Clinical Training – Hospice & Palliative Medicine

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 cultivate interdisciplinary and multidisciplinary models of care for patients with advanced illness
• To foster the development of research and teaching skills to function as a clinician scientist and educator in palliative medicine.
• To create a supportive environment where professionalism, ethical principles, teamwork, and each physician’s potential are furthered.
• To promote the field through training future leaders in Hospice and Palliative Medicine

Description of Clinical Training Experiences

The University of Chicago’s one-year clinical Hospice and Palliative Medicine Fellowship Program offers multiple 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 electives.  Longitudinal clinical experiences are also stranded within a university-based palliative care clinic and community home palliative care and hospice 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.

University of Chicago 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 UChicago Medicine.

Endeavor Health Evanston Palliative Care: 

Endeavor Health, comprised of several community hospitals on Chicago’s north side, is another primary educational partner with University of Chicago. Fellows will have 6 weeks of adult inpatient palliative medicine consults at Endeavor Health Evanston Hospital. The hospitals under Endeavor Health, including Glenbrook and Evanston Hospitals, offer a breadth of clinical experiences in consultative medicine and the Inpatient Palliative Medicine Unit.

Home Hospice Visits and Inpatient Hospice with Ingalls Hospice:

Ingalls Hospice is a non-profit, Medicare-certified hospice care agency located in Harvey, Illinois, serving approximately 50 patients at any given time in homes, nursing homes, and through an inpatient hospice program. During this 6-week rotation, fellows will take on a leadership role, make home visits with the hospice interdisciplinary staff and with a physician on select patients including those requiring hospice re-certification, manage symptoms near the end of life, address goals of care, communicate signs of impending death, participate in weekly interdisciplinary team meetings, and become familiar with Medicare hospice regulations.

Inpatient Hospice Unit with AccentCare Hospice at Endeavor Health Swedish Hospital: 

Fellows will spend 4 weeks at AccentCare Hospice, which has a dedicated inpatient hospice unit located at Endeavor Health Swedish Hospital. The inpatient unit provides opportunities for the fellow to aggressively manage pain and non-pain symptoms in a hospice unit, utilize resources in a cost-effective manner, and is an excellent learning environment for enhanced communication with family and caregivers to provide high quality patient care.

Long-term Care and Skilled Nursing Facility: 

During this 4-week rotation (currently at Warren-Barr Gold Coast and South Shore Rehab and staffed by UChicago Geriatrics Faculty), fellows learn the nuances of palliative care needs of the elderly, such as progression and management of neurologic illness (e.g. dementia, ALS, Parkinson’s), 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.

Pediatric Palliative Care: 

This block comprises 2 weeks of inpatient pediatric palliative care consults at Advocate Health (Lutheran and Christ Hospitals). Fellows also have the opportunity for additional pediatric palliative care experiences including potential long-term care experience with pediatric patients and electives with palliative care doctors at Comer Children’s Hospital and Advocate Health.

Spiritual Care/Chaplains Rotation: 

The chaplaincy services at the University of Chicago Medicine provide compassionate spiritual and emotional support to patients, families, and staff, respecting diverse backgrounds and faith traditions. Integrated within the healthcare team, chaplains address spiritual distress and existential concerns. During this 2-week rotation, fellows will work alongside chaplains to develop skills in addressing spiritual distress, facilitating values-based conversations, and integrating spiritual care into clinical practice. Through patient encounters and interdisciplinary collaboration, fellows will gain a deeper understanding of spirituality in serious illness and end-of-life care.

Longitudinal Clinic: 

The University of Chicago offers multiple established longitudinal clinic experiences where fellows care for patients under the direct supervision of an attending palliative care physician on average one-half day every week throughout the entire year (except for weeks when fellows are rotating at Endeavor Health Evanston).

• Medical Oncology Clinic: Fellows provide supportive and palliative care for patients undergoing active cancer treatments, managing physical and psychological symptoms, quality of life interventions, and redefining goals of care.
• Surgical Oncology Clinic: Fellows gain experience in the management of pre and post-surgical patients, addressing goals of care, and palliative needs following oncological surgeries.
• Neurology/ALS Clinic: Fellows manage the palliative needs of patients with neurological conditions such as ALS, incorporating symptom management and quality of life interventions.
• Potential Expansion into Hepatology Clinic: Fellows may have the opportunity for a continuity clinic within the hepatology department, which is one of our newest outpatient collaborations.

Electives: 

Fellows have 4 weeks total (two 2-week blocks) of protected time to explore a variety of electives including, but not limited to, Memory Disorders, Anesthesia/Pain, Psychiatry, Geriatric Frailty, HIV, Neurology, Medical Ethics, and Integrative Medicine. Fellows are encouraged to suggest ideas (and stated objectives) for new elective opportunities to the fellowship program director. Of note, all off-site rotations require early planning – often malpractice and other paperwork to ensure the ability of a trainee to rotate can take up to 90 days on average.

Scholarly Activity/QI Project: 

Fellows have 2 weeks of protected time to work on their scholarly activity/Quality Improvement (QI) project.