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. Professionalism: Fellows must demonstrate a commitment to professionalism and an adherence to ethical principles.
2. Patient Care and Procedural Skills
   
   1. 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. Fellows must demonstrate competence coordinating, leading, and facilitating 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
      2. Fellows must demonstrate competence in providing care to patients and families that reflects unique characteristics of different settings along the palliative care spectrum
      3. Fellows must demonstrate competence in recognizing signs and symptoms of impending death and appropriately caring for the imminently dying patient and his or her family members
      4. Fellows must demonstrate basic counseling to the bereaved, and the ability to identify when additional psychosocial referral is required; and
      5. Fellows must demonstrate competence in providing palliative care throughout the continuum of serious illness while addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice
   2. Fellows must be able to perform all medical, diagnostic, and surgical procedures considered essential for the area of practice
      1. Fellows must demonstrate competence in the assessment, interdisciplinary care planning, management, coordination, and follow-up of patients with serious illness
      2. Fellows must provide patient- and family-centered care that optimizes quality of life, by anticipating, preventing, and treating suffering.

3. 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. Fellows must demonstrate competence in their knowledge of the scientific method of problem solving and evidence-based decision making, and develop a commitment to lifelong learning and an attitude of caring that is derived from humanistic and professional values
2. Fellows must demonstrate knowledge of ethical issues, clinical utilization, and financial outcomes of palliative care; and,
3. Fellows must demonstrate competence in their knowledge and skills of primary and consultative practice.
4. 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.
5. 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.
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.

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 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.