The University of Kansas Health System, University of Kansas Hospital, Cambridge Tower A

Adult Fellows will have the opportunity to round at the VA and The University of Kansas Health System. Each offers opportunities for exposure to inpatient palliative care in varied settings. 

Patient Care

Fellows see a broad range of patients. Fellows will have opportunities to see patients from all ICU settings (medical, cardiac, surgical, neurosurgical, trauma, burn), medicine floors, and oncology floors to name a few. Fellows will have significant interaction in the ICUs and gain experience in facilitating emotional and interprofessional discussions. "Goals of care" consults range from patient/family support through aggressive trials of intervention to management of the natural dying process with a purely comfort-directed approach. There is also exposure to helping in decision-making process, logistics, and management of patients in removal from artificial life support.

Team Dynamics

There are seven rounding consult teams -- 6 general palliative care and 1 palliative heart failure --on service during weekdays. Each core team consists of an attending physician, an advanced practiced provider or nurse, and a social worker. The hospital staff chaplains also support the teams. Physician learners present on the service may include fourth-year medical students, senior residents and fellows; with no more than two physician learners per team present at any given time. Additionally, a variety of nursing, social work, pharmacy, or clinical pastoral education residents rotate on the service. If interested, the fellows will have opportunity to practice educational leadership serving in a supervisory role with learners rotating on the service.

During rotations with the palliative care consult services, the fellow participates in the daily operations of the interdisciplinary team. This includes seeing new consults as well as following up on patients with the interdisciplinary team (palliative care attending, the rounding clinical nurse specialist, and the dedicated social worker).

At each site, the fellow is integrally involved in whole patient care. This can often be involvement of symptom management, patient/family meetings, formulation of goals of care, and navigating the medical system to facilitate safe disposition. The fellow will maintain a continuity of patient care throughout the hospital stay and may follow the patient either in fellow outpatient clinic, home hospice, or inpatient hospice.

Growing to Autonomy

As the year progresses, the fellow gains graduated autonomy. By the end of fellowship, a fellow will achieve a leading role for their patients in formulation of treatment plans, communication between team members, and communicating with consulting physicians regarding patient care recommendations. This increasing autonomy is achieved in the second half of the fellowship. The fellow will serve as the lead physician on one of the inpatient teams and during this time there will be a faculty member providing direct and indirect supervision. Fellows will also eventually lead interdisciplinary rounds with the pertinent floor nursing, social work, and ancillary services daily as needed for each patient.

Collaboration with Staff

Finally, the fellow participates in the weekly interdisciplinary care team conference where patient care plans are discussed in detail and where the team debriefs on difficult/meaningful events. These are crucial skills to continue to develop to work towards efficient and effective collaboration with an interdisciplinary team.