“He had just gone through a difficult time,” says Dr. Simone Douge, talking about a VNSNY Hospice patient she had recently visited, “and I asked how he coped with it. He mentioned oxygen and medication, of course. But he said the most important thing he’d found was meditation, which a Buddhist monk had recently taught him. Here is a man who has been in hospice for quite some time and is still open to learning new things—because, he told me, each day is a new day. For me, talking to him was a real inspiration and motivation to keep doing what I’m doing.”
A hospice and palliative care physician in training at Memorial Sloan Kettering Cancer Center, Dr. Douge is also part of VNSNY Hospice and Palliative Care’s Physician Fellowship Training Program for the 2017–18 academic year. This year’s trainees include 38 physicians, five nurse practitioners, a social worker, and a doctor of pharmacy, all drawn from eight area academic medical centers—the largest cohort in the program’s 13-year history.
Each Fellow is “embedded” in a designated VNSNY Hospice team, including hospice nurses, nurse practitioners, social workers, and spiritual care counselors. Fellows provide hands-on care to hospice patients under the supervision of the team physician or discipline-specific preceptor, and collaborate with the rest of their team to ensure that their patients’ physical, emotional, and spiritual needs are being met.
“This is the third full year in which we’ve used the embedded team member model,” explains Shannon Harris, Physician Fellowship and Medical Staffing Coordinator for VNSNY Hospice. “This approach gives our Fellows a robust clinical training experience, while at the same time they’re supporting and bolstering the care provided by the regional hospice medical teams in which they’re placed.”
As the largest hospice program in New York City, VNSNY Hospice offers an ideal training ground for clinicians interested in a career in hospice and palliative care. The Fellows work with their hospice teams in rotations that generally last several weeks or longer, and also participate in didactic sessions and Grand Rounds. “The rotations, including duration, are tailored to the needs of each partner institution,” notes Harris. “For example, some of the medical centers request a pediatric palliative care component.”
For the participating medical centers, the program adds an important clinical piece to their own training curriculum. Meanwhile, the Fellows themselves gain valuable experience providing home-based hospice care in a city environment.
Philanthropic support from a dozen funders, including individuals, foundations, and corporations, helps fund the program. “It is a privilege to teach new clinicians about hospice care,” says Dr. Ritchell Dignam, Chief Medical Officer and Fellowship Program Director for VNSNY Hospice, who oversees the training program. “Our goal is that the Fellows will come away from their hospice rotations with a deeper understanding of end-of-life care, as well as for the team approach that is the hallmark of hospice.”
VNSNY’s Hospice Fellows are drawn from eight partner medical centers in New York City: The Icahn School of Medicine at Mount Sinai, Memorial-Sloan Kettering Cancer Center, Metropolitan Hospital, NewYork–Presbyterian Hospital’s Columbia Campus, NYU School of Medicine, Lincoln Medical Center, the James J. Peters VA Medical Center, and NewYork–Presbyterian/Queens.