DHM

Hospice and Palliative Medicine Fellowship

Mission:
The UCSF Hospice and Palliative Medicine Fellowship Program is devoted to training future leaders in all areas of Hospice and Palliative Medicine. Under the leadership of Dr. Steven Pantilat, UCSF offers a one-year ACGME-accredited clinical fellowship in Hospice and Palliative Medicine designed to qualify individuals for board certification.

Educational Goals:
We train physicians in the evidence-based, compassionate care of patients with serious illness. Using a combination of clinical experience, didactic instruction, and structured reflection fellows learn to support the best quality of life throughout the course of an illness and to manage factors that contribute to the suffering of patients and their families.

Through a structured self-care curriculum, fellows are taught to recognize and address their own needs, both to increase their long-term job satisfaction and to help them be present for their patients.

Through didactic sessions and a monthly journal club, fellows are taught the fundamentals of research methodology. In conjunction with a mentor, each fellow is required to complete at least one scholarly and quality improvement project.

Participating Institutions:

  • UCSF Medical Center
  • Mt. Zion Medical Center
  • San Francisco VA Medical Center
  • Kaiser Permanente Medical Center San Francisco
  • George Mark Children's House
  • San Francisco General Hospital

Fellowship Rotations:

Inpatient palliative care consultation services (6 months):

  • Fellows join the inpatient palliative medicine consultation teams at UCSF Medical Center, San Francisco General Hospital & Trauma Center (SFGH), and the San Francisco VA. Fellows see a wide-variety of patients through these distinct services, which encompass a quaternary care academic medical center, a county hospital and level 1 trauma center, and a federally-run hospital.

Long-Term Care, Inpatient Hospice and Comfort Care Suites (1 month):

  • Fellows gain direct management experience with inpatient hospice through their rotation at the inpatient hospice unit in the San Francisco VA. Here they assume the primary team role in caring for veterans nearing the end of their lives. During their inpatient rotations at UCSF Medical center and SFGH, fellows also manage Comfort Care patients in several specially appointed Comfort Care Suites.

Home Hospice Rotation (2 months):

  • Fellows master the clinical and regulatory intricacies of delivering home hospice care during their time with Kaiser Permanente Medical Center's Hospice Agency, a Medicare certified program directed by Dr. Jeffrey Beane. This home hospice agency has an average daily census of 40 patients and about 30 admissions per month. Fellows participate in weekly interdisciplinary case conferences and conduct home visits with all members of the hospice interdisciplinary team. In addition fellows care for patients in the home based palliative care program, Kaiser's concurrent care initiative designed to integrate palliative care earlier in the course of an illness. Finally, fellows perform bereavement follow-up with family members, a key element of hospice care.

Pediatric Palliative Care Rotation (1 month):

  • Fellows spend one month divided as three weeks at George Marks Children's House (GMCH) and one week at UCSF Benioff Children's Hospital. GMCH is an independent, non-profit, free-standing respite and hospice house - the only institution of its kind in the United States. At GMCH, fellows are supervised by Dr. Barbara Beach, a Pediatric Hematologist-Oncologist with over twenty years of experience in Pediatric Palliative Medicine. Fellows take part in daily clinical care and work with the interdisciplinary team to learn about the wide range of palliative medicine services GMCH provides to their patients and families. The dual role as a respite and hospice facility means that fellows are exposed to children in varying stages of illness.

    At UCSFMC - Peds, fellows join interdisciplinary members of the Integrated Pediatric Pain and Palliative Care team including anesthesiologists, pain service, specialists, hospitalists, NPs, child life specialists, social workers, and others. Fellows participate in daily rounds, inpatient consultations, and the provision of social work and child life services. They join the weekly fetal prenatal conference where pregnancies at high risk for a poor outcome are discussed. They also join Dr. Audrey Foster-Barber, a Pediatric Neurologist, in her outpatient clinic as she evaluates children with chronic neurologic conditions who have palliative medicine needs.

Outpatient palliative care experience (One afternoon per week, longitudinal):

  • Each fellow has a weekly palliative care continuity clinic with the UCSF Symptom Management Service, a dedicated palliative care service based at UCSF's Helen Diller Comprehensive Cancer Center. This service provides a broad range of palliative interventions to patients with life threatening disease and is collocated with UCSF's Psycho-oncology clinic. Fellows take on ongoing primary responsibility for a panel of palliative care patients. During fellow clinic, faculty supervisors are dedicated to fellow precepting and are not scheduled for any other clinical activity. Clinic time is protected, with fellows required to sign out their service pager.

Elective Rotations and Scholarly Activity (2 months):

  • To explore their particular interests in palliative medicine, fellows may choose from several existing electives - such as Pain Medicine, Oncology, Home-Based Care, Acute Care for the Elderly, and Neurodegenerative Diseases - or build their own elective opportunity. Multiple training sites ensure access to a wide variety of elective opportunities. Time is also set aside during these months to pursue work on the required scholarly and quality improvement projects.

Didactic Sessions:

Fellows participate in half day didactic sessions weekly during the summer and twice monthly thereafter. These sessions are taught exclusively for our fellows by dedicated interdisciplinary clinical faculty and take a variety of formats including lecture, small group discussion, role-play, workshops, and others. In the second half of the year, fellows begin to lead some of the sessions as a means to practice teaching and Practice-Based Learning and Improvement. Case conferences, facilitated by faculty, are also introduced in the second half of the year. Fellows also lead a monthly cross-campus journal club.

UCSF is one of six institutions in the nation designated as a Palliative Care Leadership Center (PCLC). Fellows attend one two-day PCLC program focused on key concepts necessary to build a successful palliative care program, including understanding and analyzing the financial outcomes of palliative care.

Fellows are strongly encouraged to attend the annual American Academy of Hospice and Palliative Medicine (AAHPM) Annual Assembly, which takes place in February or March. To facilitate their attendance, conference time is protected and the program reimburses conference expenses.

Self-Care Curriculum:

Once monthly fellows spend an afternoon with Rev. Denah Joseph, an experienced chaplain and therapist, learning and practicing a variety of reflective techniques in self-care. Between these sessions fellows meet with the program director to discuss difficult cases and any other challenges they have faced in the fellowship. Later in the year, didactic case conferences often focus on the challenges of caring for suffering patients and their families. Twice annually fellows participate in structured reflective retreats with other faculty and interdisciplinary team members.

Program Highlights:

UCSF's Fellowship in Hospice and Palliative Medicine has many strengths. Some particular highlights include:

Mentorship opportunities:
A one-year clinical fellowship passes quickly. UCSF's formal advisor system helps to quickly orient new fellows to the broad and deep array of resources available at a world-class university medical center.

High-Quality Interdisciplinary Teams:
UCSF's many sites all feature mature, well-integrated, and well-staffed interdisciplinary teams, a critical element of delivering effective palliative medicine services.

Diversity:
Our five main teaching sites care for patients from more than 20 ethnic groups across the full socioeconomic spectrum of the San Francisco community. These core clinical sites include a tertiary academic referral medical center, a Veterans Affairs Medical Center, a public hospital/trauma center, a community-based pediatric respite and end-of-life facility and an HMO, ensuring experience with patients with a broad range of ages (neonatal through adolescent, young adult to geriatric), diagnoses, (e.g., cognitive impairment, HIV disease, chemical dependency, advanced conditions), socioeconomic strata (impoverished/homeless to affluent), medical insurance statuses (e.g., uninsured, Medicaid, Medicare, HMO, PPO, VA), stages of illness, communication needs (e.g., limited English proficiency, deafness), and other palliative care needs.

Unique and Broad Pediatric Exposure:

While few of our fellows arrive with Pediatric experience, some may be called upon to provide Hospice and Palliative Medicine services to children at some point during their careers. UCSF fellows rotate through two exceptional pediatric clinical sites, working with Pediatric Palliative Medicine experts to learn to care for children in multiple settings and phases of illness.

Leadership:
Program Director
Steven Z. Pantilat, MD
Professor of Clinical Medicine
Director, Palliative Care Program and Palliative Care Leadership Center
Division of Hospital Medicine
521 Parnassus Avenue, C-126
Box 0903
San Francisco, CA 94143-0131
stevep@medicine.ucsf.edu

Associate Program Director:
Dr. Tom Reid (TReid@medicine.ucsf.edu)

VA Site Director:
Dr. Lynn Flint (Lynn.Flint@ucsf.edu)

UCSF Symptom Management Service Site Director
Dr. Michael Rabow (MRabow@medicine.ucsf.edu)

Kaiser Permanente Medical Center San Francisco Site Director:
Dr, Karla Lovett (Karla.Lovett@kp.org)

San Francisco General Hospital Site Director:
Dr. Anne Kinderman (KindermanA@medsfgh.ucsf.edu)

George Mark Children's House Site Director:
Dr. David Steinhorn (dsteinhorn@gmail.com) and Alexandra Abrams (abrams_alexandra@yahoo.com)

Self-Care Curriculum Director:
Rev. Denah Joseph, MFT (Denah.Joseph@ucsfmedctr.org)

Program Coordinator:
Shayna McElveny (Shayna.Mcelveny@ucsf.edu)

Requirements:

We accept applicants who have or will have completed residencies in anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, physical medicine and rehabilitation, psychiatry, radiation oncology, or surgery.

To Apply:

Applicants interested in pursuing training with the UCSF Palliative Medicine Fellowship should follow the instructions via ERAS Fellowships Documents Office.

ERAS Applications open December 8th for entry in July two years later (e.g., December 2013 applications are for the July 2015 program). Applications are reviewed in January and February and interviews are scheduled for February and March. We will not be reviewing applications after March 15th. Four fellowship applicants will be selected by April 1st.

For questions about the program, please email Dr. Tom Reid at treid@medicine.ucsf.edu or Shayna McElveny at Shayna.Mcelveny@ucsf.edu.