The training for Mayo Clinic's Hospice and Palliative Medicine Fellowship consists of 13 blocks of clinical training. Each block is four weeks. In addition, there is a weekly 1/2 day clinic, complemented by ongoing didactics, research opportunities, and quality improvement projects. 

Rotation schedule

Your fellowship training will consist of the following rotations.

*A wide variety of elective opportunities are available. These can vary in duration from one to four weeks. We encourage fellows to take advantage of these offerings to enhance their education and career experience. If you have a specific elective interest, please discuss it with the program director. We are open to ideas that would be helpful in your career development. Elective rotation opportunities include, but are not limited to:

• Interventional pain service
• Hematology and oncology
• Neurology and amyotrophic lateral sclerosis (ALS) clinic
• Advanced heart failure / LVAD
• Pulmonary clinic
• Pediatric palliative care
• Integrative medicine
• Psychiatry
• Spiritual care
• Research

Palliative care consultation service

You spend 20 weeks on the inpatient palliative care consultation service. During this rotation, you see patients with advanced illness to assist in symptom management and goals-of-care discussions. Consultations are requested from a breadth of medical and surgical services. Fellows are an integral part of the multidisciplinary teams, which consist of physicians, advanced practice providers, nurses, a social worker, a chaplain, and a pharmacist.

Outpatient clinic

You participate in a weekly half-day clinic. The clinic appointments consist of 90-minute new consultation visits and 45-minute follow-up appointments. In addition to the nursing staff, the outpatient clinic is supported by a full-time social worker and chaplain.

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

• Cancer
• Heart failure
• Dementia
• Renal failure
• Advanced lung disease
• Neurodegenerative diseases

Hospice experience

We are fortunate to have an inpatient hospice palliative care unit located on the Mayo Clinic campus. Sherman Home is a 12-bed unit managed in collaboration with Hospice of the Valley, which has 10 inpatient units across the metro area. Two of these units are dedicated to specific patient populations.

• Ryan House — a pediatric hospice home
• Gardiner Home — a hospice home for patients with dementing illnesses

As a part of the hospice experience, you complete two weeks of home hospice visits.

Pediatric experience

You complete a two-week rotation at the Phoenix Children's Hospital (PCH). You will be working with the palliative care team at PCH assisting in symptom control and goals of care discussions with critically ill infants and adolescents.

Call frequency

As a fellow, you will take evening call from home one night per week during the first six months of training, and two days per week during the latter six months. There will always be an assigned staff physician available for questions.

In addition, you will be responsible for weekend call in the hospital. You will be on-call for the palliative medicine service 9 weekends per year and one major holiday which is preassigned. If you wish to switch call weekends, this must be approved by the program director. You may not take more than two call weekends per rotation block.

Research training

Research opportunities at Mayo Clinic are outstanding. During the course of this fellowship, you will receive direction to develop and complete a research paper ready for submission and participate in a quality improvement project under the close mentorship of one of our faculty.

Each fellow is required to participate in scholarly activity/research. This can take many forms, including case presentations, case series, and clinical reviews. All fellows are required to participate in a quality improvement project during the training program. The program director will explore research opportunities with you. You will be provided with presentation trip days and travel per diem to support your conference attendance. You can use up to four weeks of elective rotations to help facilitate your research/scholarly activities. 

The Mayo Clinic School of Graduate Medical Education will provide funding for travel in order for you to present your Mayo research during and up to 12 months after completing your fellowship if approved by the program director. 

You are required to submit a case report to the annual American Academy of Hospice and Palliative Medicine (AAHPM) meeting. This meeting is typically held in February or March and hosts a forum for fellows to present interesting cases. Case submissions are typically accepted during the month of October with the deadline approximately Nov. 1. 

You are required to submit a scholarly project (e.g. case report, research project) to Academic Excellence Day. This is typically held in April or May. This is an education forum open to residents and fellows within the Mayo School of Graduate Medical Education and Mayo School of Health Sciences.

You will be assigned days to present at the Palliative Medicine Grand Rounds (PMGR). You are expected to present one M&M case and one topic of your choice (a total of two presentation days per fellow).

Didactic training

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

• Palliative Medicine Grand Rounds. Weekly didactics cover a broad range of topics that are of interest to the palliative care provider, including radiation therapies, advanced heart failure therapies, new and novel symptom control regimens, and resiliency training. Grand Rounds also includes a morbidity and mortality conference twice a year.
• Phoenix Palliative Medicine Education Consortium. The consortium is a collaboration of five palliative medicine fellowships and one geriatric fellowship program throughout the Phoenix area. The consortium offers weekly education sessions consisting of lectures, workshops, journal clubs, and wellness sessions. The sessions are led by a variety of experts from across each of the participating organizations.
• Tri-site conference. This is a monthly webcast case conference/journal club that includes the palliative medicine faculty and fellows from Mayo Clinic's campuses in Minnesota, Florida, and Arizona.
• Other learning opportunities. Learning opportunities abound at Mayo. You are strongly encouraged to attend Internal Medicine Grand Rounds, Psychiatry Grand Rounds, Cancer Center Grand Rounds, and Neurology Grand Rounds, as subjects relevant to your training are presented. You are encouraged to participate in the Transplant Selection Committee meetings if this is an area of interest.
• Patient education resources. You are encouraged to experience the patient-based education resources at Mayo Clinic, including the Grief Support Group and the Caregiver Class.

Conferences

Mayo Clinic provides outstanding support for you to attend national meetings. You are allotted up to five days to attend a national meeting, such as the American Academy of Hospice and Palliative Medicine Annual Assembly. Additional presentation days are provided if you have scholarly research that has been accepted for presentation at a regional or national meeting. You will have the opportunity to participate in an interactive communication workshop. The education coordinator will block the fellow's calendar to attend this local required conference.

Teaching opportunities

You are expected to participate in the teaching of other learners. You will be expected to teach residents from other specialties rotating on our service, including internal medicine and transitional year residents. You may also be invited to present at various nursing or other allied health staff meetings.

Evaluations

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 quarterly with the program director to review these evaluations. In addition, you regularly evaluate the faculty and each rotation to confirm that your educational needs are being met.