DHM

Hospice and Palliative Medicine Fellowship - Clinical Curriculum

“I cared for a diverse patient population across a wide variety of clinical venues.”

- Dr. Jessica Safra ‘11

The 12-month clinical curriculum incudes:

  • 6 months of inpatient adult consultation service (3, 2, and 1 months each at 3 separate hospitals)
  • 2.5 months of home hospice including a half month of pediatric home hospice
  • 1 month of long-term care / inpatient hospice
  • A half month of inpatient pediatric consultation service
  • 2 months of electives and scholarly time

In addition, fellows have a longitudinal outpatient clinic that runs one half day per week throughout the year.
A sample rotation schedule is below:

July August September October
UCSF Medical Center
Inpatient Consult
Pediatrics / Hospice By the Bay VA Medical Center
Inpatient Consult
Hospice By the Bay
November December January February
UCSF Medical Center
Inpatient Consult
Elective / Scholarly Zuckerburg SF General Hospital VA Medical Center
Long-Term Care
March April May June
UCSF Medical Center
Inpatient Consult
Hospice By the Bay VA Medical Center
Inpatient Consult
Elective / Scholarly

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 Veterans Affairs hospital (VA). Fellows see a wide-variety of patients through these distinct services, which encompass a quaternary care academic medical center, a county hospital & level 1 trauma center, and a federally-run hospital. During their inpatient rotations at UCSF Medical center and SFGH, fellows also manage Comfort Care patients in several specially appointed Comfort Care Suites.

Long-Term Care and Inpatient Hospice (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.

Home Hospice Rotation (2 months):

  • Fellows master the clinical and regulatory intricacies of delivering home hospice care during their time with Hospice By the Bay, a Medicare certified hospice program directed by Dr. Molly Bourne. Working under the supervision of Dr. Bourne and Dr. Jessica Safra, fellows participate in weekly interdisciplinary case conferences and conduct home visits with all members of the hospice interdisciplinary team. Fellows also receive additional didactic instruction focused on managing transitions of care as well as the medical and regulatory knowledge essential to hospice. Because a career in hospice frequently includes caring for children, two weeks of this rotation focus on minors receiving either hospice care or participating in the California hospice waiver – a program that allows children with life-limiting or life-threatening medical conditions to receive community or home-based supportive services. Finally, during this rotation fellows also participate in UCSF’s Bridges home-based palliative care program, joining Dr. Brook Calton to see home-bound patients whose goals are not consistent with Hospice.

Pediatric Palliative Care Rotation (1 month):

  • At the Benioff Children’s Hospital at Mission Bay (a new facility opened in 2015), fellows join interdisciplinary members of the Integrated Pediatric Pain and Palliative Care (IP3) team including anesthesiologists, pediatric palliative care physicians, psychologists, nurse practitioners, child life specialists, social workers, and others in caring for children with serious illness in both the inpatient and outpatient settings. Prior pediatric training is not required for these rotations.

    Fellows visit George Mark Children's House (GMCH) and two week at UCSF Benioff Children's Hospital. GMCH is an independent, non-profit, free-standing pediatric respite and hospice house - the only institution of its kind in the United States. The dual role as a respite and hospice facility means that fellows are exposed to children in varying stages of illness. 

“The best thing about the HPM fellowship at UCSF was the outpatient palliative care training I received in the Symptom Management Service. Coming from a primary care background, I loved caring directly for my own longitudinal patient panel instead of seeing the clinic attending’s patients”.

- Dr. Brook Calton ‘13

Outpatient Palliative Care Experience (one afternoon per week, longitudinal):

  • Each fellow has a weekly palliative care continuity clinic with the UCSF Symptom Management Service (SMS), 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 works closely 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 or modify several existing electives - such as Pain Medicine, Oncology, Home-Based Care, and Narrative Medicine - or build their own elective. Multiple training sites ensure access to a wide variety of elective opportunities. Supervised by the program director, fellows use elective building as an opportunity to practice curricular development. Time is also set aside during these months to pursue work on the ACGME-required scholarly and quality improvement projects.