Hospice and Palliative Medicine

Meet Our 5,000th Member!

It is with great excitement that we share that AAHPM membership has exceeded 5,000 members! This is the largest our membership has ever been and we couldn’t be where we are today without each member’s hard work and dedication to the field. To celebrate this milestone, we reached out to our 5,000th member, Kelsey Terland, MD.

Dr. Terland is currently a hospice and palliative medicine fellow at Providence Alaska Medical Center in Anchorage, AK. She isn’t native to Alaska though. She was raised in Oregon, but moved to Alaska after college. Dr. Terland attended the University of Washington School of Medicine WWAMI program which allowed her to stay in Alaska for most of her medical training. She then completed her residency at the Family Medicine Residency of Idaho in Boise.

When we asked Dr. Terland how she became interested in hospice and palliative medicine, she shared her story.

“Looking back I feel like I knew my heart was in hospice and palliative medicine even before I went to medical school”, said Terland. “Prior to medical school I worked as a case manager for patients with Alzheimer’s and related dementias. I volunteered for my local hospital’s No One Dies Alone program where I would sit with patients who were at the end of their life if they did not have family or friends to be with them. Throughout my medical training I maintained my interest in the field by participating in preceptorships with providers in the field. During my family medicine residency, I continued to find myself drawn to working with patients facing serious illness and those at the end of their lives. I spent a month during my residency working with the HPM fellowship in Anchorage and this solidified my desire to commit to the field by entering fellowship. I’m so excited for what the future may hold!”

Being a hospice and palliative medicine fellow in Alaska can be a challenge, as the state is “geographically enormous with an incredibly diverse population”, Terland says. “There are inspiring people here thinking very creatively about how to reach patients across our vast state to bring hospice and palliative medicine into very rural villages”.

Terland joined AAHPM as a way to connect with other professionals in the field and gain access to educational materials, as well as to stay up to date with the latest research.

When she isn’t dedicating her days to hospice and palliative medicine, Terland is spending time with her supportive husband and two energetic little boys, exploring the beautiful wilds of Alaska.

Kelsey Terland, MD with her two little boys

The Faculty’s Top 5 Reasons to Attend the AAHPM Board Review Course

The Summer Institute will be featuring an Intensive Board Review Course on July 25-27 in Pittsburgh, PA. Get ready for your Hospice and Palliative Medicine board certification examination by experiencing this redesigned program which includes didactic presentations, interactive sessions and exam-style questions.

1)      You’re awesome.  Let’s face it, other fields may have some nice folks, but I’ve never meet a community like AAHPM.  Where else are you going to meet hundreds of bright, articulate, and compassionate people with well-honed listening skills?  Find friends and colleagues that you’ll enjoy seeing throughout your career.  It’s time to meet your tribe, and your tribe is exceptional.

2)      “This is only a test.”  Beyond a few hours of clicking answers, possessing deep understanding of your field and of the human experience will offer personal and professional benefits throughout your life.  Prepare for the REAL test – the test at the bedside. Mastery of hospice and palliative medicine comes with interacting with the material and challenging yourself and your colleagues.  Start your career strong!

3)      It’s not for everyone.  You know that lucky person who got to see the stadium-packing rock band in an intimate venue 20 years ago?  This is your one-time chance to spend a full day in an intimate setting, having direct interaction with palliative care experts.  While the larger annual assembly offers packed conference rooms and lots of excitement, this is something far different: an opportunity to be up close and personal.

4)      Improve your chances.  There are many joys of practicing in hospice and palliative medicine.  Sitting in a testing room is not one of them.  Do this well and do this once!

5)      Pittsburgh.  Yes, really.  This a great American city that is too-often overlooked.  Enjoy the panoramic views from the Dusquene Incline.  Join us for a Pirates game, visit the Andy Warhol Museum, or enjoy the waterfront trail loop at Three Rivers Park.  Beauty and wonder are there to be found if you only take the time to look.

The early bird rate ends Tuesday, June 28. Register now and save!

A Take on the Hospice Course – From the Presenters

The Summer Institute is featuring Hospice Practice is Changing – Take Charge! where you can learn the latest knowledge and tools to advance your practice and prepare for what’s coming. See what the presenters have to say about this upcoming course in Pittsburgh, PA, July 26-27, 2016.

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Deepen your knowledge and understanding of the Medicare hospice benefit to ensure your hospice is providing and documenting care that aligns with regulatory compliance.  This course will include a review of the basics, plus discuss regulatory changes and challenges – including relatedness, eligibility, narrative construct, and the new payment model – a worthwhile investment for all hospice medical directors, novice or seasoned!

- Ruth Thomson, DO FACOI FAAHPM HMDC, Chief Medical Officer at Hospice of Dayton, Inc.
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Learn how healthcare reform is likely to impact the hospice industry as we move to a value based reimbursement system. Identify benchmarks to monitor for your hospice organization to keep you in compliance and away from the auditors!

- Janet Bull, MD, Chief Medical Officer at Four Seasons

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Learn how to “debride” those insanely long lists of medications and make solid, evidence-based decisions about which ones are worth keeping and which medications can be “voted off the island.” We will introduce you to a 5 step process of deprescribing and discuss common classes of medications that leave us scratching our head: statins, PPI’s, anticoagulation, and medications used for dementia, COPD and diabetes. Everyone wins when the medications are directed the most benefit and least risk!

- Kathryn Walker, PharmD BCPS CPE, Senior Clinical Director of Palliative Care at MedStar Health
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Haven’t taken a day for yourself in months—or years?! Come rejuvenate, rewind, relax and revisit the core of what brought you into caring for dying patients and their families. Discover the latest research on burnout and the innovative approaches recently developed to promote resiliency in those of us working in overburdened hospice and palliative care teams. Network with physician colleagues and engage in topics from leadership opportunities to regulatory compliance. Let your mind and spirit be nurtured for a few days this summer – you’ll leave feeling confident and focused on how to grow and prosper in your role in hospice care.

- Kathleen Faulkner, MD FAAHPM, Good Shepherd Community Care

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A whirlwind tour of pain management topics ranging from bread and butter issues to more difficult situations and a few cutting edge techniques as well.

- Bruce Scott, MD FACP, HMDC, Assistance Professor of Internal Medicine, Wright State Physicians
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Learn more at www.aahpm.org/summerinstitute. Register soon. The early bird rate ends June 28.

First Neuro-Palliative Care Workshop in Peru

On May 13-14 2016, the Peruvian Societies of Palliative Care (Sociedad Peruana de Cuidados Paliativos, SPCP) and Neurology (Sociedad Peruana de Neurologia, SPN) held their first two-day conference and workshop on “Palliative Care and Neurology” in Lima, Peru. In a country without a palliative care training program, and where the development of palliative care is limited, 90 Peruvian neurologists, neurointensivists, geriatricians, palliative care specialists, nurses, as well as some patients from the Peruvian national neurological institute (Instituto Nacional de Ciencias Neurologicas, INCN) gathered to learn about palliative care principles and the ethical considerations and challenges of neurological illness and disability. Dr. Claire Creutzfeldt, Assistant Professor of Neurology at the University of Washington, was gave an overview of neuro-palliative care and run a VitalTalk communication workshop, providing a framework for approaching discussions regarding serious illnesses.

Invited political and healthcare leaders included: Pilar Mazzetti Soler, MD PhD, neurologist, former Peruvian Minister of Health and president of the SPN and INCN; Lilian Hidalgo, MD, vice president of the SPCP; Maria Chumbe MD, neurointensivist at the INCN; and Claire Creutzfeldt, MD. These leaders participated in a roundtable discussion entitled “Visions for Neuropalliative Care in Peru” – fielding questions and debating the next steps to facilitate the growth of palliative care. Specific aspirational goals emerging from the conference included: (1) incorporation of palliative care specialists into clinical neurology ward teams; (2) development of home health and hospice programs; and (3) integration of a palliative care curriculum for medical school and residency programs.

The conference was co-organized by NIH Fogarty Global Health Scholar Anastasia Vishnevetsky, MDc from the Perelman School of Medicine at the University of Pennsylvania, and Peruvian Geriatrician Carla Zapata del Mar, MD. The Peruvian Society of Neurology and the Peruvian Society of Palliative Care co-hosted the event. Additional support was provided by the NIH Fogarty Interdisciplinary Cerebrovascular Diseases Training Program in South America (ICTuS) Grant (5D43TW009137, awarded to Drs. Joseph Zunt, Hugo Garcia and David Tirschwell) and the NIH Fogarty Global Health Fellows Program (R25TW009345, awarded to Drs. Joseph Zunt, Chandy John, Joseph Kolars and Vivek Nerurkar).  Special thanks to Drs. Juan Luis Cam, Mario Cornejo-Olivas and Miriam Cuba for their help and support with the conference organization.

Retreat into Learning and Wisdom

The AAHPM Research Scholars Program facilitates participation for AAHPM members to attend the Annual Kathleen M. Foley Palliative Care Retreat and Research Symposium of the National Palliative Care Research Center (NPCRC), cosponsored by the Hospice and Palliative Nurses Association (HPNA), American Cancer Society (ACS), and AAHPM. The 2015 event was held October 20 – 22 in Jackson Hole, Wyoming. Below are some reflections from this year’s scholarship winners.

“This year’s retreat was by far the most inspiring conference I have attended thus far in my career. The location was serene and peaceful in Jackson Hole, and around every corner was a preeminent thought leader in palliative care. I was in awe of everyone’s tremendous accomplishments and passion for their work. I loved being able to bounce ideas off some of the most powerful minds in the field, and I felt honored that these individuals seemed truly interested in what I was saying. I felt that, by simple virtue of the fact that I was invited to be there, my views and ideas were important and worth listening to. It was a validating feeling. I left Wyoming with a renewed sense of energy to move my own work forward, and with many new colleagues and friends.”

Kavita V. Dharmarajan, M.D., M.Sc.
Assistant Professor of Radiation Oncology and Palliative Medicine
Department of Radiation Oncology
Brookdale Department of Geriatrics and Palliative Medicine
The Mount Sinai Medical Center
New York, NY

“I wanted to thank AAHPM again for giving me the opportunity to attend the NPCRC retreat. It was a tremendous privilege to be able to attend and indeed one of the most valuable experiences of my career so far. I was in awe and near disbelief seeing the guest list for the conference – it was a who’s who of palliative care and was practically my PhD literature review come to life! I had the opportunity to meet privately with so many including Diane Meier, Scott Halpern, Joan Teno, Tony Back, James Tulsky and reconnect with others I hadn’t had the opportunity to see in a while such as Randy Curtis, Sydney Dy, Christine Ritchie, and many others. Thank you so very much!

Elizabeth Dzeng, MD, MPH, MPhil, MS
Assistant Professor of Hospital Medicine and Social and Behavioral Science
University of California, San Francisco

“I felt honored to be amongst so many palliative care expert researchers. I was very pleased with the welcoming spirit of everyone. The setting was perfect. Although an intensive two days, it was a relaxed atmosphere and the prodigious learning environment. It was well balanced with free time to explore the environment and also have the opportunity to get to know one another. As a new investigator, I was able to have discussions to assist me with moving my research forward. Hearing successful experiences of senior investigators gave me an atlas to navigate not only the scientific field of PC research but my individual career development. It was also good to interact with other junior investigators and develop possible, future collaborative relationships.

The overall wealth of information and research experience was infinite. Everyone was open to sharing their experience and made me feel as though I have something valuable to offer the field and know that there is support in my development.”

Danetta E. Sloan, PhD, MA, MSW
IRTA Post Doctoral Fellow
National Institutes of Health
Pain and Palliative Care Service
Bethesda, MD

“In October, I got to attend one of the most remarkable retreats in palliative care as an AAHPM Research Scholar: The Foley Retreat. Surrounded by the beauty and mountain air of Jackson Hole, the retreat fostered an unbelievable degree of connectivity so that more junior investigators, like me, were able to connect with a variety of individuals to learn from, develop collaborations that previously didn’t exist, and be part of conversations that felt like a form of improvisation. It was incredible. Thanks to everyone at AAHPM for supporting the research scholars program! I am very grateful to be a part of it.”

Carey Candrian, PhD
Assistant Professor | University of Colorado School of Medicine | Division of General Internal Medicine
Protocol Specialist | Palliative Care Research Cooperative Group (PCRC)

“Thank you so much for the opportunity of coming to the Palliative Care Research Retreat and Symposium—it was amazing! It was inspiring to be amongst the thought leaders in the field, and to see the innovative research that is driving the field forward. I look forward to being able to contribute. =)”

Jessica R. Bauman, MD
Assistant Professor, Department of Hematology/Oncology
Fox Chase Cancer Center
Philadelphia, PA

Nidhi in Palliativecareland

by Nidhi Khosla, PhD, MPH

I woke bleary eyed at 4 am for my 4:30 am shuttle pick up on October 20, 2015. The shuttle would take me from Columbia, Missouri to St. Louis airport where I was supposed to catch a flight to Denver. At Denver, I would board a flight to Jackson Hole to attend the much awaited Kathleen Foley Palliative Care Retreat. As a junior investigator with a PhD in Public Health and research interests in reducing health disparities, I was looking forward to this golden opportunity.

The shuttle driver actually arrived at 4:15 am because he had several pickups. My fellow riders to St. Louis were clearly in some other time zone, chattering away in the darkness in English and what sounded like an Eastern-European language, over the 2-hr journey. Sleepless, I wondered if I might meet a fellow passenger on the Denver-Jackson Hole flight who was heading to the same retreat. When we landed at Jackson Hole, the marching band was conspicuous by its absence. Surely, a plane that arrived nearly full with luminaries of the palliative care world deserved a welcome from a marching band or a resounding 21 gun salute?

The retreat eventually started after the attendees had been coaxed to actually enter the hall rather than linger at the doorway over the ‘hellos’ and ‘great to see yous’. My eyes darted from name tag to name tag. They were all there! The names of the authors in my literature review folder concerning end of life and palliative care, had metamorphosed into actual humans who were walking and talking to each other around me. My literature review had miraculously come alive! The official welcome remarks revealed the wide diversity in attendees that included 3 JDs, 61 Medical Doctors/DOs, Doctors of Philosophy, Registered Nurses and Social Workers.

In the first presentation, I learned that high intensity end-of-life care was not unique to the United States, with other developed countries also providing aggressive care. The parallels to everyday behaviors such as ‘do you like vanilla or chocolate ice-cream?’ and the interesting experiments derived from Economics and Psychology generated several interesting ideas about advance care planning and how that might be encouraged. The presenter concluded that we need to build better advance directives and motivate patients to complete them, engage physicians and encourage them to overcome their tendency to procrastinate.

Over dinner, I sat with the AAHPM staff and scholarship/award winners and learned more about them and then crashed in a huge suite that had more doors than my apartment. The next morning started with an excellent breakfast and a very well-organized poster presentation. I think more meetings need to adopt this method of small-groups led by leaders. The groups moved systematically from poster to poster, thus creating a different kind of small-group learning.

The breakout groups offered a wide variety of learning themes. The first presentation in the group I attended focused on breast cancer caregiving. One of the elements that struck me most was that most caregivers for breast cancer patients are men unlike other conditions where caregivers are female. In other presentations, I learned about Dignity Therapy and how doctors may undermine the impact or weight of their or caregivers’ decision-making preferences on that of the patients’. Learning about the challenges of the different presenters in data collection and hearing suggestions from the audience to resolve these was a good learning experience.

There was a great presentation ‘Demystifying the NIH Process’ on getting funding, with Program Officers from NIH available to share their perspective and talk about trends in funding and important dos and don’ts. I am sure experienced and novice grant seekers like me found this excellent presentation very useful. I listened closely which was very important especially given that the handouts were printed in what seemed to be font size 4. I later followed this up with one-on-one conversations with the Program Officers to get feedback on some ideas.

Just when I thought I had attended all possible excellent presentations, I got to hear Rebecca Aslakson. I had met her earlier this year through a mutual colleague at Johns Hopkins. A recommendation letter from Rebecca enabled me to attend the retreat. Rebecca’s extremely stylish presentation on her research trajectory, peppered with humor and insight into patient care challenges and triumphs, led us smoothly from one topic to another. It captured the history of palliative care in the Intensive Care Units, among surgeons and referenced books on palliative care and the surgery culture. Rebecca shared that there are different moral economies and different bottom lines in medicine. Death is the enemy in surgical cultures. In contrast, for Intensive Care Unit nurses, suffering is the worst enemy. The “covenant” between patient and doctor is part of a surgeon’s identity.

Palliative care-related experiences of surgical Intensive Care Unit patients and families led Rebecca to research into peri-operative care and involving patients via PCORI mechanisms. Since people lose decision making capacity for at least some time, the research team proposed advance care planning (ACP) and did a scan of ACP instruments. This led to research on content and instrument-based approaches, studying ACP conversations, preparing story boards and eliciting public feedback through venues such as a stall at the Maryland State Fair. Many patient-doctor conversations about ACP are couched in terms of faith, which led her to start the UNITED project with churches for using religious language and input into ACP conversations.

Finally, I attended a Mock Study Section which mimicked how actual reviews are done. Excellent examples of sample grants were provided and there was a rich discussion about the grants’ strengths and weaknesses.

I had arrived at the retreat bleary-eyed and left wide-eyed, excited at the vast range of possibilities in research that can improve quality of life for patients and caregivers. The well-rounded experience covered everything from research ideas to how to fund them and provided invaluable networking opportunities. The retreat made me inspired and enthused with the dedication and brilliance of the presenters and I got new ideas on how I could contribute to patient-centered palliative and end-of-life care.

Nidhi Khosla, PhD, MPH was chosen as one of six AAHPM Research Scholars this year and received funding to participate in the Annual Kathleen M. Foley Palliative Care Retreat and Research Symposium of the National Palliative Care Research Center (NPCRC). She is an Assistant Professor at the Department of Health Sciences, University of Missouri, Columbia. Her research involves palliative and end of life care preferences of the growing number of South Asians (persons with origins from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan and Maldives) in the U.S.

Medicare Pay for Advance Care Planning Doesn’t Fall That Short

By Phil Rodgers, MD FAAHPM
AAHPM Public Policy Committee Co-chair and RUC Advisor

Dr. Jennifer Brokaw’s article from Time magazine linked in the 11/10 SmartBrief concludes that CMS payment for advance care planning (ACP) services, that will start January 1, 2016, is inadequate to support the time necessary for physicians and qualified providers to provide advance care planning services. The article reaches this conclusion by citing that reimbursement amounts are limited to ‘initial’ palliative care consultation and ‘follow-up’ consultations, and thus do not allow payment for longer, more involved ACP and goals of care discussions.

Dr. Brokaw’s attention to the topic is very welcome, but her article may leave readers confused as to the use and value of the new CPT codes for advance care planning. Specifically, the new Current Procedural Terminology (CPT) codes would allow payment for ACP services of any length, including the long, complex discussions that are a practice staple of hospice and palliative care providers. 99497 (~$86) can be billed for the first 30 minutes of ACP services on a given day, and 99498 (~$75) can be billed for each additional 30 minutes of service performed on the same day, with no limit. There are no frequency limitations to these codes, so they may be used as often as the need arises.

They may be also be used in addition to most other inpatient and outpatient evaluation and management (E/M) codes, provided that the time counted to bill the ACP codes is only counted for ACP services, and not also used to meet time-based criteria for an E/M code. There are a few E/M codes (like those for some critical care services) alongside which the new ACP codes cannot be billed—so do read the fine print, preferably with your practice’s billing professional or consultant.

It is important to note that while CMS issued no specific documentation requirements for use of the new ACP CPT codes, they will be subject to audit. In fact, Medicare contractors may be watching a little more closely given that these codes are new, and there is an interest in making sure they are billed only when the services are delivered. As always, make sure you are documenting (in detail) the services that you perform.

I do agree with Dr. Brokaw that the new Advance Care Planning CPT codes are not a solution to better payment for advance care planning and palliative care services. They are, however, an important step in the right direction. In fact, AAHPM worked with other medical specialty societies to advance the new CPT codes for advance care planning, including presenting data from member surveys to the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) which suggested relative values for the codes to CMS.

For more information, please review the CMS fact sheet and full text of 2016 Medicare Physician Fee Schedule Final Rule.”

Notes from the Field

by Jordan Endicott, JD
Manager, Health Policy & Advocacy

I’ve worked in the health care related field for nearly the entirety of my professional career, but surprisingly, the last time I had stepped foot in a hospital was at age 10 when I broke my wrist. When I was offered the opportunity to visit Drs. Christian Sinclair and Paul Tatum at their respective hospitals, I was excited for the chance to reacquaint myself with a system that I was really only familiar with in an abstract way.

We spent the first day of our trip with Dr. Sinclair at the University of Kansas Medical Center, spending time with the interdisciplinary team there, and then seeing patients with Dr. Sinclair and a nurse from his team. The patients we saw ranged from those nearing the end of life, to cancer survivors who were left with pain and complications following treatment. The one constant though from all of the visits was that Dr. Sinclair and the nurse kept the focus on what the patient wanted and desired.

After a day spent in Kansas City, we made the short trip over to Columbia, Missouri where Dr. Tatum works at the University of Missouri. Dr. Tatum took us on a whirlwind tour that involved seeing a patient in the hospital, shadowing him during his primary care clinic hours, and ending the work day in Jefferson City to meet with Jane Moore, the CEO of the Missouri Hospice and Palliative Care Association.

When I first informed my friends and family earlier this year that I was accepting a job with the American Academy of Hospice and Palliative Medicine, the most common reaction was along the lines of “wow, that sounds terribly depressing” or “why would you want to do that to yourself?” The reaction was much the same when I told everyone that I’d actually be visiting two of our members and seeing their patients.

My usual response to the negative thoughts that people have to the field of end-of-life care is that our members are working every single day to enhance aspects of patient care that are in need of vast improvement. After seeing firsthand the relief and care that our members provide though, the biggest take away for me is that hospice and palliative care is absolutely not depressing – it’s the fact that thousands of patients across the country still lack awareness or access to this care that is a cause for sorrow. I was already proud of the work I do in supporting our members, but after my visit, I’m even more grateful for the opportunity to work for the Academy and advocate for the field of hospice and palliative medicine.

A Day in the Life…

by Jen Bose, Marketing & Membership Manager

Working with AAHPM for several years has allowed me to get to know some of our members fairly well. I look forward to the Annual Assembly and summer courses each year because I get to connect with members in real life. When the opportunity for Jordan Endicott, Manager of Health Policy and Advocacy, and I to visit Drs. Christian Sinclair and Paul Tatum came up I jumped at the opportunity. Not only would I get to see what they do on a “typical” day I would also be able to understand how the Academy impacts everyone working on the interdisciplinary team and the patients and their families.

Thursday September 24
Kansas University Hospital – Kansas City, KS

We started the morning watching offsite lectures with fellows with Dr. Sinclair. After the lectures we met the three palliative care teams as they discussed the patients for the day. Then we were off to see patients with Dr. Sinclair and the nurse on his team. Each patient had a unique situation and required a slightly different approach and discussion. Some of the discussions were led by Dr. Sinclair and some were managed by the nurse. Every conversation focused around the patient. For some it was about how he or she was feeling that day and what could be done to make him or her more comfortable. For others it was finding out what their expectations were in their recovery and what their quality of life goals were. All of the conversations were warm and personable with a focus on making sure everyone was on the same page. We ended the day at the National World War I Museum before eating delicious barbeque.

Friday September 25
University of Missouri – Columbia, MO

The day started with a team meeting and shadowing a patient visit at the University. We then made our way over to the office where Dr. Tatum sees his geriatric patients. All of the patients adore Dr. Tatum and based on the appointments it is easy to see why. He knows them all very well and has very supportive conversations with them about their present situation and what they hope for in the future and suggestions on how they can get there. We were able to meet the nurse that Dr. Tatum works with in the office that serves as his right hand woman. Then we were off to Jefferson City to meet with the CEO of a state level hospice and palliative care organization. She explained some of the issues that she has been facing in the state and the amazing educational offerings that her organization has created. Our night ended at the Roots N Blues N BBQ Festival where we met up with Dr. Gregg VandeKieft to enjoy music and great food.

Final Thoughts

I was confident that I knew what our members did but in an abstract way. I have seen the process firsthand when my Grandma started a palliative care treatment plan and eventually hospice. Shadowing Dr. Sinclair and his team at the hospital and Dr. Tatum at the hospital and clinic was truly eye opening. The warmth and compassion that was present in every conversation was astonishing. I often found myself on the verge of tears and so proud to work with the amazing people working in hospice and palliative medicine every day.

Back to the Old Schoolhouse − Students of Different Professions Learn Palliative Care Together

By Joseph D. Rotella

More and more academic centers are developing interprofessional education (IPE) programs to teach palliative care− and it makes good sense. Seriously ill patients and their families suffer as whole human beings and it takes a village of palliative care providers from different disciplines working together to comfort, support, and heal them. If we train palliative care professionals in silos, how can we expect them to be prepared for effective interdisciplinary teamwork when they emerge?

The feature story in the American Academy of Hospice and Palliative Medicine (AAHPM) Fall Quarterly (2015), Interprofessional Education: The More, the Healthier, highlights some of the programs across the country that are doing groundbreaking work in IPE.

It may be easy to see the promise of interprofessional training in palliative care, but it’s hard to do it well. In an AAHPM blog post accompanying the article, Dr. V.J. Periyakoil describes her personal experience as faculty for the VA Interprofessional Fellowship Program, “A gold standard is when all IPE fellows are taught at a level that is challenging to all of them in every single session.” That sets a high bar and she adds, “This area is really ripe for discovery and new innovation.” Like the pioneer teacher with K through 12 students in one classroom, IPE instructors strive for a curriculum that can engage learners with a wide range of individual competencies. When it works well, the students learn as much from each other as they do from their teachers.

When I think back on my own development as an internist and palliative care physician, I am struck by how much I learned informally from my colleagues in other professions. When I was a green intern on my first Cardiac Care Unit (CCU) rotation, it was an experienced (and extremely patient) CCU nurse who showed me how to run a code. Counselors taught me how to deal with challenging families and support the grieving. From chaplains, I learned to understand people in the context of the meaning of their life stories. Social workers modeled how to empower patients and families and to have healthy boundaries. A pharmacist shared best practices on stopping unnecessary medications. A nurse’s aide showed me how a bed bath can be a sacred ritual. I had some great physician mentors, but I think I learned more about palliative care from the interdisciplinary team than from other doctors.

My first experience with formal IPE was about a decade ago when I was a facilitator for a discussion group of medical, nursing, social work and pastoral care students following a screening of the film Wit. One medical student resented the whole process. He said, “This is absurd; no real doctor would behave as badly as the ones in this film.” The other medical students nodded their agreement. A nursing student rolled her eyes and said, barely audibly, “Actually, that is exactly what they do.” Her peers agreed. This was a fantastic teachable moment. IPE is not just about developing knowledge and skills. It’s also about opening minds and removing cultural barriers to teamwork.

Dr. Joe Rotella, MD MBA HMDC FAAHPM is the Chief Medical Officer, AAHPM and a frequent participant in #hpm (hospice and palliative med/care) chat.

What: #hpm chat on Twitter
When: Wed 10/14/2015 – 9p ET/ 6p PT
Host: AAHPM and Steve Smith, CEO of AAHPM

Some questions to ponder for the chat:
1. Are there opportunities for interprofessional palliative care training in your program? If so, how do they work?
2. What do you find to be the biggest challenges to interprofessional learning and collaboration?
3. What is the greatest lesson you ever learned from someone outside your profession?

If you are new to Tweetchats, you do not need a Twitter account to follow along. Try using the search function on Twitter. If you do have a Twitter account, we recommend using tweetchat.com, for ease of following.

You can access the transcripts and analytics of #hpm chats through @Symplur.