Clinical training

The training for Mayo Clinic's Hospice and Palliative Medicine Fellowship consists of 12 months of clinical training and a year-long outpatient palliative medicine clinic experience, complemented by didactics and a research experience. Our fellowship follows a 3+1 format where each four-week block is divided into an uninterrupted three-week service rotation and one week of outpatient duties. During the outpatient week, you will have two full days of palliative medicine clinic, one full day of core fellowship didactics, and two scholarly/wellness days.

Rotation schedule

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

Rotation descriptions

Palliative Care Consultation Service

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

Your fourth block of the Inpatient Palliative Care Consultation Service you will serve as an 'associate consultant.' During this last block you are in charge of running the consult service, and managing the patients and the team. You still have backup support from the attending physician but that mentoring is expected to be more distant allowing you a supported 'practice run' at being a full-fledged consultant just before you graduate.

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

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

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

Inpatient Palliative Care Service (IPCS)

The palliative medicine inpatient unit is housed at the Methodist Campus of Mayo Clinic Hospital —  Rochester and is a primary service addressing advanced, complex symptom management such as refractory pain, refractory nausea, refractory delirium, and palliative sedation for patients with oncologic diseases. The fellow role on this service is supervisory and includes dedicated teaching duties.

Palliative Medicine Clinic

Our free-standing Palliative Medicine Clinic provides subspecialty, longitudinal palliative care in addition to acute or urgent symptom management. You will carry your own panel of patients with palliative needs. Our outpatient clinic is also intraprofessional with advanced practice clinicians, nursing, social work, and chaplaincy all embedded into the clinic.

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
• Renal failure
• Multimorbidity

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

In addition to our free-standing palliative medicine clinic, we also have embedded clinics within oncology and neurology. You will spend some of your clinic days in these clinics as well, allowing you to experience the benefits and drawbacks of both types of outpatient palliative medicine practice.

Combined Inpatient/Outpatient Hospice

You spend three blocks on Mayo Hospice in a combined inpatient/outpatient rotation modeling a hospice medical director role. While working with the inpatient team, you provide general inpatient hospice services to patients with very high symptom burdens during their dying process. You also provide home hospice visits with Mayo Clinic Hospice. This includes dedicated time with the hospice interdisciplinary team members.

During the three blocks, you lead a robust interdisciplinary team, gaining the necessary skills to provide comprehensive end-of-life care and administration as a hospice medical director.

For all hospice rotations, you will be required to have your own transportation and a cell phone to use for hospice call.

Scholarship

Scholarly activities are longitudinal over the course of your fellowship and include a dedicated two days a month during the outpatient week. During this time, you will hone your academic skills through a combination of online classwork and the development of a mentored research protocol. 

Additionally, you will be conducting a mentored group QI project from conception to dissemination over the year.

Pediatrics

You spend one block with our pediatric palliative medicine consult service, also known as the 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 will spend time with the pediatric bereavement coordinator and child life specialists learning about childhood development and how it relates to illness and grief responses.

IDT/Pharmacy

You spend one half-block rotating with a variety of palliative team members to understand the roles of our colleagues and how best to utilize their expertise in the care of palliative medicine patients. This includes time with our palliative social workers (both inpatient and outpatient), chaplains, pharmacists, nurses, and music therapists.

Wound

You spend one half-block rotating with the experienced inpatient wound team nurse practitioners. During this week, you see patients with pressure sores, incision wounds, and burns for wound care management at Mayo Clinic Hospital - Rochester, Saint Marys Campus.

Pain Service

We have an outstanding working relationship with our interventional pain colleagues. The one-week pain rotation includes primarily 1) time with our clinical specialists who focus on nonpharmacological treatments of chronic pain, such as cognitive behavioral therapy and mindfulness, and 2) time with the intrathecal pump nurses.

Outpatient pain consults including consults for interventional pain procedures and the opportunity to observe interventional pain procedures are available as an elective option. 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.

Electives

Electives are available in nearly every specialty at Mayo Clinic that might be of interest to our fellows, including pain, complementary and integrative medicine, radiation oncology, addiction medicine, pain rehabilitation, and paracentesis procedure clinic. You can also use elective time for research or additional hospice training.

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.

Didactic training

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

• Hospice and palliative medicine noon conference. Mandatory, interactive, weekly didactics for the entire palliative department that incorporate complex case discussions, wellness, journal club, and knowledge-based didactic sessions from specialists within and outside palliative medicine.
• Hospice and palliative medicine grand rounds. Quarterly lectures given by national and international experts in palliative medicine.
• Palliative medicine fellowship core didactics. One full day each month and roughly 1-2 Tuesday noon hours per month are dedicated to core didactic training. These didactic sessions incorporate a variety of lecture, small group, and experiential learning (including the SIM Center) to convey necessary core skills in a fun and collegial manner. Some of these didactic sessions include our palliative fellows from the Mayo Clinic campuses in Phoenix, Arizona, and Jacksonville, Florida, as well.
• Journal club. These monthly evening meetings alternate between on campus and in faculty homes. It is a shared conference that includes both palliative medicine and geriatric medicine fellows. Meetings are attended by faculty from both groups.
• Finding Meaning in Medicine activities.
  • Self-care processing group. For fellows only, these monthly meetings are led by a mentor outside of the fellowship faculty who has years of experience coaching physicians. 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.
  • Leadership book club. This monthly meeting explores the skills needed to lead an intraprofessional palliative medicine team. Building off of classic leadership literature, a senior palliative medicine leader mentors fellows in exploring the nuances of leading within a team structure and identifying and practicing the skills necessary to be successful in the leader role.
  • Humanities. This monthly meeting utilizes art, writings, plays, and poems to explore perspective and help us find meaning in our daily work.
• 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 encouraged to attend Internal Medicine Grand Rounds, Geriatrics Core Curriculum, and Pain-Anesthesia Core Curriculum when subjects relevant to your training are being presented.

External conferences

Mayo Clinic has outstanding trip support for fellows. We encourage participation 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 participate in scholarly activity, including submission of a case presentation or abstract to a national meeting and development of a mentored research protocol. Additionally, you complete a mentored quality improvement project during the course of your fellowship in coordination with your co-fellows.

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 fellows in the inpatient palliative unit and an opportunity in nearly every other rotation.

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.