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Hospice and Palliative Care Fellowship Columbia - Curriculum

Hospice and palliative care educational experiences

Fellows will spend one year with our program, divided into 13 four-week blocks. Applicants will be eligible to apply after completion of an ACGME-approved residency or during approved research time in the middle of certain residencies.

During these 13 blocks of preparation, the fellow will gain the knowledge and skills necessary to manage conditions for seriously ill patients and for those at the end-of-life. Elective time will be offered to tailor training to the career goals of the fellow. Fellows will have a longitudinal palliative care clinic one half-day per week, seeing patients discharged from the hospital or referred from the community to our freestanding palliative care clinic.

Our fellowship didactics include weekly internal medicine grand rounds and hospice and palliative care noon conferences. We will offer several mornings per month of educational and experiential time—board review, supplemental lectures from fellowship faculty, or field trips to places in the community related to the field of palliative care. This may include meeting with the Richland County Coroner, a trip to a place of worship (as part of our ‘coffee with the clergy’ series), or a coffee shop for a poetry in medicine discussion.

The first month serves as a time to get to know each other, the hospital and our patients. Fellows will meet the people responsible for supervising them and shaping their education through didactics, patient care and team-building activities. Orientation will also consist of time to start working on the mandatory quality improvement/research project. 

Inpatient palliative care: five blocks

The fellow’s inpatient palliative care rotation consists of managing a diverse range of patients throughout the hospital. Fellows will see patients in the intensive care units (surgical, medical, neurology, cardiac, and cardiovascular), stepdown units, acute care for the elderly unit and general medical floors. 

Fellows will be responsible for leading our teaching service and working with our interdisciplinary team to provide comprehensive palliative care according to the biopsychosocial model. 

During time on the inpatient service, fellows will cultivate not only their ability as palliative care physicians, but also their teaching ability. Our program hosts all third-year medical students on their internal and family medicine rotations, as well as students choosing to spend their elective time with us. Resident physicians from family medicine, internal medicine and psychiatry spend time with our service as well.

We work closely with our heart failure team and are an essential component of evaluation and management for patients with left ventricular assist devices (LVAD). 

Inpatient and outpatient hospice: three blocks

Fellows will rotate with Prisma Health Hospice and the Agape Hospice House. They will round on inpatient hospice patients across two hospitals as well as in the hospice house, providing symptom management and supporting patients and their families.

Fellows will acquire the necessary skills to become hospice medical directors. They will learn the logistics of a hospice program and come to understand how all the services of a hospice come together to support patients near the end of their lives. Fellows will see patients for face-to-face visits, symptom management visits, and hospice admissions in the community. After the end of fellowship, trainees will be eligible to sit for the Hospice Medical Director Certification Exam.

Pediatric palliative care (inpatient and outpatient): one block

During this month, fellows will learn how pediatric palliative care prioritizes quality of life for pediatric patients with complex medical needs. Two weeks of the pediatric palliative care experience consist of rounding with Hands of Hope, our fellowship-affiliated outpatient pediatric palliative and hospice care group. Fellows will have an opportunity to interact with patients within a multidisciplinary team alongside Kara Huncik, MD, the medical director of Hands of Hope. Fellows will see pediatric patients with complex medical needs in the outpatient setting, when they are hospitalized, and at their medical appointments. Fellows will also round with Robin Welsh, MD, as she follows patients across the spectrum of perinatal palliative care. Fellows will have the opportunity to spend time with an inpatient pediatric palliative care team at another institution should they desire a more intensive pediatric palliative care experience

Long-term care: one block

Fellows will rotate with Victor Hirth, MD, at Still Hopes Episcopal Home, medical director for the retirement community. Fellows will round in the acute inpatient rehabilitation unit, see patients in the office, and in their homes and apartments. Highlights of the rotation include learning to perform geriatric assessments and new admissions as well as understanding the business aspects of concierge medicine practices.

Oncology: one block

Of course, early access to palliative care can prolong life among patients with advanced cancer. During this month, fellows will spend time with medical oncology, surgical oncology and radiation oncology with the goal of understanding the special relationship between oncologists and their patients. Fellows will spend time with outpatient medical oncology, inpatient/outpatient surgical oncology, and radiation oncology to understand their perspective on treating cancer and managing treatment-related symptoms.

Electives: one block

Fellows have four weeks of elective time to explore areas of interest. Previous electives have included additional time with any of the established rotations, as well as working with other specialties such as infectious disease, LGBTQ+ care, nephrology, or pulmonology. Fellows have even created rotations at other institutions to explore their interests. The flexibility with our elective time is intentional and another example of this fellowship being designed to give our fellows the best learning experience possible

Didactics

  • Noon conference.
  • Monthly journal club.
  • Internal medicine grand rounds.
  • Resident ethics series.

Assignments

Fellows will be expected to complete the following over the course of their fellowship:

  • Two noon conferences.
  • Two journal clubs.
  • One grand rounds.
  • Two ethics cases.
  • One quality improvement project.