Hospice and Palliative Care Fellowship Program

Lincoln Palliative Care Services

Our Palliative Care Service is an interdisciplinary service for patients with advanced illnesses, and their families, dedicated to relief of suffering and improvement of quality of life. A primary goal of Palliative Care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative Care expands the traditional disease-model of medical treatments to include one’s goals, directives and also to address the spiritual and social needs of patients and their families.

Within the New York City Health and Hospitals Corporation, Lincoln is among the top providers of Palliative Care services. In 2024 Lincoln Medical Center took care of more than 125,000 Emergency Department visits, nearly 500,000 Ambulatory Care visits and almost 20,000 Inpatient Discharges. Our Palliative Care consultation service has been active since 2004 and has grown to seeing more than 1000 inpatients per year with an additional 800+ ambulatory care visits each year. Our training provides a wealth of clinical experience in the inpatient and outpatient settings as well as long term and hospice care.

The Hospice and Palliative Care Fellowship Program at Lincoln Health and Hospitals is fully accredited by the American Council of Graduate Medical Education (ACGME) and provides comprehensive post-graduate training in all areas of the Hospice and Palliative Care. Lincoln Health and Hospitals is located in the South Bronx (an area experiencing remarkable development and reinvigoration) and has long tradition of providing care to the underserved and the disadvantaged in the city of New York. Additionally, the Palliative Care program at Lincoln has been awarded certification as an Advanced Palliative Care Program by The Joint Commission since 2012.

Schedule and Rotations

The principal teaching methods of the Hospice and Palliative Care Fellowship program involve a combination of patient based encounters, clinical case discussions and a wealth of didactic conferences. In each patient encounter, there is a detailed discussion with an Attending Physician or a supervising provider. The didactic conferences similarly utilize a patient based approach to integrate the basic sciences of pathophysiology with clinical presentations and an evidence-based approach to diagnosis and management. It is our strong belief that this patient-based approach utilizing both individual and group teaching maximizes our educational efficacy.

Inpatient Consultation Service – Monday to Friday 8:00AM – 4:00PM

Outpatient Ambulatory Clinic – Half day, weekly sessions on Tuesday and Friday mornings at 9AM- Clinics are located in 9A Cancer Center

Didactic Sessions

Multidisciplinary Solid Tumor Board Conference – Wednesdays at 8AM – 2C3-578

✓ Subspecialty led discussion of cancer cases, diagnosis, treatment and prognostication

Interdisciplinary Team (IDT) Rounds and Bereavement Rounds – Wednesday at 930AM – 5C 192

✓ Discussion of consultation cases with all team members to foster learning, develop care plans and make appropriate nursing, pastoral care, social work and hospice referrals

✓ Bereavement support, condolence card signing, case discussion

Morbidity and Mortality Conference – Wednesdays at 930AM – 5C 192

✓ Quarterly presentations of morbidity and/or mortality cases led by fellows

Lectures – Thursdays at 10AM – 5C 192

✓ Weekly Lecture series focused to pain and symptom management, hospice referrals, advanced illness prognostication, communication, Bioethics & Medical Humanities

✓ Journal Club sessions with article presentations led quarterly by fellows

Self Care Rounds –Alternating First Thursdays at 1PM

✓ Wellness sessions dedicated for fellows, held with Psychologist Dr. Heather Nash

Grand Rounds – Thursdays @ 8AM in Auditorium (Pediatrics), Fridays @ 8AM – 8-32 (Internal Medicine)

LiveOn NY Clinical Case Collaboration Series – monthly

✓ Interdisciplinary case conference led by local organ procurement agency with participation across Health & Hospitals network

CAPC Curriculum Review and Board Review – monthly

Research and Quality Improvement Meetings – quarterly

Palliative Care Committee Meetings –quarterly

Ethics Committee Meetings – semi annual

The one year fellowship comprises of the following rotations:

Inpatient Consultation Service

The fellows’ inpatient experience will comprise a minimum of six months, and will include exposure to a diverse patient population with significant psychosocial, supportive and symptom management needs. The acute care inpatient consultation service sees patients with a very broad array of diagnoses pertaining to Cardiology, Pulmonology, Infectious Disease, Oncology, Hematology, Neurology, Nephrology, Geriatrics, Surgery, Trauma, Rheumatology and Gastroenterology. The consults arise from all across the institution, i.e. medical and surgical floors, medical and surgical intensive care units, emergency rooms and inpatient Pediatrics. The service is regularly consulted for patients with advanced and life-threatening illnesses to manage symptoms such as pain, dyspnea, nausea and vomiting, delirium, terminal agitation and restlessness, as well as complex discharge planning, defining goals of care, resolving ethical dilemmas and spiritual / social concerns. Apart from pain and advanced illness symptom management, the team facilitates complex family meetings to establish goals of care, completion of healthcare proxy documents, and to discuss advanced care planning with a focus on advance directives and non-resuscitation orders. The fellows will gain thorough experience in issues surrounding the withdrawal of life sustaining treatments for which we have developed institutional protocols and management of symptoms at the end of life.

The fellows will interact with the interdisciplinary team, playing an instrumental role in assessing and coordinating the implementation of our symptom management recommendations. The fellows will also learn about the acute treatment of palliative emergencies such as spinal cord compression, brain metastases, superior vena cava syndrome and malignant bowel obstruction. Rotation through Pediatrics service will provide the fellows with an opportunity to learn the palliative aspects of pediatric care in complex diseases including sickle cell management and uncontrolled diabetes. Fellows will learn advanced pain management in pediatric sickle cell pain crises including patient controlled analgesia management. The fellows will attend Ethics Committee meetings and will participate in Ethics consultation (directly with consultants or indirectly via case discussion), as many cases overlap with Palliative Care consultation. The fellows will learn and provide bereavement therapy with the interdisciplinary team and facilitate debriefing on the acute care floor when death occurs. Best practices have been compiled in the form of policies and literature syllabus to facilitate learning and online educational resources are readily available at the bedside. The fellows will lead Journal clubs, morbidity/mortality conferences and will participate in conferences and committees such as ethics, tumor board, organ donation and palliative performance improvement.

Ambulatory Care Experience

Lincoln has an established Palliative Care Ambulatory clinic. This clinic expands access to Palliative Care services to patients that suffer from advanced, debilitating illnesses. Referral sources include patients known from inpatient consultation or new cases referred from Oncology as well as other primary or subspecialty clinics. The diagnoses of the clinic patients include: advanced heart failure, cancers, neurodegenerative diseases, advanced lung diseases, and end-stage renal / liver failure. The fellows ambulatory care experience is longitudinal throughout the year to facilitate continuity and evaluation of outcomes as the fellows will care for the patients throughout the trajectory of their illness from inpatient to clinic follow up and eventually through the hospice referral process. The fellows are supervised by an Attending Physician in a one-on-one mentoring structure and with support of social work and nursing. The fellow will master the treatment of symptoms that are prevalent in outpatients with life-threatening medical conditions. The fellows will learn about opioid pharmacotherapy initiation, titration and rotation to best treat symptoms of pain and dyspnea as well as non opiate management for acute and chronic pains. Other commonly managed symptoms include fatigue, anxiety, nausea, vomiting, itching, hiccups, abdominal and muscles spasms, depression and constipation. In addition to medical management, patient and family education is paramount in the ambulatory care setting. Addressing goals of care, advance directives, completion of health care proxy forms, delivering of bad news and referring patients to comprehensive home care services are key components of the ambulatory care experience. The fellows also learn to identify patients that need to be admitted to inpatient service for intensive pain and symptom management or those who need to be transitioned with home or inpatient hospice services. Full interdisciplinary support is available on site during ambulatory visits.

Long Term Care

The long-term care experience will comprise a minimum period of one month (4 weeks) for each fellow and will take place at the Elizabeth Seton Pediatric Center. The fellow will conduct morning rounds with the supervising Attending, Dr. Alvin Moyer, will participate in interdisciplinary rounds, and patient and family meetings to establish symptom control, address goals of care, establish health care surrogacy and address advanced directives. All aspects of this rotation are directly supervised by the Attending Physician and the interdisciplinary team. During this experience the fellows will be an integral member of the interdisciplinary team, will present and discuss the patients with the team and faculty and will follow up the patients assigned to them. The fellows will participate in scholarly activities and are expected to present on a topic of their choice pertinent to Pediatric Palliative Care during this rotation.

 Hospice Experience

The Fellow’s Hospice experience will take place with the VNS Health Home Hospice program. The hospice experience consists of 10 weeks total, scheduled as two 5 week rotations. A minimum of 25 home visits must be completed. The fellows may also rotate with VNS Health Hospice Liaisons at alternative sites and inpatient hospice units for an enhanced experience once they complete the minimum number of home visits. The fellows will evaluate the patients under supervision of the Attending Physician and with other interdisciplinary team members, including Registered Nurses and Nurse Practitioners who are certified in Hospice and Palliative Medicine as well as Social Workers and Chaplains. The fellow will evaluate and discuss the cases with the interdisciplinary team members and tailor the care plan based on this care setting. The team will execute the plan in parallel with the patient and the family’s goals of care. The fellow will complete a log of the home hospice cases which will be discussed as clinical vignettes based on the interventions and outcomes. The fellows will provide patient and family education on end of life; provide symptom control, psychosocial and spiritual support. The fellows collaborate with the Hospices’ bereavement program. If interested fellows will be provided the opportunity to rotate at Harlem Hospital in collaboration with VNS Health to learn about Hospice Administration and becoming a Hospice Medical Director.

Electives

Fellows have a total of 6 weeks of elective time. Elective rotations are scheduled as 2-4 weeks of Chronic Pain and Palliative Care consultation (at Harlem Hospital), and options of Oncology, Geriatrics, Developmental Pediatrics, Addictions Medicine, Anesthesia Pain Management, Hospitalist Medicine, Physical Medicine and Rehabilitation (PM&R), Critical Care, Cardiology or Research. Additional flexibility for elective rotations may be requested pending interest and will be considered on a case-by-case basis.