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Curriculum

Photo of Mayo Clinic hospice and palliative medicine faculty and fellows in a meeting

Rotation schedule

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

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

Clinical training

Palliative Care Consultation Service

Fellows spend six blocks of time on the inpatient Palliative Care Consultation Service. During this inpatient consultative block, fellows 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.

Fellows 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. Fellows care for patients with advanced cardiac and lung diseases, trauma, cancer, 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. Fellows 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

Fellows see patients weekly in the Symptom Management, Pain, and Quality of Life (SYMPAQ) 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 SYMPAQ experience provides fellows the opportunity to follow their longitudinal patients during transitions of care from outpatient to inpatient and on hospice as the physician of record.

Hospice

Fellows spend four weeks in an inpatient hospice unit, with a choice of rotating at one of three inpatient hospice units:

Fellows spend their remaining six weeks providing home hospice visits with Mayo Hospice and Seasons Hospice. During both the inpatient and outpatient hospice experiences, fellows 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.

Pain Service

We are extremely blessed to have an outstanding working relationship with our interventional pain colleagues. Fellows spend four weeks working with these experts in pain management.

This rotation includes both inpatient and 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.

The inpatient pain consults encompass predominantly cancer-related pain and provide ample opportunity to observe interventional pain procedures. The outpatient pain consults encompass a wide array of cancer-related and non-cancer-related pain management, including somatic and neuropathic pain management using opioids, adjuvants and interventional procedures.

Pediatrics

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

Pharmacy

Fellows 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.

Electives

Electives are available in nearly every specialty at Mayo Clinic that may 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.

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

Ethics

Fellows 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, fellows gain exposure and understanding of the significant overlap between palliative medicine and medical ethics.

Long-term care

Fellows spend four weeks on a variety of activities surrounding long-term care. Fellows 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, fellows participate in home visits with our homebound palliative care program during this month.

Didactic training

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

  • Hospice and palliative medicine didactics. Mandatory, small group, interactive, weekly didactics.
  • Palliative medicine bootcamp. Intensive half-day curriculum formulated to introduce new fellows to key subject matter in palliative medicine and quality improvement. This runs the first four Mondays of the fellowship.
  • Journal club. Monthly evening meeting held at the homes of the faculty. This is a shared conference that includes both the palliative medicine and the geriatric medicine fellows. It is attended by faculty from both groups.
  • Tri-site conference. A case conference/journal club that occurs once a month and includes the palliative medicine faculty and fellows of Mayo Clinic's campuses in Rochester, Minnesota; Jacksonville, Florida; and Phoenix/Scottsdale, Arizona.
  • Master class teaching skills workshop. Three half-day workshops geared at honing the teaching skills of fellows. 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. Three-day intensive communication training held in Madison, Wisconsin, for all of the upper Midwest hospice and palliative medicine fellowships. All fellows' participation, hotel, meals and transportation are covered by the fellowship. This outstanding opportunity affords palliative medicine fellows intensive training in expert-level communication in a fun and relaxed setting that also fosters networking among fellow trainees.
  • Other learning opportunities. Fellows are strongly encouraged to attend Internal Medicine Grand Rounds, Geriatrics Core Curriculum and Pain-Anesthesia Core Curriculum when subjects relevant to their training are being presented.
Photo of Thomas P. Pittelkow, D.O., and J. Keith Mansel, M.D.

Fellow Thomas P. Pittelkow, D.O., and faculty member J. Keith Mansel, M.D.

Call frequency

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

Teaching opportunities

Teaching opportunities abound. Formal curriculum is provided in medical education, and teaching is an expected role for seasoned fellows in the latter two-thirds of the year.

Research training

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

Conferences

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

Evaluation

To ensure that fellows acquire adequate knowledge and develop the necessary technical skills, performance is monitored carefully during the course of the Hospice and Palliative Medicine Fellowship. Fellows are evaluated formally by their supervising faculty member after each clinical rotation and meet quarterly with the program director to review these evaluations.

In addition, fellows evaluate the faculty and each rotation to ensure that their educational needs are being met.

  • June 7, 2016
  • ART761322