Overall Program Goals:

• To provide physicians the knowledge, skills, attitudes, and behaviors to integrate palliative approaches throughout the continuum of medical care and to qualify as subspecialists in palliative medicine.
• To understand the models of care and the healthcare system to achieve the best possible quality of life for patients and families suffering life-threatening illnesses.
• To foster the development of research and skills to function as a clinician scientist and educator in palliative medicine.
• To participate in the dissemination of the science of palliative medicine through authorship and scholarly presentations.
• To provide tools for physicians to build a comprehensive knowledge base and encourage life-long learning habits.
• To create a supportive environment where professionalism, ethical principles, teamwork, and each physician’s potential are furthered.
• To recognize the self care needs of health professionals and develop practices for self care.
• To employ effective communication skills in interactions with patients, families, and other healthcare professionals.
• To develop familiarity with key ethical concepts in the care of patients with advanced illness and their families.

Description of Clinical Training Experiences:

The one-year clinical fellowship program is comprised of 13 four-week block rotations with diverse experiences in inpatient palliative care consultation, home hospice and palliative care, pediatric hospice and palliative care, long term care, inpatient hospice care, and several selectives.  Longitudinal clinical experiences are also stranded within a university-based palliative care clinic and community home palliative care program to provide fellows abundant opportunities to care for patients and families throughout the course of illness.  Fellows will care for patients with a broad range of diagnoses, from various socioeconomic and cultural backgrounds, and with diverse palliative care needs.  Goals and objectives of the rotation that address the 6 core competencies of the ACGME will be reviewed with the fellows prior to each clinical experience.

Adult Inpatient Palliative Care Consultation

Through this experience, trainees will be responsible for communicating with the primary team, running family meetings, discussing bad news, delineating goals of care near the end-of-life, advising on the care of the actively dying patient, coordinating care, transitioning care, and teaching other trainees.  The service functions as a dynamic team that represents one of the busiest and most valued inpatient consultative services at the University of Chicago Medical Center.

Pediatric Hospice and Palliative Care

This block combines inpatient pediatric palliative care consults at the University of Chicago Comer Children’s Hospital with home-based pediatric hospice and palliative care provided by Horizon Hospice’s “All About Kids” Program.    

Home Hospice, Horizon Hospice and Palliative Care, Inc. and St. Joseph’s Hospital Inpatient Hospice     
Fellows benefit from a longitudinal experience as they combine inpatient and outpatient hospice in the same rotation, and across inpatient and home care settings.  Objectives of the rotation include developing skills in assessing and treating patients at home, managing symptoms near the end of life, addressing goals of care, identifying and communicating to families signs of impending death, participating in the weekly interdisciplinary team meetings and helping to develop a comprehensive care plan, appreciating the role of the team, and becoming familiar with Medicare hospice regulations.  

Montgomery PlaceLong-term Care and Skilled Nursing Facility
During this rotation, fellows will learn the nuances of palliative care needs of the elderly, such as progression and management of neurologic illness, assessment and management of chronic non-cancer pain, wound care, geriatric syndromes (incontinence, delirium, non-cancer related functional decline, and frailty), advance care planning, and policies and regulations of long-term care settings.   
 
Longitudinal Clinical Experiences
There are two established longitudinal clinic experiences where fellows care for patients under the direct supervision of an attending palliative care physician one-half day every other week for the entire year.  
 
Oncology Palliative Care Clinic.  Fellows will provide supervised consultations for, and co-management of, cancer patients undergoing aggressive chemotherapeutic regimens including management of physical and psychological symptoms, quality of life interventions, and redefining goals of care.

Horizon Home Palliative Care.     This provides fellows a longitudinal experience caring for patients with advanced illness and a high symptom burden at home, many of whom ultimately transition to hospice, so that fellows obtain skills in assessing and treating symptoms in non-terminal patients, coordinating care with other clinicians, and refining bed side assessment skills.

Selectives
Based on level of interest, fellows will be able to select from a variety of other experiences to round out their educational training.

Anesthesia Pain Clinic.  Fellows will understand and observe invasive pain management skills such as localized injections and nerve plexus blocks, intrathecal and epidural opioid delivery, and implantable devices.

Ethics Consultation.  Through this rotation Palliative Medicine fellows will have the opportunity to understand the intricacies of ethics consultation.

SOCARE (Specialized Oncology Care and Research in the Elderly) Clinic.  During this rotation fellows will focus on older adult patients with cancer who have palliative care needs.

PATCH (Palliative Access Through Care at Home). During this rotation fellows will have the opportunity to work within a palliative care program dedicated to home-bound older adults.     

Memory Center During this rotation, fellows develop the skills in assessing and treating cognitive disorders in an interdisciplinary environment (physician, nurse, and social worker).