| PROGRAM-SPECIFIC ELEMENTS |
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| Contact |
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| Daniel Handel, MD. Suzanne B. Richardson, Fellowship Coordinator |
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Eligibility Criteria
Palliative Medicine and Hospice Fellowship Sample Schedule 
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Candidates must have a MD or DO degree from an accredited medical school. We require satisfactory completion of three postgraduate years of training at the time of appointment as a fellow in this training program, as well as board eligibility or board certification in one of the following specialties: internal medicine, family practice, pediatrics, or Physiatry. Applicants from other specialties will be considered on a case by case basis.
Overview and Structure of the Training Program
The Fellowship program at the Clinical Center of the National Institutes of Health is designed for candidates who have long term career goals as a clinician or an academician in hospice and palliative medicine. The program is designed to achieve seven overall educational objectives:
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1. Develop and train experts in palliative medicine |
The program offers a one-year Fellowship leading to board eligibility in hospice and palliative medicine. The opportunity exists to extend the Fellowship for a research-focused second non-ACGME accredited year for those interested in an academic or research track. All Fellows will receive a stipend based on the salary guidelines of the National Institutes of Health.
Fellows will receive broad, practical experience in palliative medicine and hospice through inpatient and outpatient rotations at the NIH Clinical Center, a 240-bed research hospital, and through clinical experiences in home, hospital, and long-term-care based hospice programs, and community hospital palliative care programs. Select elective clinical experiences are also available. It is expected that each fellow shall do a literature based review, peer-review quality journal article, book chapter, other professional writing project, or a limited research project with close mentoring by selected faculty. Throughout the training period, in addition to clinical rotations, Fellows will participate in educational activities for medical students, fellows, and other disciplines
The NIH-Capital Hospice Fellows are actively involved in the care and management of a significant number of patients at the NIH through participation in the Pain and Palliative Care Service. The Service is a consultative service that provides management expertise for medical symptoms, and holistic care through integrative approaches. Palliative care services are provided through inpatient care, outpatient clinics, and day-hospital clinics. Both pediatric and adult patient populations are served in these settings. Patients with commonly encountered medical problems are cared for, including cancer of all types as well as heart, renal, genetic, infectious, and neurological diseases. Rare diseases under research are also commonly encountered through the NIH research protocols. This combination allows for a unique clinical experience for the Fellow, rich in research opportunities and clinical learnings.
Community-based rotations occur in home hospice, long-term-care, and inpatient hospice settings through participating sites at a large nonprofit hospice, Capital Hospice. Additional core rotations in community based palliative care services occur at Washington Medical Center, or Inova Fairfax Hospital.
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Research
The NIH Pain and Palliative Care Service actively participates in research projects including Phase 0, I, II, III, and IV studies. Studies are being or have been conducted in pain and symptom management, translational (bench to bedside) pain management, quality of life, complementary therapies, education, and palliative medicine outcome studies. An Institutional Review Board (IRB) for National Institutes of Health is dedicated to ensure the protection of all study participants. The number of protocols initiated by Pain and Palliative Care Service investigators continues to grow at an impressive rate.
NIH Fellows have abundant opportunities to interact clinically with investigators at all Institutes within the National Institutes of Health and affiliated institutions. Under the supervision of clinical faculty, Fellows are encouraged to participate in or conduct clinical trials.
Fellowship Structure:
The Fellowship’s one year training program is structured into thirteen four week blocks, as noted below. An intensive orientation process for all incoming fellows provides basic didactic material in preparation for clinical rotations, orientation to the National Institutes of Health, and information specific to all rotations. Goals and objectives for the training program are discussed, and fellows are oriented to the scheduling and nature of ongoing group didactics, scholarly projects, mentor meetings, and psychosocial and bereavement educational activities.
Didactic education specific to each rotation will occur throughout the year, in addition to the year-long didactics. Site-specific didactics will address the goals and objectives for each rotation, and can reflect the personal learning goals of the rotator as discussed early in the rotation.
Fellowship Rotations are structured in four-week blocks and include:
Palliative Medicine Consult Service- National Institutes of Health: 6 blocks (in two rotations of three blocks each).
During this twenty-four week rotation (divided into two twelve week rotations) at the NIH Clinical Center fellows will learn comprehensive and effective palliation of symptoms and treatment of physical, psychological, emotional and spiritual suffering for individuals and families with advanced life limiting and life threatening conditions. This is achieved through well-rounded and thorough education in symptom management techniques; effective team facilitation; knowledge and effective utilization of various components of the health care system for patients facing life threatening conditions and complex psychosocial and medical needs; and knowledge of and development of effective management strategies for suffering due to existential and spiritual suffering. Fellows participate daily in inpatient consultative palliative care on a very active consult service under close faculty supervision; twice-weekly outpatient clinics with an emphasis on continuity of care; interdisciplinary team meetings; and regularly scheduled didactic training.
Home Hospice Care- Capital Hospice: 1 block
During this four week block rotation, the Fellow will conduct hospice medical visits in patients’ homes under the supervision of a primary mentor, and will perform visits with nursing, social work, chaplains, and other members of the interdisciplinary team to foster an understanding for their unique roles in developing a patient and family centered plan of care. Emphasis will be placed on the attainment of skills in the assessment and management of end of life symptoms, assessment of hospice appropriateness for certification and recertification, and discharge, and appreciation for the hospice medical director’s role in leadership, education and collaboration within the interdisciplinary team. Fellows will also observe and facilitate hospice interdisciplinary team meetings, and participate in all clinical educational activities at Capital Hospice as designated by the supervising faculty member.
Long Term Care- Capital Hospice: 1 block
During this block rotation at Capital Hospice the Fellow will primarily conduct visits to designated patients in long-term care facilities under the faculty mentor’s supervision. Emphasis will be placed on the attainment of skills in the assessment and management of symptoms of advanced illness, and coordination of care to improve quality of life.
Inpatient Hospice Care- Capital Hospice: 1 block
During this rotation the fellow will admit and care for hospice patients that require admission for aggressive symptom management for problems such as pain crises, malignant bowel obstruction, refractory nausea, delirium or other non-pain symptoms that can not be managed in an outpatient setting. Care is supervised by mentoring faculty at an inpatient hospice hospital which has 24 hour nursing, nursing assistants, patient care volunteers (including musicians and massage therapists), social work, chaplain, dietitian, and physical therapy. Specific educational objectives include ethical and practical issues around palliative sedation for refractory symptoms, rapid opioid titration for severe pain, care coordination across settings, and correct death certificate completion. Fellows will participate in and facilitate weekly interdisciplinary team meetings on all patients. The Fellow will attend and participate in all designated clinical educational activities at Capital Hospice as designated by the supervising faculty member.
Community Palliative Care- Washington Hospital, Georgetown University Medical Center, and Inova Fairfax (Capital Hospice): 2 blocks
During these two rotations, each of four weeks, the Fellow will serve on a palliative care consult team within a large community hospital. The Fellow will see a variety new consults that emerge from all areas of the hospital, including the SICU, MICU, CCU, TICU, telemetry, pediatrics, medical / surgical units, oncology and the emergency room. The Fellow will be mentored in skills to maximize comfort and quality of life, as well as navigating conflict in plan of care between patients, families, and medical staff. Special emphasis will be placed on expert communication skills in end of life care, including decisions around cessation of life sustaining therapies and ventilator withdrawal, cultural issues in end of life care, and unique consultant etiquette issues for the palliative medicine physician. Additional objectives will include specific teaching around physician billing and coding in palliative medicine, developing a business plan, and marketing palliative care within hospital settings. The Fellow will attend and participate in all designated clinical educational activities at Capital Hospice as designated by the supervising faculty member.
Capital Hospice- Home Hospice, Inpatient Hospice, or Community Palliative Care: 1 block
This four week block allows Fellows to pursue limited options for additional training in home hospice, inpatient hospice, or palliative care service.
Elective Rotation: Neurology, Psychiatry, Physiatry, Administrative Hospice, or Research: 1 block
This elective rotation is designed to enhance didactic and experiential learning objectives unique to the individual fellow. A broad range of settings and experiences facilitates individualized learning goals.
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The Palliative Medicine and Hospice Fellowship Training Program
Our program is designed to develop the following competencies at or above the level expected of a new Palliative Care practitioner.
PATIENT CARE
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
Fellows are expected to:
1. Communicate effectively and demonstrate caring and respectful behaviors
when interacting with patients and their families
2. Gather essential and accurate information about their patients
3. Make informed decisions about diagnostic and therapeutic interventions
based on patient information and preferences, up-to-date scientific
evidence, and clinical judgment
4. Develop and carry out patient management plans
5. Counsel and educate patients and their families
6. Use information technology to support patient care decisions and
patient education
7. Perform competently all medical procedures considered essential for the
area of practice
8. Provide health care services aimed at preventing health problems or
maintaining health
9. Work with health care professionals, including those from other disciplines,
to provide patient-focused care
MEDICAL KNOWLEDGE
Fellows must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Fellows are expected to:
1. Demonstrate an investigatory and analytic thinking approach to clinical situations
2. Know and apply the basic and clinically supportive sciences which are appropriate to their
discipline
PRACTICE-BASED LEARNING AND IMPROVEMENT
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Fellows are expected to:
1. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology
2. Locate, appraise, and assimilate evidence from scientific studies related to their patients'
health problems
3. Obtain and use information about their own population of patients and the larger
population from which their patients are drawn
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness
5. Use information technology to manage information, access on-line medical information;
and support their own education
6. Facilitate the learning of other health care professionals
INTERPERSONAL AND COMMUNICATION SKILLS
Fellows must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Fellows are expected to:
1. Create and sustain a therapeutic and ethically sound relationship with patients
2. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills
3. Work effectively with others as a member or leader of a health care team or other
professional group
PROFESSIONALISM
Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Fellows are expected to:
1. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supercedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development
2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices
3. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and
disabilities
SYSTEMS-BASED PRACTICE
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Fellows are expected to:
1. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements
of the system affect their own practice
2. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources
3. Practice cost-effective health care and resource allocation that does not compromise
quality of care
4. Advocate for quality patient care and assist patients in dealing with system complexities
5. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system
performance
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Fellows work with members of the interdisciplinary team. They are responsible for consultation services that guide the direction of palliative care and participate in the interdisciplinary care of patients and families. In addition, Fellows work in conjunction with NIH staff attending and physicians-in-training in providing continuity of care for these inpatients. Weekly patient management conferences and seminars are held to provide background about patient management and pertinent research. Fellows will be able to discuss psychosocial and spiritual issues with the interdisciplinary team both informally and at scheduled conferences. The Service is interdisciplinary in philosophy and in staff. The Fellow will learn about complementary and traditional healing methods through team members from disciplines such as recreational therapy, nutritional therapy, social services, massage therapy, movement therapy, relaxation therapy, hypnosis, guided imagery, spiritual therapy, healing touch therapy, music therapy, and thanatology.
Vacations
Fellows are provided 13 days of vacation per year.
Faculty and Staff
Ann Berger, MSN, MD; Chief of Service
Karen Baker, RN MSN, CRNP
Sarah Brooks, MA
Hunter Groninger, MD
Dan Handel, MD; Fellowship Director
Jessica Heintz, MD; Site Director
Elaine Lehr, M Div
Cameron Muir, MD
Brian Murphy, MD
Jayne Phillips, RN, CRNP
Genevieve Wroblewski, MD
Application Procedure
Fellows will usually be selected six to eighteen months before the training period that begins on July 1st. A completed application including three letters of recommendation should be sent to the Director of the Fellowship Program as soon as possible. Candidates will be judged on the strength of prior training, demonstrated clinical competence, and potential for excellence in a career in hospice and palliative medicine. Faculty members will interview selected candidates before final decisions are made. Successful candidates must have an unrestricted state medical license at the beginning of training.
It is the policy of the National Institutes of Health and its Pain and Palliative Care Service not to discriminate against any individuals on the basis of race, color, religion, national origin, sex, sexual orientation, marital status, age, handicap or veteran status in matters of admissions, employment, or services in the educational programs or activities that it operates, in accordance with civil rights legislation and agency commitment.
An application and additional information may be obtained from:
Suzanne B. Richardson. Fellowship Coordinator
NIH - Capital Hospice Palliative Medicine and Hospice Fellowship Coordinator
2900 Telestar Court
Falls Church, VA 22042
Phone: 703.538.2030
Fax: 888.781.0159
