Psychosocial Oncology and Palliative Medicine

Credits: 4.00 CREDITS (Clinical Elective)
Sites: BWH, DFCI
Directors: Peteet, John Raymond; Schaefer, Kristen Gallion
Prerequisites: HMS Principal Clinical Experience (Core Clinical Clerkships) or equivalent
Offered: Full time for one month. Not offered in July and August. Not offered in April 2016.
Open to Exclerks: Yes (may be restricted for international students)
This course provides opportunities to develop knowledge and skills in the comprehensive care of patients and their families with serious illness at any stage of their disease, including the end of life and those with cancer and non-cancer diagnoses. Management of symptoms such as pain and nausea, anxiety and depression, psychosocial and spiritual support of patients and families, decision making, communication, coordination of care and bereavement care will be emphasized. Students will participate actively with residents, fellows, and members of the interdisciplinary team (nurses, SW, chaplain, pharmacy) on the psychosocial oncology and palliative care teams providing these patients with expert interdisciplinary care. Shared activities include collaborative interviews with faculty members; assessment, management recommendations for, and follow-up of patients; teaching rounds; and a range of conferences examining the clinical, ethical and research aspects of comprehensive palliative and end of life care. Senior palliative medicine and psychiatric staff supervise clinical work, acquisition of a knowledge base, and preparation of a brief presentation on a topic of the student’s interest. Student interested in pediatric palliative care may choose to shadow the Boston Children’s Hospital/DFCI pediatric palliative care team for one day of the rotation. Course Directors - John Peteet, MD and Kristen Schaefer, MD. Clinical sites: BWH, DFCI.
Learning Goals:
To assess and formulate a management plan for addressing (a) anxiety, depression and other common problems of oncology patients seen in psychiatric consultation and (b) distressing symptoms such as pain, nausea, dyspnea, and insomnia in cancer and non-cancer patients.
To apply pharmacologic principles to the treatment of seriously ill patients needing psychotropic and/or analgesic or other palliative medications, and to choose non-pharmacologic therapies appropriate to the patients’ needs.
To work effectively with an interdisciplinary team of palliative care professionals (representing medicine, anesthesia, psychiatry, nursing, social work and chaplaincy) in the care of patients and their families.
To articulate ethical principles involved in choices regarding end of life care, such as designation as DNR, DNI, the use of proxies and living wills, withdrawal of treatment and assisted suicide.
Incorporation of Basic Science Content and Evidence-Based Medicine:
A reading syllabus, discussion on rounds, and preparation of a final presentation incorporate evidence based scholarship into learning about practical problems.
Faculty will use the following means to assess students’ mastery of the above learning objectives:

(1) Observed interviews of or consultations with patients, and of the student’s formulation and discussion.
(2) Write-ups of patients seen on the Psychosocial Oncology and Palliative Care Services.
(3) Assessment during supervision and team rounds of the student’s ability to integrate the issues involved in an organized and comprehensive manner.
(4) A brief scholarly oral presentation (or equivalent paper) during the student’s final week.
(5) Review of the student’s answers to pre- and post-test questions.

Course directors will monitor and review the progress of the student on a weekly basis.
Grade Criteria:
High Honors:
Exceptional performance eliciting and synthesizing data, interviewing and following patients, participating actively in team activities, utilizing relevant literature in clinical formulations and final presentation.
Superior performance eliciting and synthesizing data, interviewing and following patients, participating actively in team activities, utilizing relevant literature in clinical formulations and final presentation.
Adequate attention to and synthesis of clinical data, satisfactory relationships with patients, average participation in team activities and use of evidence based resources. Meets attendance, documentation and professionalism responsibilities.
Inadequate attention to clinical data, unempathic or incomplete patient interviewing, poor write-ups, unexcused absenses, neglected scholarly responsibilities and/or unprofessional conduct.
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