Education and Training Opportunities
Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School
PGY V Fellowships in Psychosocial Oncology
The Psychosocial Oncology Program at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) is recruiting full-time PGY V fellows in psychiatry to service the clinical needs of a busy academic psychosocial oncology service. Fellowship runs for a full year, from July through June.
Responsibilities will include clinical services to cancer patients and their families, consultation and follow-up with inpatients, development of collaborative relationships with oncology subspecialty practices, and other disciplines. Mentored research and teaching opportunities are available. Fellows work closely with the Palliative Care Service at DF/BWCC and BWH. The fellow will be supervised by Psychosocial Oncology Program faculty. Interested candidates should send a curriculum vita and a letter describing their clinical interest to:
John Peteet, MDDepartment of Psychosocial Oncology and Palliative Care
Dana-Farber Cancer Institute
44 Binney Street
Boston, MA 02115
jpeteet@partners.org
Faculty
Susan D. Block, MD
Chair, Department of Psychosocial Oncology and Palliative Care
Co-Director, HMS Center for Palliative Care
Professor of Psychiatry (Medicine), Harvard Medical
School.
Dr. Block is board certified in internal medicine and psychiatry. She is nationally known as a leader in medical education reform and in the development of the field of palliative care. She has been responsible for the development of innovative educational programs for medical students, residents, fellows, and faculty, and has been recognized by the Association for Academic Psychiatry, the Association of American Medical Colleges and the American Academy of Hospice and Palliative Medicine for national leadership in education and research. She is the National Program Director for the Project on Death in America (PDIA) Faculty Scholars Program and a member of the Board of the PDIA. She has numerous grants from foundations and the National Cancer Institute to evaluate and improve education in palliative care and has published extensively in medical education and palliative medicine. Dr. Block is also a trustee of the American Board of Hospice and Palliative Medicine.
John Peteet, MD
Clinical Director, Department of Psychosocial Oncology and Palliative
Care
Associate Professor of Psychiatry, Harvard Medical School
Dr. Peteet is board certified in psychiatry and has worked for over 25 years in psychosocial oncology. He has published numerous papers in the field and has been recognized for his teaching by the Association for Academic Psychiatry and the John Templeton Foundation.
Michael Miovic, MD
Staff Psychiatrist, Department of Psychosocial Oncology and
Palliative Care
Instructor of Psychiatry, Harvard Medical School
Dr. Miovic received his bachelor's degree from University of California, Santa Cruz, and his medical degree from the University of California, San Diego. He trained in psychiatry at the Harvard Longwood Program, Boston before completing a fellowship in Psycho-oncology at the Dana-Farber Cancer Institute and Brigham and Women's Hospital. Dr. Miovic has a special interest in spiritual issues in mental healthcare and recently published an article on that topic in the Harvard Review of Psychiatry. He is also interested in cross-cultural psychiatry (he is fluent in Spanish), complementary/alternative treatments, and using EMDR (eye-movement desensitization reprocessing) to treat post-traumatic syndromes.
Laurie Rosenblatt, MD
Staff Psychiatrist, Department of Psychosocial Oncology and Palliative Care
Assistant Professor of Psychiatry, Harvard Medical School
Dr. Rosenblatt is a board certified psychiatrist who has published papers and book chapters on grief, psychosocial issues at the end of life, and patient decisions to stop treatment. She has developed narrative teaching materials from patient interviews and uses creative writing (including poetry) in teaching medical students, interns, and fellows about caring for patients at the end of life.
General Description
This year-long program is designed to help psychiatrists acquire knowledge and skills in the psychosocial care of patients and families at all stages of cancer, including the end of life. Fellows receive supervision in the psychiatric care of both oncology outpatients at the Dana-Farber Cancer Institute (DFCI) and inpatients at Brigham and Women's Hospital (BWH). They develop collaborative relationships with oncology subspecialty practices and other disciplines, learn to teach non-psychiatric staff and trainees, and undertake a scholarly project for presentation and/or publication. Close contact with faculty of both the Psychosocial Oncology and Palliative Care Services of the Dana-Farber/Brigham and Women's Cancer Center and, through the Harvard Medical School Center for Palliative Care, with faculty at Massachusetts General Hospital (MGH) provides enhanced opportunities for focused clinical learning about palliative care and the emotional support of patients with cancer. Specifically, fellows learn to:
- Assess and co-manage (a) anxiety, depression, delirium and other common problems of oncology patients seen in psychiatric consultation, and (b) emotional components of distressing symptoms such as pain, nausea, dyspnea, and insomnia.
- Identify, assess and work therapeutically with patients who are fearful, uncertain, or struggling with dependency, loss of control and other psychosocial issues associated with life-threatening illness.
- Apply pharmacologic principles to the treatment of seriously ill patients needing psychotropic and/or analgesic or other palliative medications. Choose non-pharmacologic therapies appropriate to the patients needs, using a psychodynamic understanding of the patient's personality style, values, relationships and other resources.
- Work effectively with an interdisciplinary team of oncology and palliative care professionals (representing medicine, anesthesia, psychiatry, pharmacy, nursing, social work and chaplaincy) in the emotional care of patients and their families.
- 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.
- Understand hospice services and refer appropriately to community hospice providers.
- Identify needs and provide psychosocial support to families dealing with life-threatening illness.
- Describe the bereavement process and implement appropriate interventions to support families in bereavement.
Fellows will participate in the following activities:
Clinical
Core:
- Comprehensive assessments of patients referred to the Psychosocial Oncology Service, including communication with the patients' primary treatment team, and follow up of these patients during their hospital stay. The fellow will consult on cases with supervisory physicians, who will, in turn, be available for guidance and support. A supervising attending will be readily available at all times. (In situations in which the responsible attending cannot be reached in a timely fashion, when immediate help is required, when the fellow encounters a heavier load than s/he feels able to safely manage, or when the fellow falls ill and cannot complete her/his assigned clinical duties, the fellow should page the Chief of Service for direction and back-up.)
- Psychiatric care of patients on the new inpatient palliative care unit.
- Consultation and treatment of scheduled outpatients at DFCI (expected target, 12 hours/week).
- Availability to respond to urgent requests for outpatient consultation during the work week.
- Availability by beeper during evenings and weekends, or arrangement of appropriate coverage.
- Multidisciplinary meetings of clinical staff and families regarding patients.
Elective:
- Home visits with hospice staff of various disciplines, and participation in one or more interdisciplinary hospice meetings.
Educational
Core:
- Orientation activities, including:
- DFCI employee orientation
- BWH Medical Psychiatry introductory breakfast
- Psychosocial Oncology and Palliative Care Fellows Orientation
- Welcome at Dr. Block's home
- Introductory lectures for oncology fellows (see schedule)
- Educational sessions for Palliative Care and Psycho-Oncology Fellows (see schedule)
- Supervision. Two hours of clinical supervision per week, including case by case supervision of inpatients. Dr. Peteet will provide the primary weekly supervision, with monthly supervision by other attending faculty.
- Career mentoring with Dr. Block monthly.
- Mentoring. Each fellow will chose a mentor with whom to meet monthly. These sessions are in addition to any regularly scheduled meetings with fellowship program directors or chiefs of service. The focus of these sessions will be determined by the fellow and mentor; however topics that will be important to cover include:
- How the fellowship is meeting the individual needs of the fellow
- Goals for the fellowship year
- Supervision regarding clinical and self-care issues
- Feedback and progress meeting the expectations of the fellowship
- Assistance with the development of teaching sessions for peers and others
- Career guidance and assistance with networking locally and nationally
- Reading. Each fellow will receive a syllabus of basic readings in psychosocial oncology and palliative care.
- Scholarly project. Development and presentation of a research or writing project, in collaboration with supervising faculty (a topic and work plan should be presented to your mentor by 9/1).
- Rounds and conferences (see weekly schedule).
- Psychosocial Oncology/Palliative Care Walk Rounds
- Palliative Care Rounds
- Medical Psychiatry Resident's Rounds
- Medical Psychiatry Fellows Didactic Seminar
- Weekly Psychosocial Oncology/Palliative Care Seminar
- HMS Palliative Care Faculty Seminar
- HMS Palliative Care Journal Club
- HMS Palliative Care Fellows Teaching Conference
- BWH Ethics Service Meeting
Elective:
- Exchange Rotation. Fellows will spend one month, part-time doing inpatient consultation on the BWH medical psychiatry service. During these afternoons a BWH Medical Psychiatry fellow will cover DFCI inpatient consultation responsibilities. (BWH)
- Rounds and conferences (see weekly schedule)
- Palliative Care Grand Rounds, Wednesdays 8-9 AM, Sept-June (DFCI, video-conferenced from MGH)
- Psychosocial Research Seminar, first Wednesday, 3:30-4:30 PM (DFCI)
- Schwartz Center Rounds, first Thursday, 11:30-12:30 AM (BWH)
- Psychosocial Rounds for Oncology Fellows, third Monday, 12-1 PM (DFCI)
- Living with Life-Threatening Illness lectures, Thursday (Spring Semester), 4-5 PM
- (MEC)
- Harvard Longwood Psychiatry Grand Rounds, Tuesday 12-1:30 (BIDeaconess)
Enrichment. Fellows can arrange opportunities through the fellowship program director (depending on scheduling and availability) to individualize and enhance their educational experience. Elective options include:
Pediatric Palliative Care Consultation: Joanne Wolf and Jenny Mack at the Children's Hospital include fellows in consultations. These are typically scheduled a day or two in advance, making it possible to plan ahead for time away from the service at the DFCI.
PACT: Nina Muriel and Paula Rauch see children of parents with cancer in consultation, usually at the MGH. Fellows can contact either Nina or Paula when they have a patient who would benefit from PACT consultation or to see new consults with the PACT service if they do not have patients of their own.
Communication skills: Fellows are encouraged to video-tape a patient interview at least once during the year. This video can be reviewed in the monthly fellows educational session from 4-5pm. Fellows can contact Leslie Forman in General Services at the DFCI (632-3136) to arrange for use of the video camera.
Retreats: Palliative care and geriatrics fellows will take part in an intensive communication session on October 10th from 2-5pm after the HMS Center for Palliative Care faculty seminar.
Living with Life-threatening Illness (LWLTI) - This is a course for first-year Harvard Medical students to explore the issues related to caring for dying patients. The course runs Thursday afternoons in the spring semester. Opportunities for fellows to be co-facilitators for small group teaching will be available.
The Program in Palliative Care Education and Practice (PCEP) - A national faculty development course that runs for two weeks (one week in November and one week in April). Fellows have the opportunity to be a full participant in the course taking part in both large and small group activities.
Oncotalk - An NCI-sponsored intensive communication program for oncology fellows. The four-day retreat is held in Aspen, CO two times per year. More info is available at http://depts.washington.edu/oncotalk.
American Academy of Hospice and Palliative Medicine - This is a yearly conference. It is an opportunity to attend research symposia, educational sessions, network with national colleagues, and job search.
American Psychosocial Oncology Society (APOS) - has two national meetings per year. Details are available at www.apos-society.org.
Academy of Psychosomatic Medicine (APM) - Holds its annual meeting in November. Details available at www.apm.org.
Teaching
Core:
- Fellows will supervise 4th year medical students in the Psychosocial Oncology and Palliative Care elective.
Elective:
- Opportunities exist to teach medical students taking Introduction to Psychiatry and Psychopathology (Psychiatry 700 M.J.), and Living with Life Threatening Illness.
- Teaching and liaison activities within a Disease Program at DFCI or an inpatient unit at BWH (see listing of faculty liaison relationships)
Administrative
- Clearance of vacation and other time away as far in advance as possible through the Clinical Director.
- Timely completion of dictation, billing, QA/QI and other administrative responsibilities, including the use of inpatient and outpatient templates.
- Participation in bi-weekly Psychosocial Oncology Staff Meetings
Evaluation
Faculty will use the following means to assess and review on a regular basis fellows' mastery of the above learning objectives:
- Observed interviews of or consultations with patients, and of the fellow's formulation and discussion.
- Write-ups of patients seen on the Psychosocial Oncology Service.
- Assessment during supervision and walk rounds of the fellow's ability to integrate the issues involved in an organized and comprehensive manner.
- A scholarly oral presentation (or equivalent paper) during the fellow's final month.
- Feedback from clinicians in other disciplines.
- Standardized assessment forms (fellows will use parallel forms to evaluate their supervision)
