The learning goals for this fellowship will be achieved via a combination of supervised clinical and research rotations, didactic seminars , lectures, and discussions, case conferences, summary of readings, individual supervision, teaching, and research projects and presentations.
1) Center for Palliative Care Grand Rounds (weekly). Fellows will attend the continuing education Center for Palliative Care lectures series. These one hour lectures focus upon the multiple practical, social, spiritual, psychological, and physical challenges faced by patients living with advanced disease. Sample topics include:
- Whole Patient Assessment
- Syndrome of Imminent Death
- Pain Crisis Management
- Withdrawal of Ventilator
- Pain Management and Addiction
- Bereavement and Anticipatory Grief
2) Supportive Care Meeting/Psychosocial Oncology Seminar (twice monthly). Fellows will attend the Psychosocial Oncology lunchtime educational series. This lecture series will provide fellows with the opportunity to learn new clinical skills and techniques for providing psychosocial care to cancer patients from a panel of interdisciplinary providers including social work, psychology, chaplaincy, mental health nursing, children’s programs, and bereavement specialists. During these meetings we will be planning psycho-oncology educational and support group activities. Fellows will have the opportunity to meet other mental health providers in the hospital and learn about the services they provide. We will also be reviewing Psycho-Oncology (2nd Edition; Eds Holland, Breitbart, Jacobsen, Lederberg, Loscalzo, McCorkle), Handbook of Psychiatry in Palliative Medicine (Eds Chochinov & Breitbart) and Oxford Textbook of Palliative Medicine (Eds Dolman, Hanks, Cherny & Calman) at these sessions. The fellow will present and teach a chapter from these texts approximately once every 2-3 months.
3) Psychosocial Oncology Case Conference (quarterly). Fellows will attend the Psycho-Oncology Case Conference attended by Psychologists, Licensed Independent Social Workers, Mental Health Clinical Nurse Specialists, and Professional Chaplains. During this case conference one to two clinical cases are reviewed with feedback from the multidisciplinary group regarding progress toward clinical goals. At this conference, fellows will have the opportunity to discuss complex patient care issues, to evaluate their current approach to treatment with specific clients, examine issues of transference and countertransference and gain support/assistance from other multidisciplinary psychosocial providers in the development of psychosocial plans of care. Members of this group are available for case consultation to medical staff including physicians, nurses, and administrative staff facing challenges in the psychosocial/behavioral management and care of their patients and family members.
4) Psychooncology & Palliative Medicine Journal Club (monthly). Fellows will participate in the monthly journal club, rotating with current Center for Palliative Care Physician Fellows to present current literature on the psychosocial or psychiatric aspects of palliative medicine. Program faculty and other staff attend this meeting to review/discuss state-of-the art empirical research in palliative care.
5) Other relevant coursework within the Department of Psychiatry and The Ohio State University. Fellows will have the opportunity to participate in courses offered as part of the Residency Program in the Department of Psychiatry. Example courses that may be relevant to the practice of Psycho-Oncology and Palliative Medicine include Addiction Psychiatry, Emergency Psychiatry, Ethics, and Psychopharmacology. Example courses outside of the Department of Psychiatry might include Introduction to Immunology (College of Medicine), Judgment and Decision-Making (Psychology), or Neuro-Oncology (Neurology). Coursework in these areas is based on external departmental approval and advance approval of Program Director and course instructor.
Psycho-Oncology/Palliative Medicine (two years) - The fellow will spend the first six months in the outpatient Center for Palliative Care Program working with Dr. Wells-Di Gregorio and other faculty members of the Palliative Care team. The fellow will also be available by consultation to the inpatient Center for Palliative Care team. During these outpatient and inpatient activities they will broaden their medical and psychological knowledge including diagnosis and treatment of psychological disorders in the context of serious medical illness. The fellow will learn to complete comprehensive interdisciplinary palliative care assessment and better understand the roles of interdisciplinary team members. They will learn to consult and refer to other providers to assist with the biopsychosocial care plan.
The fellow will also learn key concepts in symptom assessment and management, including psychoeducational and non-pharmacologic techniques for symptom management. The fellow will learn how to determine capacity for medical decision-making. They will coordinate with social work to meet patient and family social needs and with pastoral care to address spiritual and religious needs. They will learn to provide care and support to dying patients and their family members, ensuring that family members obtain necessary information to cope with death and bereavement. He/she will have the opportunity to co-facilitate Pathways, the hospital grief support group. The fellow will work with patients and/or family members in the outpatient psycho-oncology/palliative care program throughout their fellowship to provide long-term management for patient and families living with advanced disease.
Consultation-Liaison Psychiatry (one month) – The fellow will complete a one month part-time rotation with the OSUMC C-L Psychiatry Service during the first year of their fellowship. This experience will allow the fellow to better understand the role of a psychiatric/psychological consultant to medical services, to learn legal regulations regarding voluntary and involuntary commitment, to identify risk factors for suicidal or homicidal behavior and to develop a working familiarity with psychopharmacologic treatment of psychiatric disorders seen commonly among medical inpatients. The fellow will provide the team with assessment and non-pharmacologic, behavioral management services.
Pediatric Psycho-Oncology/Palliative Medicine (one month) – During the fellow’s second six months, the fellow will complete a one to two-month rotation at Nationwide Children’s Hospital. The goals of this fellowship experience include learning how pain and other non-pain symptom assessment differs depending on the age of the child. They will have the opportunity to shadow the management of acute sickle cell pain crisis including the implementation of behavioral plans following adequate pain control. The fellow will utilize behavioral techniques in order to assist patients and families to manage issues of non-compliance. The training experience at Nationwide Children’s Hospital will enable the fellow to observe the variability in patient and family responses to cancer and end of life across the age continuum.
Hospice (one month) – During the first months of the fellow’s second year, they will have the opportunity to complete a one-month rotation in a hospice setting. They will assess patients and/or family members’ pre-death needs and determine the degree of risk for complicated grief. They will help formulate individualized interventions to support the grieving process. They will provide grief interventions through phone calls and counseling and participate in Bereavement Support Group Programs including Pathways, the Center for Palliative Care’s Grief Support Group. They will have the option of continuing to follow a limited number of families throughout the 13 month hospice bereavement follow-up period in order to optimize their understanding of the trajectory of grief following loss.
Palliative & Psychosocial Care Research Program (24 months) – The fellow will be an active participant in the Palliative & Psychosocial Care Research Program throughout their fellowship. The fellow will learn research design and methods as it applies to patients and families at the end of life. They will learn a variety of standardized symptom assessment methods and will learn to structure studies to limit burden and emotional distress of patients and family members. The will have the opportunity to supervise undergraduate research projects and teach them stages of the research process including idea generation, literature review, hypothesis development, study design, measurement, data collection and verification, basic statistics, and presentation of research findings. The fellow will gain experience writing empirical and review manuscripts and will have the opportunity to develop a grant that, if funded, could be utilized for an additional year of research training or could assist in obtaining their first academic position.
Pediatric Psycho-Oncology/Palliative Medicine Research (6 months, elective) – If desired, during the first 6 months of the second year, the fellow could obtain research training with Cynthia Gerhardt, Ph.D., Principal Investigator, Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital. Dr. Gerhardt currently has several studies underway that would be relevant for this fellowship including a longitudinal sibling bereavement project, a family communication study involving patients who have a new diagnosis of cancer or who have relapsed, and a palliative care study involving families that will examine symptoms, sleep patterns, and fatigue. During this research rotation, the fellow would have the opportunity to learn many new research techniques including observation and coding of communication data, behavioral and affect coding, and transcription and coding of grief interviews. These techniques, and their unique application with children, will be useful for a fellow planning to start and independent research career in pediatric palliative medicine.
Psycho-Oncology Research (6 months, elective) – This elective experience would occur at the start of the fellow’s second year and would involve developing a new study with an oncologist in the James Cancer Hospital. This project would be limited in scope, allowing for the collection of pilot data, which could then be utilized for a grant application. The topic and methods would be at the discretion of the fellow and the oncologist, with research supervision provided as needed by Dr. Wells-Di Gregorio. The primary requirement is that this project be completed during this six month rotation including data analyses.