Palliative Medicine Fellowship Research Articles

End-of-Life Ethics Content in the Ten Residencies Offering Hospice and Palliative Medicine Fellowship

End-of-Life Ethics Content in the Ten Residencies Offering Hospice and Palliative Medicine Fellowship

Primary Addiction Training for Hospice and Palliative Medicine Fellows: A National Survey of Program Directors

Primary Addiction Training for Hospice and Palliative Medicine Fellows: A National Survey of Program Directors

An Evaluation of Hospice and Palliative Medicine Fellowship Websites

An Evaluation of Hospice and Palliative Medicine Fellowship Websites

Formal Training in Palliative Care for the Trauma Surgeon: Hospice and Palliative Medicine Fellowship

Formal Training in Palliative Care for the Trauma Surgeon: Hospice and Palliative Medicine Fellowship

Attitudes and Beliefs Regarding Pain Medicine: Results of a National Palliative Physician Survey

ContextPain is a prevalent symptom in patients with serious illness and often requires interventional approaches for adequate treatment. Little is known about referral patterns and collaborative attitudes of palliative physicians regarding pain management specialists. ObjectivesTo evaluate referral rates, co-management strategies, and beliefs of palliative physicians about the value of Pain Medicine specialists in patients with serious illness. MethodsA 30-question survey with demographic, referral/practice, and attitudes/belief questions was mailed to 1000 AAHPM physician members. Responses were characterized with descriptive statistics and further analyzed for associations between training experiences, practice environment, and educational activities with collaborative practice patterns and beliefs. ResultsThe response rate was 52.6%. Most survey respondents had initial board certification primarily in internal medicine (n = 286, 56%) or family medicine (n = 144, 28%). A minority of respondents had completed a formal ABMS Hospice and Palliative Medicine fellowship (n = 178, 34%). Respondents had been in practice for a median of nine years, (range 1-38 years) primarily in community hospitals (n = 249, 47%) or academic hospitals (n = 202, 38%). The variables best associated with collaborative practices and attitudes was practice in an academic hospital setting and participation in regular joint academic conferences with pain medicine clinicians. ConclusionThis study shows that Palliative Care physicians have highly positive attitudes toward Pain Medicine specialists, but referrals remain low. Facilitating professional collaboration via joint educational/clinical sessions is one possible solution to drive ongoing interprofessional care in patients with complex pain.

Novel Integration of a Health Equity Immersion Curriculum in Medical Training.

Health disparities education is an integral and required part of medical professional training, and yet existing curricula often fail to effectively denaturalize injustice or empower learners to advocate for change. We discuss a novel collaborative intervention that weds the health humanities to the field of health equity. We draw from the health humanities an intentional focus retraining provider imaginations by centering patient narratives; from the field of health equity, we draw the linkage between stigmatized social identities and health disparities. We describe a longitudinal health equity curriculum for the Hospice and Palliative Medicine fellowship in Memphis, Tennessee, to give trainees exposure to the concept of structural violence and how it affects clinical care. The curriculum was developed in partnership with humanities and social sciences faculty who staff a Health Equity academic program at a small liberal arts college in Memphis. This curriculum has been implemented for the past four years in support of 22 hospice and palliative medicine fellows. Group debriefs and a mixed methods survey have revealed widespread and lasting impact towards understanding health equity concepts, enhanced communication and treatment of patients, and empowerment to address the broader needs and policies affecting patients and the communities in which they live. Ultimately, we model an educational initiative that integrates equity across the full scope of healthcare practice and equips learners with skills for sustaining compassionate practices, focusing on equity-oriented, person-centered care across the full scope of healthcare practice.

Grief Training in Palliative Care Fellowships

IntroductionNo prior study has assessed grief and bereavement curriculum in Hospice and Palliative Medicine (HPM) fellowship programs in the United States. MethodsA 14-item survey was created and distributed to Accreditation Council for Graduate Medical Education (ACGME)-accredited HPM fellowship Program Directors to assess program demographics, curriculum emphasis, grief and bereavement programming, and attitudes toward grief and bereavement training for HPM fellows. ResultsThe overall survey response rate was 63%. Most palliative care programs were academic (74%) and had four or fewer fellows (85%). 90% devoted a minority (0%–10%) of their curriculum to grief and bereavement training. Most programs reported at least some program-led grief and bereavement programming (69%); however, 53% endorsed that fellows are not very or not at all involved in this programming. Almost half of programs only have a small amount of programming related to supporting families after loss (49%). The majority endorsed having a great deal of programming for debriefing or supporting fellows through professional grief (55%), and the most common modalities were debriefing sessions (62%) and ensuring access to mental health resources (41%). The most common ways of teaching grief and bereavement were through bedside/anecdotal teaching and lectures/case conferences. Most program directors felt that palliative care fellowships should provide grief and bereavement training (81%) and consider it important or very important for fellows to learn how to process grief and bereavement (92%). DiscussionIt was widely reported by program directors that grief and bereavement training are important curricular components for HPM fellows. Acknowledging professional grief remains an underrecognized need in palliative care training and practice. Our study suggests that for grief and bereavement curricula in HPM fellowships, the time dedicated, specific types, and amount of fellow involvement was highly variable. It will be critical for programs to disseminate best practices to help move toward a more uniform approach for ensuring basic competency in grief and bereavement training in HPM fellowship programs in the United States.

A Report on the Innovative University of Colorado Community Hospice and Palliative Medicine Fellowship.

Background: Predictive health services modeling signals a shortage of board-certified Hospice and Palliative Medicine (HPM) physicians. Methods: This article introduces the Community Hospice and Palliative Medicine (CHPM) Fellowship, an Accreditation Council for Graduate Medical Education (ACGME) Advancing Innovation in Residency Education (AIRE) project designed to enable mid-career physicians (at least five years out from residency or fellowship) to achieve eligibility for board certification in HPM. Results: From 2020 to 2023, 24 fellows have completed or are currently participating in the CHPM fellowship which is evaluated using the Kirkpatrick model. Conclusion: This program shows promise in addressing the impending HPM workforce shortage by allowing physicians to complete a fellowship in their local communities.

A Call to Action: Using Curriculum Mapping at Four Medical Schools in Massachusetts to Advance Serious Illness Communication Training in Undergraduate Medical Education.

Background: Practicing physicians require serious illness communication (SIC) skills to ensure high-quality, humanistic care for patients and families as they face life-changing medical decisions. However, a majority of U.S. medical schools do not require formal training in SIC and fail to provide students deliberate practice before graduation. The Massachusetts Medical Schools' Collaborative was created to ensure that students receive foundational SIC training in undergraduate medical education. This Collaborative developed a curriculum-mapping tool to assess SIC at four medical schools. Objective: We aimed to understand existing educational activities across four medical schools and identify opportunities to build longitudinal, developmentally based curricular threads in SIC. Design: From July 2019 to April 2021, faculty, staff, and medical students assessed current educational activities related to five core competencies in SIC, adapted for students from national competencies for palliative medicine fellows, using a curriculum mapping tool. Measurements: The group selected 23 keywords and collected metrics to describe the timing, instruction and assessment for each school's educational activities. Results: On average, there were only 40 hours of required curricula in SIC over four years. Over 80% of relevant SIC hours occurred as elective experiences, mostly during the postclerkship phase, with limited capacity in these elective experiences. Only one school had SIC educational activities during the clerkship phase when students are developing clinical competencies. Assessment methods focused on student participation, and no school-assessed clinical performance in the clerkship or postclerkship phase. Conclusions: Medical schools are failing to consistently train and ensure basic competency in effective, compassionate SIC. Curriculum mapping allows schools to evaluate their current state on a particular topic such as SIC, ensure proper assessment, and evaluate curricular changes over time. Through the deliberate inclusion of SIC competencies in longitudinal curriculum design, we can fill this training gap and create best practices in undergraduate medical education.

Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors.

Psychological and psychiatric care is a core domain of palliative care. Despite a high burden of mental health comorbidity among individuals with serious illness, the Accreditation Council of Graduate Medical Education gives little guidance about training hospice and palliative medicine (HPM) fellows in this domain of care. Currently, there is a lack of empiric data on HPM physician fellowship training in mental health topics. To characterize HPM physician fellowship training practices in the psychological and psychiatric aspects of palliative care. A cross-sectional survey study querying HPM fellowship training directors nationally. A total of 95 programs participated (51% response rate). A total of 98% programs offered didactics on mental health topics. Topics universally deemed as important by program directors were commonly taught, but there was variability in both the perceived importance and the didactic coverage of several topics. Only 15% of programs offered core rotations in psychiatry. Most programs offered psychiatry electives, but such electives were only rarely utilized by fellows. Interdisciplinary team (IDT) rounds infrequently included doctoral mental health clinicians. Beyond a few commonly identified and taught key topics, there is variability in clinical and didactic exposure to mental health training among HPM fellowships. Standardizing key learning objectives and guiding educators in how to achieve these objectives could improve the preparedness of the physician workforce in HPM to meet the mental health needs of patients with serious illness.

Miracles Abound: Submission to The Journal of Pain and Symptom Management, Humanities section.

A hospice and palliative medicine fellow ponders the nature of the miraculous and the mundane in healthcare and everyday life as he transitions from emergency medicine to palliative care, leading him to a greater sense of gratitude and wonder.

Development of a palliative care lecture series for hematology-oncology fellows.

e24112 Background: Many major organizations endorse provision of palliative care (PC) services for patients with advanced cancers from both oncologists and PC specialists. While ACGME has outlined core PC competencies, PC education during hematology-oncology (HO) fellowship is highly variable, and many fellows feel inadequately trained. We assessed whether incorporation of a PC lecture series could improve fellows’ self-perceived preparedness in basic PC skills. Methods: In this educational quality improvement initiative, current HO fellows at an NCI-designated cancer center received lectures on PC topics. Members of both the HO and hospice and palliative medicine fellowship programs met to discuss key components of a PC curriculum and identify available experts. Seven multidisciplinary faculty members delivered eight one-hour video-recorded virtual lectures to HO fellows over a three-month period. Lecture videos remained available online for later viewing in the event of fellow absences. Within a few weeks both pre- and post-lecture series, HO fellows completed surveys addressing their level of preparedness on a 5-point scale (from 1-not at all prepared to 5-extremely prepared) in performing several key skills. Two-tailed paired t-tests were performed to analyze pre/post changes in fellows’ level of preparedness. Results: Eleven fellows participated in the PC lecture series. Fellows’ level of preparedness increased across several PC topics (Table). The greatest increases were in creating a survivorship plan, converting from one opioid to another, and managing pain in a patient at risk for a substance use disorder. Fellows ranked individual lectures as very helpful to their learning, especially lectures on management of GI symptoms (4.9 +/- 0.3), pain management with opioids (4.8 +/- 0.4), and communication (4.5 +/- 0.5). Conclusions: Incorporation of a structured PC didactics series into HO fellowship is feasible, perceived as very useful, and associated with increased self-perceived preparedness. While more longitudinal and hands-on PC experience would likely promote HO fellows’ PC skills more deeply and durably, dedicated PC lectures are an important adjunctive component that can be easily incorporated into HO fellowship education. [Table: see text]

Developing Narrative Competence in Palliative Medicine Fellows (Sch422)

Developing Narrative Competence in Palliative Medicine Fellows (Sch422)

Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training.

Few individuals have fellowship training in both hospice and palliative medicine (HPM) and a surgical specialty including general surgery, general obstetrics and gynecology, or affiliated subspecialties. There is a paucity of data to explain why some surgeons choose to pursue HPM fellowship training. Identify facilitators and barriers to palliative medicine fellowship training among physicians from a surgical specialty. We conducted individual semistructured interviews with 17 surgeons who were also fellowship-trained in HPM. Interviews were recorded, transcribed, and thematic analysis was conducted to identify themes. Participants reported pivotal experiences-either positive exposure to palliative care or suboptimal surgical care experiences-as a key motivator for pursuing specialty palliative care training. Additionally, participants chose HPM training because they felt that practicing from a HPM perspective aligned with their personal care philosophy, and in some cases, offered professional opportunities to help achieve career goals. Participants reported encountering bias from both HPM and surgical faculty, and also found that some HPM fellowship programs did not accept surgical trainees. Surgeons also reported logistical concerns related to coordinating a one-year fellowship as a barrier to formal HPM training. Understanding the motivations of surgeons who pursue HPM training and identifying challenges to completing fellowship may inform solutions to expand surgeon representation in palliative care. Both HPM and surgical faculty should be educated on the benefits of specialty HPM training for surgical trainees and practicing surgeons. Further research should explore HPM fellowship best practices for welcoming and training surgeons and other underrepresented specialties.

A Call for the Creation of LGBTQ+ Competencies for Hospice and Palliative Medicine (HPM) Fellowship Programs.

LGBTQ+ people and their families have unique needs, concerns, and issues when navigating serious illness. To develop curricular milestones and an educational framework for hospice and palliative medicine (HPM) fellowship programs to meet the needs of this community. A working group has developed a plan for the inclusion of LGBTQ+ competencies in HPM fellowship programs, utilizing input from an AAHPM Special Interest Group (SIG) at a national meeting. Learning to provide culturally competent care is essential for all HPM providers. Our group recommends specific clinical training competencies with plans to pilot them in upcoming academic years. Creating curricular recommendations will help guide fellowship programs education in the care of LGBTQ+ patients with serious illness.

Integration of the Verbatim Exercise into a Hospice and Palliative Medicine Fellowship.

One of the more challenging aspects of specialty level training in any medical fellowship is learning to communicate mindfully and effectively with patients and families in the face of serious illness. For the past five years, our accredited Hospice and Palliative Medicine (HPM) fellowship program has been integrating the "verbatim"-an exercise with a long and integral history in the training of health care chaplains. Verbatims are word-for-word accounts of a clinician's encounter with a patient and/or the patient's family. The verbatim serves as a formative educational exercise offering a method to hone one's clinical skills and competencies, while providing a unique space to practice self-awareness and self-reflection. Although sometimes difficult and intense for the fellow, we have found this to be a helpful exercise in improving the fellow's ability to make meaningful connections with patients and leading to improved outcomes of communication episodes. This potential growth in self-awareness supports both resiliency and mindfulness, which are essential skills for longevity and reduction of burnout risk in the field of HPM. The verbatim invites all participants to reflect on their own participation in facilitating whole person care to patients and families. Out of the six HPM milestone metrics for fellowship training, the verbatim exercise supports achievement in at least three of the milestones. We present survey data over the past five years of our fellowship in support of the utility of this exercise and for consideration to include this exercise in a palliative medicine fellowship. We offer additional suggestions for further study of this formative tool. This article delineates the verbatim technique and its specific integration into our accredited ACGME Hospice and Palliative Medicine fellowship training program.

Hospice and Palliative Medicine Fellows’ Clinical Discussions, Perceived Knowledge, and Formal Training Regarding Medical Cannabis Use: A National Survey Study (TH108B)

Hospice and Palliative Medicine Fellows’ Clinical Discussions, Perceived Knowledge, and Formal Training Regarding Medical Cannabis Use: A National Survey Study (TH108B)

Promoting Specialty Diversity in Hospice and Palliative Medicine: A Call to Action

The Covid-19 pandemic amplified not only the well-established gap between the supply of the palliative care workforce and the demand for palliative care services across a wide range of specialties, but also the importance of diversity in rising to the challenges of our time. 1 Kamal AH Bull JH Swetz KM Wolf SP Shanafelt TD Myers ER. Future of the palliative care workforce: preview to an Impending Crisis. Am J Med. 2017; 130: 113-114 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar , 2 Kamal AH Wolf SP Troy J et al. Policy changes key to promoting sustainability and growth of the specialty palliative care workforce. Health Aff (Millwood). 2019; 38: 910-918 Crossref PubMed Scopus (71) Google Scholar , 3 Cooper Z Bernacki RE. To face coronavirus disease 2019, surgeons must embrace palliative care. JAMA Surg. 2020; 155: 681-682 Crossref PubMed Scopus (9) Google Scholar , 4 Shalev D Nakagawa S Stroeh OM et al. The creation of a psychiatry-palliative care liaison team: using psychiatrists to extend palliative care delivery and access during the COVID-19 crisis. J Pain Symptom Manage. 2020; 60: e12-e16 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 5 Dundin A Siegert C Miller D et al. A pivot to palliative: an interdisciplinary program development in preparation for a coronavirus patient surge in the Emergency Department. J Emerg Nurs. 2020; (S0099-1767(20)30286-5) Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 6 DiversityEquity & Inclusion Strategic Plan. American Academy of Hospice and Palliative Medicine, 2022http://aahpm.org/uploads/Final_Revised_D__I_Strategic_Plan_Approved_3_13_19.pdf Google Scholar The pool of physicians represented under the 10-member multispecialty board recognizing Hospice and Palliative Medicine (HPM) is critical for filling this workforce gap and for bridging specialty palliative care and the parent specialties. Surgeons, anesthesiologists, psychiatrists, emergency medicine physicians, and others outside the field of internal medicine (IM) are critical emissaries both to and for palliative care. These clinicians, educators, and researchers promote primary palliative care education in their parent specialties, foster acceptance and receptivity to palliative care interventions among their primary specialty colleagues, and build the programs and evidence base that ensure patient access to palliative care across the full spectrum of serious illness. They also bring diverse knowledge, skills, perspectives, and experiences to HPM, informing and shaping the field and augmenting its capacity to serve the needs of a broad range of patients and families. 7 Bassette E Salyer C McCammon S Veazey Brooks J Spoozak L Value of hospice and palliative medicine fellowship after surgical training: bridging the gap for improved patient care. Am J Hosp Palliat Care. 2022; (Epub ahead of print)10499091221128966https://doi.org/10.1177/10499091221128966 Crossref PubMed Scopus (0) Google Scholar

11 Implementation of a Hospice Transition Protocol in an Emergency Department to Facilitate End-of-Life Care

11 Implementation of a Hospice Transition Protocol in an Emergency Department to Facilitate End-of-Life Care

Value of Hospice and Palliative Medicine Fellowship After Surgical Training: Bridging the Gap for Improved Patient Care.

Objective: Surgeons comprise 2% of HPM-trained physicians. Little is known about the perceived value of HPM training to the surgeon or medical community. We aim to demonstrate the value of HPM fellowship training to surgeons and surgical practice from the point of view of HPM fellowship trained surgeons. Design: A qualitative analysis was performed using semi-structured zoom interviews that elicited the lived experiences of HPM trained surgeons. Data was analyzed using descriptive statistics and thematic analysis. Setting: Researchers were from the University of Kansas School of Medicine and the University of Alabama at Birmingham. Participants were trained and worked across the United States in a variety of settings. Participants: Eligibility included training in general surgery, obstetrics and gynecology, or affiliated subspecialties and completion of a 1-year HPM fellowship. Results: 17 interviews were performed. Several themes emerged regarding the transformative value of HPM training to their medical and surgical practice: (1) Learning to apply shared decision making and goal-concordant care to surgical decision making, and (2) Decreasing personal bias in medical decision making, and (3) Enabling wellness in surgeons. Two themes emerged regarding the perceived value to both the surgical community and the HPM community: (1) Value of the HPM Fellowship Trained Surgeon to the Surgical Community, and (2) Value of the HPM Fellowship Trained Surgeon to the HPM Community. All study participants valued their HPM training and felt highly valued by the healthcare team. Conclusion: HPM trained surgeons are highly valued on the healthcare team and improve patient-centered surgical care.