Curriculum

Mayo Clinic hospice and palliative medicine faculty and fellows in a conference

Clinical training

The training for Mayo Clinic's Hospice and Palliative Medicine Fellowship consists of 12 months of clinical training, complemented by didactics and a research experience.

Rotation schedule

Each block is four weeks, with a total of 13 blocks.

Rotation Length
Palliative Care Consultation Service (inpatient) 6 blocks
Outpatient continuity clinic 1 day a week throughout year
Hospice 2.5 blocks
Long-term care 1 block
Pain Service 0.5 block
Pediatrics 0.5 block
Pharmacy 0.5 block
Ethics 0.5 block
Electives 1.5 blocks

Rotation descriptions

Palliative Care Consultation Service

You spend six blocks of time on the inpatient Palliative Care Consultation Service. During this inpatient consultative block, you are an integral part of the multidisciplinary team. Team members include board-certified consultants, advanced practice providers, nurses, and a social worker, pharmacist and chaplain. We also work closely with ethics and continuously have learners from multiple disciplines joining our team.

You provide care at both campuses of Mayo Clinic Hospital — Rochester, gaining experience in expert symptom management and complex communication.

  • Mayo Clinic Hospital, Saint Marys Campus. As a fellow, you care for patients with advanced cardiac and lung diseases, trauma, cancer, and geriatric and neurological conditions. At this campus, our Palliative Care Consultation Service plays an integral part of the left ventricular assist device (LVAD) service and also sees patients receiving other advanced high-risk heart procedures.

  • Mayo Clinic Hospital, Methodist Campus. Here, you care for patients with hematologic/oncologic diseases, including solid-organ and hematologic malignancies and post-transplant populations. This campus also has patients with liver failure, including those who are post-transplant.

    One of the six blocks is served on the hospital medicine service at the Methodist Campus. This service is solely for patients with complications of hematologic/oncologic illnesses and is particularly high in symptom management. The main objectives for this rotation are to develop the knowledge needed to care for patients with both complex symptoms and general oncologic needs.

Outpatient continuity clinic

You see patients weekly in the Palliative Care Clinic. In this clinic, we provide routine subspecialty palliative care in addition to acute or urgent symptom management.

The outpatient practice serves patients with the complete spectrum of serious illnesses, including but not limited to:

  • Cancer
  • Heart failure
  • COPD and pulmonary fibrosis
  • Dementia
  • Stroke
  • Amyotrophic lateral sclerosis (ALS)
  • Renal failure

The Palliative Care Clinic experience provides the opportunity for you to follow your longitudinal patients during transitions of care from outpatient to inpatient and on hospice as the physician of record.

Hospice

You spend four weeks at an inpatient hospice unit, with a choice of rotating at one of three locations:

You spend your remaining six weeks providing home hospice visits with Mayo Clinic Hospice and Seasons Hospice. During both the inpatient and outpatient hospice experiences, you are exposed to the workings of a robust interdisciplinary team, all while gaining the necessary skills and proficiencies in providing comprehensive end-of-life care and hospice administration.

Long-term care

You spend four weeks on a variety of activities surrounding long-term care. You rotate with dedicated geriatric specialists at a variety of local nursing homes learning the nuances of providing palliative medicine to chronically ill residential nursing home patients nearing the end of their lives. Additionally, you participate in home visits with our homebound palliative care program during this month.

Pain Service

We are extremely blessed to have an outstanding working relationship with our interventional pain colleagues. Pain Clinic and Palliative Care Clinic are co-located, and you work side by side with our interventional pain colleagues.

This rotation includes primarily outpatient pain consults, in addition to spending time with our clinical specialists who focus on nonpharmacological treatments of chronic pain, including cognitive behavioral therapy and mindfulness. There is also the opportunity to observe interventional pain procedures on an individual basis. The outpatient pain consults encompass a wide array of cancer- and noncancer-related pain management, including somatic and neuropathic pain management using opioids, adjuvants and interventional procedures.

Pediatrics

You spend two weeks with our pediatric palliative medicine consult service, also known as Comprehensive Pediatric and Adolescent Support Services (ComPASS), providing both inpatient and outpatient pediatric consultations at Mayo Eugenio Litta Children's Hospital.

In addition, you accompany staff on home visits for both pediatric palliative and hospice patients. You also spend time with the pediatric bereavement coordinator and child life specialists learning about childhood development and how it relates to palliative medicine.

Pharmacy

You spend two weeks with our dedicated hospice and palliative medicine pharmacist focusing on the pharmacodynamics of medications commonly used in hospice and palliative medicine, including expertise with methadone and ketamine.

Ethics

You spend two weeks with Mayo Clinic's robust and active ethics consult service learning the mechanics of performing ethics consultations along with rigorous medical ethics. During this rotation, you gain exposure and understanding of the significant overlap between palliative medicine and medical ethics.

Electives

Electives are available in nearly every specialty at Mayo Clinic that might be of interest to our fellows, including complementary and integrative medicine, medical oncology, physical medicine and rehabilitation, pain medicine and anesthesia, psychiatry, and geriatrics, to name just a few.

You may choose to spend additional time with hospice or pursue specific research projects during your elective time as well.

Call frequency

There is no in-house call during this fellowship. You are expected to take phone call from home in a graduated fashion throughout the year commensurate with your level of training.

Mayo Clinic hospice and palliative medicine faculty and fellows engaged in discussions during fellow continuity clinic

Didactic training

Didactic training is an integral part of the Hospice and Palliative Medicine Fellowship. During your training, you participate in these conferences:

  • Hospice and palliative medicine noon conference. Mandatory, interactive, weekly didactics that incorporate complex case discussions, expanded bereavement and wellness, knowledge-based didactic sessions from specialists within and outside palliative medicine, as well as journal club are included.
  • Palliative medicine core didactics. One full day each month is dedicated to core didactic training. These didactic sessions incorporate a variety of lecture, small group and experiential learning styles to convey necessary core skills in a fun and collegial manner.
  • Journal club. These monthly evening meetings are held in faculty homes. It is a shared conference that includes both the palliative medicine and the geriatric medicine fellows. Meetings are attended by faculty from both groups.
  • Self-care group. For fellows only, these regular meetings are led by a mentor outside of the fellowship faculty. These sessions give you dedicated time to reflect on the challenges and rewards of your chosen profession in an environment of safety. This group historically has been highly regarded by our fellows.
  • Master class teaching skills workshop. Three half-day workshops are geared at honing your teaching skills. Topics discussed include best practices of effective teaching and giving effective feedback to learners, as well as improving and increasing confidence in presentation skills.
  • PalliTALK. This three-day intensive communication training is held in Madison, Wisconsin, for all of the Upper Midwest hospice and palliative medicine fellowships. All your participation, including hotel, meals and transportation costs, are covered by the fellowship. This outstanding opportunity affords intensive training in expert-level communication in a fun and relaxed setting that also fosters your networking among fellow trainees.
  • Other learning opportunities. You are strongly encouraged to attend Internal Medicine Grand Rounds, Geriatrics Core Curriculum and Pain-Anesthesia Core Curriculum when subjects relevant to your training are being presented.

Conferences

Mayo Clinic has outstanding trip support for fellows. We strongly encourage you to participate in the American Academy of Hospice and Palliative Medicine (AAHPM) Annual Assembly.

Research training

Research opportunities abound at our world-class academic medical center. You have access to all of the research resources at Mayo Clinic, and mentoring is available for all levels of expertise. You are expected to complete a mentored quality improvement project during the course of your fellowship.

Teaching opportunities

Opportunities are available for you to teach rotating residents and medical students. Formal curriculum is provided in medical education, and teaching is an expected role for seasoned fellows in the latter two-thirds of the year.

Evaluation

To ensure that you acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, your performance is monitored carefully during the Hospice and Palliative Medicine Fellowship. You are formally evaluated by supervising faculty members after each clinical rotation and meet with the program director on a quarterly basis to review these evaluations. In addition, you regularly evaluate the faculty to confirm that your educational needs are being met.

Dec. 21, 2017