INT 473 - Internal Medicine/Palliative Care

The course is designed for senior medical students whose careers might include patient and family discussions about life and death decisions, treatment of difficult pain and other symptoms, and working with interdisciplinary teams. The Sentara Norfolk General Hospital Palliative Care Service consists of a physician; a nurse practitioner, a nurse specialized in neuroethics, and a social worker. While the primary teaching site is Sentara Norfolk General, students are also scheduled time with the Palliative Care Consult Service at Sentara CarePlex and Chesapeake Rehab and Care Center. This rotation allows the student the opportunity to experience the human side of tertiary care medicine, to integrate science with humanities and to test the waters for a fellowship or career in the new field of hospice and palliative care. The rotation aims to give future physician the opportunity to care for the sickest of the sick patient, to acquire new skills and work with a dynamic interdisciplinary team. Palliative care consults are generated on patients with serious illness, often with multi-system failure and suffering. The team evaluates patients, conducts family conferences and attempts to set goals of care. In addition, the team tries to control suffering. Conferences frequently include other physicians, consultants, chaplains and nurses in addition to the palliative care team. The student will participate in daily conferences to learn about patients and to plan the day and Team meetings. Students will be mentored by Dr. Marissa Galicia-Castillo, Dr. Lauren Mazzurco or Dr. Deborah Morris on the Palliative Care Team and/or other team members (social worker, nurse practitioner), observe evaluations and family meetings, and participate in the debriefings in which the team discusses family dynamics, and decision-making. Depending on interest and skills, students may begin to work independently and conduct family meetings, learn to work collaboratively with nurses, social workers and chaplains and to lead debriefings. There will be an opportunity to read and compose patient reports to present at team meetings or other forums. Often the student will interact with the ethics team and attend the Sentara Norfolk General Hospital Ethics Committee Meeting as scheduled. Students attend one Grief Counseling/Support Group session with the social worker. Students receive a syllabus with links to key readings and articles. Students are also required to select a topic and give a presentation no longer than 30 minutes to the Palliative Care team in the last week of the rotation. Any Palliative Care Team member or the course director may offer guidance about the topic.