OCOM 8119 - Internal Medicine Subspecialty - Hospice and Palliative Medicine

After completing one required four-week rotation in General Internal Medicine, students must complete an additional eight weeks of internal medicine selectives. These selectives may consist of two-, three- or four-week rotations in a subspecialty approved by the American Board of Internal Medicine. Recently the Board has approved Hospice and Palliative Medicine as a subspecialty, so this selective is being added to the options available to students. The purpose of the Hospice and Palliative Medicine (HPM) rotation is to provide the student with an overview of hospice care and palliative medicine. The student is expected to encounter the following diseases and conditions on the rotation: End-Stage chronic obstructive pulmonary disease (COPD) End-Stage congestive heart failure (CHF) Aspiration Pneumonia Altered mentation/delirium/dementia Severe coronary artery disease (CAD) Palliative management of surgical patients End-Stage Renal failure/dehydration Uncontrolled diabetes mellitus Stroke Sepsis End-Stage Pancreatitis Stage IV Cancer

Credit Hours: 4-8

Course Outcomes

Acquire the technical, clinical, and interpersonal skills important in palliative and end-of-life care.
Anticipate medicine adjustments for the patient entering into renal failure and/or heart failure which is common in the HPM patient population.
Assess presenting symptoms of the HPM patient.
Become familiar with appropriate use of opioids and benzodiazepines.
Become familiar with the medications used in HPM care including side effects, contraindications, and drug-to-drug interactions.
Communicate effectively with HPM patients, their families, unit personnel, and medical staff.
Describe the history of HPM in the United States.
Describe the unique contribution to the patients care by the social worker, chaplain, aides, nurses, and medical staff.
Develop a pharmacological and non-pharmacological approach to control the patients symptoms.
Develop a plan of care for a HPM patient that takes into consideration the physical, emotional, and spiritual needs of the patient.
Develop skill in assessing patient prognosis.
Discuss the scope of care and responsibilities of HPM
Efficiently and effectively assess the HPM patient and be able to decide if the patient should be admitted to the inpatient unit, followed at home, or admitted to a long term care facility.
Gain an appreciation of palliative and end-of-life care, including interactions with the patient and family.
Interact with the HPM unit personnel as a team member respecting each members special contribution in the holistic approach to every patient.
Know the definitions and implications of Advance Directives for the HPM patient and become familiar with Do Not Resuscitate Comfort Care (DNRCC), Do Not Resuscitate Comfort Care Arrest (DNRCCA), Physician Orders for Life-Sustaining Treatment (POLS
Know the role of steroids in the HPM patient, especially those with primary or metastatic lesions in the brain.
Manage opioids and converting one opioid to another.
Order appropriate lab and radiological studies for the HPM patient taking into consideration the unique Medicare reimbursement.
Recognize HPM emergencies.
Recognize the various physical and psychological stages of the dying process and understand how to adjust the plan of care accordingly.
Review indications for feeding tubes/total parenteral nutrition.
Understand appropriate use of OMM in HPM.
Utilize OMM in the HPM patient to relieve symptoms and improve quality of life.