Curriculum

Curriculum

The subspecialty of Hospice and Palliative Medicine represents the medical component of the broad therapeutic model known as palliative care.

These subspecialists reduce the burden of serious illness by supporting the best quality of life throughout the course of an illness, and by managing factors that contribute to the suffering of the patient and the patient's family.

  1. Palliative care addresses physical, psychological, social, and spiritual needs of patients and their families, and provides assistance with medical decision-making.
  2. The major clinical skills central to the subspecialty of Hospice and Palliative Medicine are the prevention (when possible), assessment and management of physical, psychological and spiritual suffering faced by patients with serious illness , and their families.
  3. Hospice and Palliative Medicine is distinguished from other disciplines by:
    1. High level of expertise in addressing the multidimensional needs of patients with serious illnesses, including a practical skill set in symptom control interventions;
    2. A high level of expertise in both clinical and non-clinical issues related to advanced illness, the dying process and bereavement;
    3. A commitment to the interdisciplinary team approach; and,
    4. A focus on the patient and family as the unit of care.

A fellowship program in Hospice and Palliative Medicine consists of 12 months of education in the subspecialty.

The Fellowship Program must integrate the following ACGME competencies into the curriculum.

  1. Patient Care: Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Fellows:
    1. Are expected to demonstrate assessment, interdisciplinary care planning, management, coordination and follow-up of patients with serious illness;
      1. The care provided will be patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering.
      2. Fellows will provide palliative care throughout the continuum of illness while addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice.
    2. Are expected to coordinate, orchestrate, and facilitate key events in patient care, such as family meetings, consultation around goals of care, advance directive completion, conflict resolution, withdrawal of life-sustaining therapies, and palliative sedation, involving other team members as appropriate;
    3. Are expected to provide care to patients and families that reflects unique characteristics of different settings along the palliative care spectrum;
    4. Are expected to recognize signs and symptoms of impending death and appropriately care for the imminently dying patient and their family members; and,
    5. Are expected to provide treatment and counseling to the bereaved.
  2. Medical Knowledge: Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Fellows:
    1. Are expected to learn the scientific method of problem solving and evidence-based decision making and develop commitment to lifelong learning, and an attitude of caring that is derived from humanistic and professional values.
  3. Practice-Based Learning and Improvement: Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Fellows are expected to develop skills to meet the following goals:
    1. Identify strengths, deficiencies, and limits in one’s knowledge and expertise;
    2. Set learning and improvement goals;
    3. Identify and perform appropriate learning activities;
    4. Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement; and,
    5. Demonstrate knowledge of ethical issues, clinical utilization, and financial outcomes of palliative care.
  4. Interpersonal and Communication Skills: Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and professional associates. Fellows are expected to:
    1. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds;
    2. Communicate effectively with physicians, other health professionals, and health related agencies;
    3. Work effectively as a member or leader of a health care team or other professional group;
    4. Act in a consultative role to other physicians and health professionals;
    5. Maintain comprehensive, timely, and legible medical records, if applicable.
    6. Demonstrate the ability to educate patients/families about the medical, social and psychological issues associated with serious illness;
    7. Demonstrate the above skills in common situations occurring with serious, life-threatening illness and at the end of life, and write an informative, sensitive note in the medical record;
    8. Organize and lead or co-facilitate a family meeting;
    9. Collaborate effectively with others as a member or leader of an interdisciplinary team; and,
    10. Collaborate effectively with all elements of the palliative care continuum, including hospitals, palliative care units, nursing homes, home and inpatient hospice, and other community resources.
  5. Professionalism: Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Fellows are expected to demonstrate:
    1. Compassion, integrity, and respect for others, including all patients and their families as well as other clinicians;
    2. Responsiveness to patient needs that supersedes self-interest;
    3. Respect for patient privacy and autonomy;
    4. Accountability to patients, society and the profession;
    5. Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation;
    6. The ability to recognize one’s own role and the role of the system in disclosure and prevention of medical error, and
    7. The capacity to reflect on personal attitudes, values, strengths, vulnerabilities, and personal experiences to optimize personal wellness and capacity to meet the needs of patients and families.
  6. Systems-Based Practice: Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care as well as the ability to call effectively on other resources in the system to provide optimal health care. Fellows are expected to:
    1. Work effectively in various health care delivery settings and systems relevant to their clinical specialty, if applicable;
    2. Coordinate patient care within the health care system relevant to their clinical specialty;
    3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate;
    4. Advocate for quality patient care and optimal patient care and/or public health systems;
    5. Work in interprofessional teams to enhance patient safety and improve patient care quality;
    6. Participate in identifying system errors and in implementing potential systems solutions;
    7. Evaluate and implement systems improvement based on clinical practice or patient and family satisfaction data, in personal practice, team practice, and within institutional settings; and,
    8. Demonstrate knowledge of the various settings and related structures for organizing, regulating, and financing care for patients at the end of life.

Overall Goals and Objectives

The purpose of this Palliative Medicine Fellowship is to prepare the graduates of specialty training programs (Internal Medicine and its subspecialties, Family Medicine and its subspecialties, Neurology, Physical Medicine and Rehabilitation, Surgery, Pediatrics, Obstetrics/Gynecology, Psychiatry, Anesthesiology, Emergency Medicine, and Radiation Oncology) to become competent palliative medicine physicians whether in academic medical centers or in the community setting.

The individual is mentored in transition from recent graduate status to palliative medicine physician. Our curriculum provides a supervised, in-depth experience that allows the fellows to acquire the knowledge, skills, and attitude to function as a competent palliative medicine physician. Graduates will also be prepared to successfully pass the Palliative Medicine board examination. Using a combination of a core set of experiences and flexible scheduling, the program will allow the fellow to pursue a track that meets their career goals.

At the completion of a year-long palliative medicine fellowship, the fellow will:

  • Formulate an estimate of prognosis and sensitively communicate it to the patient and family in the context of shared-decision making.
  • Establish goals of care and recommend an appropriate treatment plan.
  • Practice life-long learning and improvement.
  • Demonstrate excellent interpersonal and communication skills.
  • Provide care, education, and support for the imminently dying patient and family.
  • Cultivate self-care and self-compassion in order to promote resilience and prevent burnout.
  • Demonstrate knowledge of the broader health care system and its impact on the care of seriously ill patients, especially as it applies to transitions of care.
  • Function as a physician member and leader of an interdisciplinary team.
  • Demonstrate excellence in teaching palliative medicine to professional students and practicing clinicians.
  • Serve as a palliative care expert in the role of primary physician or consultant.
  • Support patients and their families in the psychosocial and spiritual domains in the context of interdisciplinary team care.
  • Function as an administrator and leader of hospice or palliative care program.