The Hospice and Palliative Medicine Fellowship provides fellows a rigorous and clinically intense training experience that will prepare them for a successful palliative medicine career in the ambulatory, hospice, or hospital setting. We focus on symptom assessment and management, as well as communication skills with patients, families, and other health care providers. The one-year fellowship program has been fully accredited through the ACGME. Depending on level of interest and commitment, fellows in the one-year program may also work toward obtaining a certificate in medical education through the University of Pittsburgh.
For fellows who want to pursue further training for a career in academic palliative medicine—either as a clinical investigator or educator—we offer an elective second year. The two-year program combines the palliative care program's own research and educational resources with the opportunities offered by the Institute for Clinical Research Education (ICRE) degree programs in clinical research and medical education at the University of Pittsburgh. These programs provide fellows with didactic training in a broad spectrum of research and educational methodologies, technologies, and tools; exposure to multidisciplinary research and educational teams; hands-on mentored experience in conducting patient-oriented research; and the conceptual and writing skills necessary to submit competitive grant applications for successful, long-term patient-oriented research or education careers. By the end of the second year, fellows will obtain a master's degree from the University of Pittsburgh in clinical research or medical education, with a special focus on palliative care.
The fellows' clinical experiences span a diverse array of settings, including our quaternary care transplant program, the region's largest cancer and hospice program (Family Hospice and Palliative Care), and our children’s and community hospitals. The clinical focus of the fellowship is on acquiring skills in providing comprehensive care to patients with life-limiting illnesses in acute care, ambulatory care, home care, and long-term care settings. Fellows will spend substantial time in each of these settings and will follow patients longitudinally as they move between different settings. The role of the physician as a member of an interdisciplinary care team will be emphasized in all clinical settings and encounters. The individual aspects of the clinical program are:
- Inpatient Palliative Care Consultation Service - Fellows spend a minimum of one month each at UPMC Presbyterian-Montefiore Hospitals, UPMC Shadyside Hospital, and Magee-Womens Hospital of UPMC, for a total of five months in the inpatient setting.
- Home Care and Hospice - Fellows will gain extensive experience managing home care and hospice patients through time spent with Family Hospice and Palliative Care, the largest hospice program in western Pennsylvania. Fellows will spend one half-day a week attending hospice interdisciplinary team meetings and providing clinical support to the hospice team. They will spend one month doing hospice home visits and an additional six weeks at an inpatient hospice facility.
- Long-Term Care - Fellows will spend at least one month working in a long-term care facility.
- Outpatient Clinic - Fellows will maintain their own outpatient clinic practice under the supervision of the palliative care faculty, spending at least one half-day a week for 12 months in one of two clinics—the Pittsburgh AIDS Comprehensive Treatment Center (PACT) or the Hillman Cancer Center Palliative Care Clinic. As part of a multidisciplinary team, fellows will manage patients at all disease stages with multiple physical, psychosocial, spiritual, and existential issues. Fellows will follow new patients longitudinally in the ambulatory setting as well as across settings if patients are admitted to the hospital or go to hospice.
- Elective and Supplemental Clinical Experiences - Fellows will spend three months on clinical elective experiences. Additional elective time is available to individual fellows based on their own needs and interests. Formal elective experiences are available in ethics, oncology, radiation oncology, behavioral medicine, HIV care, neurology, geriatrics, geriatric psychiatry, pain care, pediatrics, liver transplantation, critical care, cardiology, and pulmonary care and can easily be arranged in other areas of special interest. Fellows will also have the opportunity to arrange experiences at any of our specialty palliative care clinics, including the Palliative Congestive Heart Failure Clinic, the Magee-Womens Hospital Palliative Care Clinic, and the Multidisciplinary Pancreatic Cancer Clinic.
- Other Experiences - Fellows attend all the relevant ongoing teaching conferences, including Journal Club, Psychosocial Conference, and Palliative Care Grand Rounds, as well as weekly palliative care team meetings in which both clinical and educational topics in palliative care are discussed. Bereavement training is conducted through meetings with the Good Grief Center.
There are five required courses that have been designed specifically for the Hospice and Palliative Medicine Fellowship. These courses provide a fundamental knowledge base for the clinical practice of palliative care and focus on research skills relevant to studies concerning palliative care.
- Principles and Practice of Palliative Care - This two-credit course provides fellows with a thorough introduction to the knowledge base and skill set needed for the clinical practice of palliative care. This clinical knowledge base not only prepares fellows for their clinical work in palliative care but also guides and informs their choice of a research interest. The course meets for one hour each week from September through March.
- Research Methods in Palliative Care - This special methods course provides a critical bridge between the more general research skills covered in the ICRE clinical research training programs and the particular challenges of performing patient-oriented research in palliative care. This course, along with the clinical course, is a cornerstone of the concentration in palliative care.
- Teaching Communication Skills - Doctor-patient communication has received increasing attention in medical education. The new ACGME requirements list communication skills as one of six major areas of focus. In the future, physicians will need to be able to document their communication skills for certification and licensure. Over the past 10 years, studies have provided increasing data regarding the efficacy of educational interventions to improve physician communication skills. The point of this course is to ensure that medical educators understand the data and have the practical skills needed to design and teach communication courses.
- Communication Skills - In addition to the Teaching Communication Skills course described above, fellows also attend a three-day intensive communication retreat attended by fellows from the region. Following completion of the retreat, fellows participate in a series of sessions involving professional-simulated patients and facilitated by faculty with extensive expertise in communication skills training.
- Ethical Issues in Palliative Care - This case-based course exposes fellows to three important aspects of ethics in palliative care practice: (1) a conceptual analysis of clinical situations based on ethical principles, (2) the opportunity to recognize ethical issues that arise in their own current practice, and (3) an awareness of the influence of personal feelings and emotional reactions on ethical deliberation in care of the dying.
Fellows in the two-year program can choose additional elective courses, based on their individual interests and planned research program. Electives that suit the individual fellow's goals can be selected from courses offered by the ICRE, as well as from other locations, including the Center for Bioethics and Health Law, the Graduate School of Public Health, the School of Social Work, and the School of Nursing.
- Quality Improvement and Patient Safety Project - All fellows will complete a quality improvement project. Fellows will be paired with faculty mentors as well as quality improvement experts to help investigate and address quality improvement issues they encounter in the inpatient, ambulatory, or hospice setting.
- Research/Education Project - Fellows in the two-year program will complete a research/education project during their fellowship. To help in this process and with career counseling, each fellow will select at least one primary research or education mentor whose experience and interests complement the fellow's. A diverse group of experienced mentors from multiple departments has been assembled to encourage the development of an effective mentoring relationship. The group includes funded researchers in the departments of medicine, psychiatry, and critical care medicine, as well as researchers at the University of Pittsburgh Cancer Institute.
- Case of the Month - All fellows contribute to this monthly publication and collaborative effort between the Palliative and Supportive Institute and the University of Pittsburgh Palliative Care faculty members. In addition to being distributed through the Pitt/UPMC community, the Case of the Month articles are posted on Pallimed: Arts & Humanities, a blog focusing on the many themes in palliative medicine that intersect with film, music, paintings, books, and other artistic media.
Depending on their level of interest, fellows also have the opportunity to work on smaller projects, such as "Fast Facts," article reviews, or presentations at local or national meetings.
The fellowship program is housed in the Section of Palliative Care and Medical Ethics, and we have active research programs with millions of dollars in grant support, as well as active relationships with educators and researchers in oncology, ethics, anesthesia, and geriatrics.
Shannon Haliko, MD, is a first year fellow in the Hospice and Palliative Medicine fellowship program. Dr. Haliko earned a BS from the University of Florida and an MS from Tulane University. She attended the University of Miami Leonard School of Medicine where she received an MD before completing her internal medicine residency, as well as a fellowship in pulmonary and critical care at Jackson Memorial Hospital, University of Miami.
Jordan Keen, MD, is a first year fellow in the Hospice and Palliative Medicine fellowship program. Dr. Keen received a BS and an MD at the University of Minnesota and completed an internal medicine residency at Tufts Medical Center.
Ritu Soni, MD, is a first year fellow in the Hospice and Palliative Medicine fellowship program. Dr. Soni earned a MBBS from Baroda Medical College. She completed the internal medicine residency at University of Pittsburgh and a fellowship in Nephrology from the University of Pittsburgh being Chief Nephrology Fellow in 2013. The following year Dr. Soni was a core hospitalist in the Section of Hospital Medicine. She maintains professional society memberships in the American Osteopathic Association, American College of Physicians, and the Christian Medical and Dental Association.
Post-residency physician fellows must meet the following criteria:
- Have completed an ACGME or AOA-accredited residency program in anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry, radiation oncology, or surgery
- Be board-certified or board-eligible with demonstration of active pursuit of certification
- Demonstrate interest in pursuing an academic career with palliative care as a primary focus
Fellowship applicants submit applications through the Electronic Residency Application Service (ERAS). The ERAS post office accepts applications annually, November 15 - May 31. Of note, the specialty of palliative care does not participate in the match process. Applications will be accepted through ERAS starting on November 15, 2014, for fellowship starting July 2016. If all fellowship slots are not filled when the ERAS post office closes on May 31, an application may be submitted outside of ERAS. Applicants are considered in a rolling admissions process. Historically, we have filled all of our fellowship slots at least one year before the start of the fellowship. Please contact us directly if you have any questions about the application process.
All completed applications will include:
- A personal statement (a statement of the applicant's interest in and commitment to an academic career in palliative care)
- At least three letters of support, one of which should be from the applicant's department head, program director, or division chief
- Scores from USMLE Step 1, 2, and 3
- A curriculum vitae
For more information, contact:
University of Pittsburgh
Hospice and Palliative Care Fellowship Coordinator
Department of Medicine, Office of Education
UPMC Montefiore Hospital, N715
200 Lothrop Street
Pittsburgh, PA 15213