Clinical training

The year-long fellowship follows a 3+1 schedule comprised of 13 four-week blocks: three weeks of service rotation and one week of outpatient duties. The outpatient week includes two full days of palliative medicine clinic, one full day of core fellowship didactics, and two days of scholarship/wellness time. 

Rotation schedule

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

Rotation descriptions

Palliative Care Consultation Service

Fellows spend four blocks on the Palliative Care Consultation Service (PCCS). ,where they are an integral part of the interdisiplinary team, alongside board-certified consultants (attendings), advanced practice clinicians, nurses, social workers, chaplains, and a pharmacist. Trainees from multiple disciplines also rotate with the team.

During the fourth block of the Palliative Care Consultation Service, fellows serve as an “associate consultant” and are responsible for  managing the patients and the team, with backup support provided by the supervising consultant (attending) . The goal is to provide fellows with a supported “practice run” at being a palliative care consultant (attending) prior to graduation.

Fellows care for patients at both campuses of Mayo Clinic Hospital – Rochester.

• Mayo Clinic Hospital — Rochester, Saint Marys Campus. Patients at Saint Marys Campus often carry diagnoses of complex conditions, spanning critical care, trauma, medical, surgical, and neurological conditions. At this campus, the Palliative Care Consultation Service also plays an integral part in advanced cardiology care for patients being considered for left ventricular assist device (LVAD) and other advanced high-risk cardiac procedures.

• Mayo Clinic Hospital — Rochester, Methodist Campus. Patients at this campus often carry diagnoses of hematologic/oncologic diseases. Patients who have received bone marrow transplants and liver transplants are also cared for at this campus.

Inpatient Palliative Care Service (IPCS)

The inpatient palliative care unit is housed at Mayo Clinic Hospital  - Rochester, Methodist Campus and is run by the Inpatient Palliative Care Service, a primary team that addresses advanced, complex symptom management needs such as refractory pain and delirium and palliative sedation. The fellow role on this service includes dedicated teaching of residents.

Palliative Medicine Clinic

The Palliative Medicine Clinic provides subspecialty, longitudinal palliative care for patients with serious, potentially life-limiting illnesses. Fellows carry their own panel of patients and have the opportunity to follow their patients during transitions of care from outpatient to inpatient and hospice, as the hospice attending. 

The interdisciplinary clinic includes dedicated advanced practice clinicians, nurses, social workers, music therapists, and chaplains. 

The clinic cares for patients across the spectrum of serious illnesses, including but not limited to: 

• Cancer
• Heart failure
• Neurodegenerative diseases, including dementia, ALS, and atypical parkinsonian disorders
• COPD and pulmonary fibrosis
• Dementia
• Renal failure
• Multimorbidity

Combined Inpatient/Outpatient Hospice

Fellows spend three blocks with Mayo Hospice in a combined inpatient/outpatient rotation modeling the role of a hospice medical director. Fellows learn to lead an interdisciplinary team, gaining the necessary skills to provide comprehensive end-of-life care and administration as a hospice medical director. 

While working with the inpatient team, fellows care for patients during respite stays and for patients with very high symptom burden on general inpatient hospice. On the outpatient side, fellows conduct home hospice visits for patients in their places of residence, including in assisted living facilities and skilled nursing facilities. This rotation also includes dedicated time with hospice interdisciplinary team members. 

Fellows are required to provide their own transportation for home visits and to have a cell phone to use for hospice call. 

Pediatrics

Fellows spend one half-block with the pediatric palliative medicine consult service, also known as Comprehensive Pediatric and Adolescent Support Services (ComPASS), providing inpatient consultations at Mayo Eugenio Litta Children's Hospital.

In addition, fellows may accompany staff on home visits for pediatric palliative care and hospice patients. Fellows 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

Fellows spend one half-block rotating with palliative team members to understand their roles and how best to utilize their expertise in the care of patients. This includes time with advanced practice clinicians, social workers, chaplains, pharmacist, nurses, and music therapists.

Wound

Fellows spend one week rotating with the experienced inpatient wound team nurse practitioners. During this week, fellows see patients with pressure sores, incision wounds, and burns.

Pain

The one-week pain rotation includes 1) time with clinical specialists who focus on nonpharmacological management of chronic pain, such as cognitive behavioral therapy and mindfulness, and 2) time with the intrathecal pump nurses. 

Fellows can spend elective time in the outpatient pain clinic, assessing patients for and observing interventional pain procedures. The outpatient pain clinic encompasses a wide array of cancer- and non-cancer-related pain management, utilizing opioids, adjuvants, and interventional procedures. 

Electives

Electives are available in nearly every specialty that might be of interest to our fellows, including integrative medicine, radiation oncology, addiction medicine, pain rehabilitation, clinical ethics, and paracentesis procedure clinic. Elective time can also be used for research. 

Scholarship/Research

Research is an integral part of the mission of Mayo Clinic. Scholarly activities occur longitudinally over the course of fellowship, including through dedicated time two days a month during the last week of each block.

Fellows complete a mentored group quality improvement project from conception to dissemination over the course of the year. Fellows are also expected to submit a case presentation or abstract to a national meeting.  Fellows who want to pursue additional research opportunities have access to research resources at Mayo Clinic and mentoring for all levels of research expertise.

Call frequency

There is no in-house call during this fellowship. Fellows are expected to take call from home with graduated responsibility throughout the year.

Didactics

Didactics are an integral part of the Hospice and Palliative Medicine Fellowship. Fellows participate in: 

• Hospice and Palliative Medicine Noon Conference: Monthly didactics for the entire hospice and palliative medicine team that feature complex case discussions, wellness, and other topics relevant to hospice and palliative medicine. 
• Hospice and Palliative Medicine Grand Rounds: Invited lectures given by national and international experts. 
• Palliative Medicine Fellowship Core Didactics: Sessions that utilize a variety of formats, including lecture, small group discussion, and experiential learning (in our simulation center). Some sessions include hospice and palliative medicine fellows from the Mayo Clinic campuses in Phoenix, Arizona, and Jacksonville, Florida. 
• Journal Club: These monthly evening meetings occur on campus or in faculty homes and include geriatric medicine fellows and attending faculty. 
• Meaning in Medicine 
  • Process Group: These quarterly meetings provide dedicated time to reflect on the challenges and rewards of this profession in a safe environment. 
  • Leadership Book Club: A palliative medicine physician uses classic leadership literature to help fellows identify and practice the skills necessary to be successful as a leader of an interdisciplinary hospice and palliative medicine team.  
  • Narrative Medicine: This curriculum utilizes art, writings, plays, and poems to explore perspective and help find meaning in daily work. 
• Master Class Teaching Skills Workshop: Three half-day sessions that focus on practices of effective teaching, including giving effective feedback to learners, teaching in different settings, and addressing burnout.
• PalliTALK: This three-day intensive communication training workshop is held in Madison, Wisconsin, for all of the Upper Midwest hospice and palliative medicine fellows, fostering growth in serious illness communication and networking among other trainees.
• Other learning opportunities: Fellows are encouraged to attend other conferences, such as Internal Medicine Grand Rounds and Clinical Ethics Grand Rounds, when subjects relevant to the fellow’s training and interests are being presented. 

External conferences

Mayo Clinic has outstanding trip support for fellows. Fellows will receive financial support to attend PalliTALK and the Annual Assembly of Hospice and Palliative Care. 

Teaching opportunities

Fellows have ample opportunities to teach rotating residents and medical students. Fellows complete a formal workshop in medical education (Master Class Teaching Skills Workshop). Teaching is an expectation of fellows on the Inpatient Palliative Care Service and an opportunity in nearly every other rotation. 

Evaluation

To ensure that fellows acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, performance and skill acquisition are tracked during the course of the fellowship. Fellows receive evaluations from supervising faculty members after each clinical rotation and meet with the program director each quarter to review these evaluations. In addition, fellows regularly evaluate the faculty to assure that their educational needs are being met.