at conferences, and original research or quality improvement projects too.

The Nuvance Health Hospice and Palliative Care Fellowship Program at Vassar Brothers Medical Center thanks you for your interest in applying to our program. We accept all applications through ERAS only and participate annually in the NRMP Match Program. We hope you choose to join us.

Requirements: The following items are required for consideration of interview. All items must be received through ERAS application portal:

• Personal Statement
• Current CV
• 3 Letters of Recommendation
• USMLE Step 1 CK or COMLEX Level 1 Score
• USMLE Step 2 CS or COMLEX Level 2 PE Score (we understand that due to COVID-19 and USMLE changes some people may not have been able to take CS or PE)
• USMLE Step 2 CK or COMLEX Level 2 CE Score
• USMLE Step 3
• Program Director’s Letter (for new or recent graduates)