Rotation: Bootcamp and Psychosocial Interdisciplinary Team

The boot camp and psychosocial interdisciplinary team shadowing is a two-week rotation and will have three components:

1. Texas Children’s Hospital general fellow orientation: Will include hospital orientation, electronic medical record training, and didactics on goal-setting and working toward success in fellowship alongside fellows from all other specialties at Texas Children’s.
2. Introduction to the Pediatric Palliative Care Core Didactic curriculum and the first series of lectures. These didactics combined with the Texas Children’s orientation will comprise the first week.
3. Working with the psychosocial interdisciplinary team members will comprise the second week. Fellows will spend time engaging with the psychosocial members of the interdisciplinary team (social worker, bereavement coordinator, and chaplain) to provide patient care and learn about their jobs and role on the team. The goal is that through understanding each team member’s role, the fellow will be better able to function as a member of the interdisciplinary team.

Rotation coordinator: Dr. Jill Ann Jarrell. Contact: jajarrell@texaschildrens.org. Phone: (832) 826-8046.

Clinical experience: Bedside teaching from PACT IDT members in Texas Children’s.

Didactic experience: Beginning of the core palliative care lecture series. Texas Children's general fellowship orientation and didactics.

Daytime: Fellows will participate in all orientation activities and boot camp lectures. Fellows will spend at least one day with each psychosocial member of the IDT.

Call: No call.

• Timely verbal feedback provided by faculty throughout rotation.
• Structured written evaluation of fellow using American Academy of Hospice and Palliative Medicine evaluation tools at end of rotation.
• Fellow provides feedback to program director about rotation at end of rotation.

Goals and objectives based on Pediatric Hospice and Palliative Medicine Competencies, version 2.0

The fellow should demonstrate compassionate, appropriate, and effective care based on existing evidence base in pediatric palliative medicine and aimed at maximizing the well-being and quality of life for patients with chronic, complex, and/or life-threatening conditions and their families. The fellow should provide care in collaboration with other subspecialists and within an interdisciplinary team.

Objectives: At the completion of this rotation, the palliative care fellow will be able to:

• Obtain a comprehensive history and exam including:
  • Goals of care and advance care planning
  • Detailed symptom history
  • Psychosocial and spiritual history
  • Functional assessment
  • Quality of life assessment
  • Developmental age of the child
• Demonstrate ability to respond appropriately to suffering by addressing sources of medical, psychosocial, and spiritual distress, bearing with patient’s and family’s suffering and distress, and remaining a presence, as desired by patient and family.
• Demonstrate the importance of collaboration with an interdisciplinary care team in providing care to a patient and family.
  • Collaborate with the social worker in an interdisciplinary palliative care team
  • Collaborate with the chaplain in an interdisciplinary palliative care team
  • Collaborate with the bereavement specialist in an interdisciplinary palliative care team

The fellow should demonstrate knowledge about established and evolving biomedical, clinical, population, and social-behavioral sciences relevant to the care of patients with life-threatening conditions and to their families, and relate this knowledge to the hospice and palliative care practice.

Objectives: At the completion of this rotation, the palliative care fellow will be able to:

• Describe the scope and practice of pediatric palliative care including a basic understanding of the following topics covered in the core didactic series, which is comprised of topics such as:
  • Performing a comprehensive palliative care assessment
  • Assessment of pain
  • Acute and chronic pain management
  • Spirituality in palliative care
  • Team collaboration with effectiveness
  • Grief and bereavement
  • Self care for professionals
• Recognize the role and importance of an interdisciplinary team in pediatric palliative care.
  • Understand the role of the social worker in an interdisciplinary palliative care team
  • Understand the role of the chaplain in an interdisciplinary palliative care team
  • Understand the role of the bereavement specialist in an interdisciplinary palliative care team
• Explain principles of assessing and treating common symptoms including the concept of total pain.
• Demonstrate knowledge of opioid mechanisms of action and effective use including concepts of tolerance, withdrawal, and addiction.

The fellow should be able to investigate, evaluate, and continuously improve personal practices in caring for patients and families and appraise and assimilate scientific evidence relative to palliative care.

Objectives: At the completion of this rotation, the palliative care fellow will be able to:

• Utilize self-evaluation and feedback from interdisciplinary team to appraise his/her performance and continually improve.
• Identify knowledge gaps in the course of providing patient care and cultivate the habit of continuous inquiry to expand one’s knowledge base.
• Utilize new knowledge of member roles on the interdisciplinary team to function more effectively as a member of the team.

The fellow should be able to demonstrate interpersonal and communication skills that result in effective relationship building, information exchange, emotional support, shared decision making, and collaboration with patients, patients’ families, and professional associates.

Objectives: At the completion of this rotation, the palliative care fellow will be able to:

• Utilize compassionate, effective communication skills to enhance interactions with patients and families, within the palliative care interdisciplinary team, and with other healthcare colleagues.
• Utilize learned communication skills to effectively navigate interactions with patients and families including information sharing, discussing concept of palliative care, discussing advance care planning and resuscitation status, discussing goals of care, and discussing symptoms and suffering.
• Demonstrate growing knowledge of the unique language of hospice and palliative medicine and begin to demonstrate facility using this language in conversation.

The fellow should be able to demonstrate a commitment to carrying out professional responsibilities, awareness of his or her role in reducing suffering and enhancing quality of life, adherence to ethical principles, sensitivity to a diverse patient population, and appropriate self- reflection.

Objectives: At the completion of this rotation, the palliative care fellow will be able to:

• Demonstrate care that shows respectful attention to age/developmental stage, gender, sexual orientation, culture, religion/spirituality, disability, and family interactions.
• Demonstrate ability to balance the needs of patients, families, and team members with one’s own need for self-care.
• Recognize his/her own limits and ask for help when needed.
• Demonstrate accountability and ownership in interactions with patients, families, and colleagues.

The fellow should be able to demonstrate an awareness of and responsiveness to the larger context and system of healthcare, including hospice and other community-based services for patients and families, and the ability to effectively call on system resources to provide high-quality care.

Objectives: At the completion of this rotation, the palliative care fellow will be able to:

• Explain the role of the palliative care interdisciplinary team in care of patients and families.
• Appraise the benefits and challenges of providing team-based care.
• Collaborate effectively with colleagues spanning the palliative care continuum including hospitals, nursing homes, long-term care facilities, and hospice agencies.
• Describe elements of the healthcare system relative to palliative care and constructs care plans that operate effectively within that system.