A Novel Program to Promote Competency and Hospice and Palliative Medicine Board Certification

Abstract

Dear Editor:Board certification in Hospice and Palliative Medicine(HPM) by the American Board of Medical Specialties (ABMS)will require the completion of a 12-month clinical fellowshipafter2012.Toaccommodateestablished,mid-careercliniciansdesiring HPM certification and to improve staffing and sup-port of our rapidly growing HPM practice, we developed anovel curriculum and training experience. The ABMS Lear-ners’Programatourinstitution(MayoClinic,Rochester,MN)hasprovidedstructuredclinicalanddidactictraininginHPMoutside of a formal fellowship. The major goals of the pro-gram are to lead to clinical competence and to HPM-boardeligibility.Five physicians from our institution (two general inter-nists, one geriatrician, one psychiatrist, and one hematolo-gist) were selected to participate based on interest andaptitude for HPM. Participants use 20% clinical effort over a2-year period (2010–2012) to meet ABMS ‘‘Practice PathwayA’’ requirements (Table 1). Funding for the program has beenprovided by a combination of institutional grants and de-partmental support from the respective divisions of eachlearner. Learners have participated in the full range of HPMclinical activities to meet the ABMS requirement for sub-specialty-level exposure (Table 1). Learners regularly attendweekly HPM Fellowship didactics and participated in astructured ‘‘Boot Camp’’ with 12 hours of intense HPM ed-ucation in fundamental content areas. Direct feedback withprogram coordinators has been provided semi-annually.Learning has been augmented with off-campus electives in-cluding nursing home experience, home hospice visits, andattendance at national meetings (i.e., American Academy ofHospice and Palliative Medicine [AAHPM] National Meet-ing, Harvard Medical School Program in Palliative CareEducation and Practice [PCEP]). In the first 6 months of theprogram, learners were precepted by board-certified HPMphysicians on approximately 100 new consultations and80 follow-up visits. After the first year, learners will per-form consults independently, with HPM-certified physiciansavailable as backup. Thus far, learners have qualitativelyreported improved confidence with end-of-life discussionsand ethical issues, familiarity with Medicare HospiceGuidelines, and improvement in pain and symptom man-agement skills.To our knowledge, curricular programs with focused di-dactic and clinical content delivered systematically havenot been reported to enhance HPM board passing rate or toTable 1. ABMS Learners’ Program at Mayo Clinic, Rochester, MNPractice pathway A requirements How requirements were met800 hours in subspecialty-level practice of hospice andpalliative medicine including:Palliative Care Consult Service (1-year supervised and 1-yearindependent with ‘‘backup’’)