What to Expect as a Hospice and Palliative Medicine Fellow
- Inpatient Palliative Care 14 weeks
- Hospice (Hospice Home and home) 13 weeks
- Discretionary (hospice or PC) 3 weeks
- Home palliative care 2 weeks
- Complex medicine 6 weeks
- Oncology 4 weeks
- LTC/nursing home PC 4 weeks
- Pediatrics 2 weeks
- Elective(s) 4 weeks
- Total: 52 weeks
Non-hospice palliative care and hospice (home and inpatient)
30 weeks total is required, as allocated above. You may decide which area to spend your discretionary three weeks, depending on interests and career goals.
Home palliative care
Partnering with Aspire.
Supportive care clinic/outpatient palliative care
Longitudinal experience — Minimum of one afternoon weekly for the entire year. When on inpatient palliative care, you may have additional clinic time.
Long-term care/nursing home palliative care
Four weeks doing palliative care in skilled nursing facilities (SNFs) with the senior health team and on the nursing facility palliative care consult service.
Oncology sub specialties (medical oncology, radiation oncology, IR)
Pediatrics at Prisma Upstate with their inpatient palliative care team
Complex medicine (one week each of inpatient neuro, nephrology, GI, ICU, cardiology, critical care)
Four weeks — Many options are available within the system, so consider what you would like to do so that we can set it up. If you would like some ideas, we can provide those.
Program faculty will be supervising this, and can speak to the various opportunities available to you.
Evaluations of the Fellow
Entire extended faculty (physicians and non-physician providers such as advanced practice providers, nurses, social worker, chaplains)
- Situational: leadership chart — the “big picture”
- Milestones: summative evaluation with program director at four, eight and 12 months.
- “Instant feedback” process
- 360-degree evaluation by the interdisciplinary faculty in hospice and palliative care
- End of rotation faculty evaluations
- In-service exam — HPM Pass, which you will take as a proctored exam in January
- Monthly meeting with program faculty
- Resiliency didactic curriculum
- System wide “burnout prevention” training
Patient contact requirements
New patients over the course of the program — 100 — This can be either hospice or non-hospice palliative care patients and can be in any venue as long as you are participating in an evaluation on a patient who is new to the program you are working with.
Hospice: 25 “hospice home visits” (that means house calls on hospice patients — could be initial visits, face to face, follow ups, etc.)
Longitudinal experience: Must follow at least 10 patients across settings.
Meetings with program director/associate program director
You will have a meeting with the program director and associate program director the third week of each month on Thursday afternoon for debriefing, informal feedback, questions, concerns, etc.
Institute for Healthcare Improvement (IHI) quality modules
You will be assigned seven of these.
Didactics — Entire faculty, plus selected outside speakers
We provide a comprehensive series of core “lectures” (interactive), both in the weekly “Core Topics” series and didactics specific to the rotations (e.g. hospice). These will touch on essentially all important topics in the field. You will be expected to do six to eight of these lectures yourself to partially fulfill the ACGME requirement that you participate as both “a learner and a teacher.”
Monthly, on the fourth Thursday after Core Topics. Three articles assigned each meeting and one of which is assigned to the fellow. I will assign these at least two weeks prior the meeting. You have 20 minutes to review the article, with these three questions in mind:
- What was the study/article about?
- What were the outcomes or key information presented?
- How is the paper relevant for us as hospice and palliative medicine providers?
- Structured communication training using format provided. This is particularly important in the first half of the fellowship year.
- Didactics and roleplaying throughout the year.
- “Instant Feedback” process — New this year.
- Communications “boot camp” at University of Pittsburgh — This is a weekend session in January that you will attend at the expense of the fellowship program.
- “Verbatim training.”
Textbooks and Core References
You will be provided with a copy of:
- Primer of Palliative Care — AAHPM - loan
- Care at the Close of Life — JAMA publication - provided
- Essentials of Hospice and Palliative Medicine — AAHPM - loan
- The Hospice Medical Director Manual - provided
- A variety of review articles of interest
We would suggest the following also:
- A comprehensive hospice and palliative medicine text of your choice
- UptoDate has good articles on current state of the art of hospice and palliative medicine.
- Palliative Care: Transforming the Care of Serious Illness — eds. Meier, Isaacs, Hughes
- AAHPM has some great references available to you.