Summary

Subject(s): What Matters Most? Serious Illness Conversation Skills, “Total Pain” Assessment, Narrative Medicine, Meaning and Legacy Centered Care, (Physical ) Pain Management, Non-Pain Symptom Management, Legal issues in Advance Directives, Physiology and Symptomatology of Serious illnesses, Navigating Family Meetings, Role of Early Palliative Care with diagnosis of serious illness.
Objectives:
1. Cure Sometimes: Palliative and Supportive Care is not divorced from medication with curative intent. Any and all means to understand and intervene to restore health and heal are in scope of palliative care.
  1. 1. Interpreting history, performing physical exams, selecting laboratory tests, radiological studies, and suggesting clinical referrals remain foundational for establishing a shared understanding of disease process and what to expect from untreated illness.
2. Relieve Often: Elicit and Understand Concerns about illness, Establish Clear Goals of Care, and Strategize how to use the tools of medicine to bring them closer.
  1. 1. Elicit their concerns: use your knowledge of disease process to elucidate fears and concerns.
    2. Goals of care can be established through reflective listening and shared decision-making. This may involve navigating between seemingly conflicting values – living as long as possible and minimizing pain and suffering by avoiding invasive procedures.
    3. Confirm a strategy to target those goals. Use Serious Illness Conversation Guide or SPIKES, REMAP mnemonics to help have successful conversations with patients about their illnesses. Success can be measured by the extent to which patients and their families feel they have a supporter and ally in their Palliative Specialist team.
3. Comfort Always: Hear the patient, family, caregiver’s perspectives. Recognize their emotional reactions. Understand the BATHE technique for interceding with psychological support in a brief way,

Adult Learning Tip: What do you know about these topics? Have you cared for patients living with serious illnesses (Neurodegenerative conditions, Cancer, Heart Failure, Severe Lung disease, stroke, end stage liver disease, end stage kidney disease, peripheral vascular disease leading to pain or amputation, progressive vision loss, progressive hearing loss… What questions have come to mind? Use your questions as conversation starters to introduce to your subspecialty faculty as you get to know them over the next few weeks.

Time Allotment: Longitudinal specialty clinic experiences will be assigned during each Y block during a set time over 6 months (occurs for 2 out of every 6 weeks). Alternatively, a dedicated 2 week section of X block can be used for a focused learning work experience.

Materials & Resources

Adult Learning Tip: We participate in Center to Advance Palliative Care (www.capc.org) and sponsor your membership to access learning resources. Please set up an account at no cost to you using your @nychhc.org email address and Kings County Hospital Center as your sponsoring organization. These include other educational materials you may find useful. Explore and learn more about yourself as you use them - what kind of learner are you? Auditory? Visual? Tactile? These are by no means comprehensive - if you find additional learning tools that you love, please share them with us!

Resources:
1. Podcasts:
2. MKSAP
  1. Chief created quizzes
  2. System based chapters / reviews
3. Video Lectures
  1. Downstate Noon Conferences
  2. Cleveland Clinic IM Review 2022 (slide sets)
4. Physical Exam Skills
  1. Stanford 25 Pulmonary Examination: https://stanfordmedicine25.stanford.edu/the25/pulmonary.html

Assessment

At the end of your rotation, your faculty subspecialty attendings will be asked to complete an evaluation on your performance. This will reflect your progress on the objectives outlined above. You will have an opportunity to evaluate our rotation as well - we look forward to specific feedback which will help us grow and improve these experiences going forward!