Hospice & Palliative Medicine Fellowships

The Palliative Care Fellowship in the Department of Palliative, Rehabilitation and Integrative Medicine (PRIM) offers six clinical fellowship positions in Hospice and Palliative Medicine accredited by the Accreditation Council for Graduate Medical Education (ACGME). The fellowship is one year, with an option to apply for a second year concentrating on palliative care research individuals who have secured outside funding from their home institution or a granting agency. In addition, 2 clinical fellowship positions for Michael E. DeBakey Veterans Affairs (VA) track and 1 clinical fellowship position for Houston Methodist Hospital (Methodist) track are also offered.

Fellows are trained in the practice of palliative care and symptom management for patients with advanced cancer and other chronic illnesses. Our patient population ranges from children to adults, inpatients to outpatients, and involves the assessment and management of pain and other symptoms arising from advanced disease. Fellows benefit from active interaction with all medical disciplines involved in the care and treatment of patients with advanced cancer as well as their families.

The addition of the VA and Methodist Hospital rotations provide unique opportunities for all fellows to get exposure to non-cancer patients in advanced neurological, cardiovascular, respiratory, and renal diseases. Additionally, fellows rotating in VA will benefit in caring for the unique challenges of veteran patients such as post-traumatic stress disorder and other similar conditions. There are very few academically trained palliative care physicians in the country that are equipped to handle this variety of cases. This unique integration with VA and Methodist enhances the learning opportunity for all trainees.

Fellows in the MD Anderson Cancer Center track rotate for 7 months in the inpatient services in MD Anderson, 1 month in Houston Methodist Hospital, and 1.5 months in the VA service. Fellows in the VA track rotate for 5.5 months in VA and 4 months in MD Anderson Cancer Center while fellows in Methodist track rotate for 5 months in Houston Methodist Hospital and 4.5 months in MD Anderson Cancer Center. All fellows will spend 2.5 months between a dedicated hospice service, pediatric, and elective rotations. All fellows will also have a weekly continuity clinic experience.

Fellowship Program Goals

• To train individuals to provide state-of-the-art multi-disciplinary care for patients with advanced cancer and other chronic illnesses.
• To develop leaders in the field of palliative medicine.
• To provide a rigorous academic experience in which fellows can participate in clinical research under the guidance of experienced mentors.

Clinical Goals

The primary objective or outcome of the clinical fellowship program is that fellows should be competent to serve as a consultant to other specialties for symptom control and palliative care, to care for inpatients on the palliative care primary service, and to provide a learning experience, which promotes fellows to develop an attitude, knowledge and skill base required to participate in effective and compassionate palliative care. Seven and half months attendance in MD Anderson Palliative Care Services, four and half months at outside participating palliative sites and two weeks elective.

• Fellows will be familiar with the clinical course in major symptomatic complications of cancer. Fellows will understand the pathophysiology, assessment and management of pain, cachexia/anorexia, dyspnea, delirium, depression, anxiety, asthenia, fatigue, nausea, constipation, insomnia and other clinical symptoms.

• Fellows will have expertise in clinical decision-making in palliative cancer care including artificial nutrition and hydration, medical and surgical management of bowel obstruction, metabolic complications and sepsis.

• Fellows gain experience in assessing and treating other chronic illnesses including respiratory, cardio and neurological diseases.

• Fellows will be familiar with the pharmacology of all major drug groups used in the management of cancer and non-cancer related symptoms including analgesics, anti-emetics, cardiac and respiratory drugs, and psychotropics.

• Fellows will have excellent skills in communication and counseling of patients and their families.

• Fellows will be able to implement follow-up planning to establish community support for patients, including hospice care, long-term cancer rehabilitation, nursing homes, long-term acute care, home care, etc.

• Fellows will be able to incorporate evidence-based decision making for dying patients and their families.

• Fellows will be able to access the relevant literature in helping to solve clinical problems.

• Apply critical appraisal skills to literature in palliative medicine.

• Fellows will be able to discuss the ethical issues of confronting dying patients, their families and their physicians, including end of life decision making, advance directives, care planning, competency, euthanasia and assisted suicide.

• Outline a general framework for ethical decision-making.

• Describe an approach to managing the particular ethical issues of the end of life including withdrawing or withholding therapy, advance directives, euthanasia and assisted suicide.

• Understand the health care delivery system and understand the economics of different setting.

• Demonstrate integrity, honesty, and compassion in the care of patients.

• Act as an effective advocate for the rights of the patient and family in clinical situations involving serious ethical considerations.
  

Research Goals

This program is designed to prepare fellows for a career in academic and clinical research. An advanced hospice and palliative medicine research position is available to selected individuals who have secured outside funding from their home institution or a granting agency. Recognizing that trainees have different backgrounds, interests, and training in research, as well as different career goals, one of the major objectives of the research component of the fellowship is to help prepare individuals for transition to a faculty position in which they will be able to pursue investigative activities and compete for funding from the NIH and other funding agencies.

• Fellows will become familiar with methodological and content aspects of symptom control and palliative care research.
  
• Fellows will receive formal training in critical appraisal of the literature and research methodology.
• Fellows will be mentored in the preparation of at least two peer review publications.
• Fellows will attend the biweekly “Chief’s Journal Club” for brief analyses of recent supportive care topics.

Teaching Goals

• Fellows will become effective educators. They will be expected to regularly present articles in the monthly journal club as well as in the weekly PRIM rounds and unit rounds. They will participate in weekly didactic lectures with the faculty.
• Our palliative care program has active didactic sessions which include both weekly and monthly academic presentations by fellows, as well as, monthly research presentations by the research team. At the beginning of the year, fellows will be assigned a mentor to overlook their scholarly activities. The weekly fellows’ presentations are supervised by faculty, and if deemed appropriate, will culminate into a manuscript for publication. Fellows will become familiar with methodological and content aspects of symptom control and palliative care research. They will receive formal training in critical appraisal of the literature and research methodology.
• Fellows will become familiar with education of residents, fellows, and visiting faculty.
• Fellows will become familiar with the process of development of a curriculum for symptom control and palliative care.
• A completed project, either in clinical or basic science research and quality (QI), is required of each fellow, and a written paper suitable for publication is expected before a certificate from MD Anderson Cancer Center is issued. Our track records indicate our fellows, in average, publish at least two papers per year.

Administration Goals

• Fellows will become familiar with the organization and reimbursement of symptom control and palliative care services.
• Fellows will be capable of preparing a project (including clinical and financial justification) for the development of PRIM programs in academic medical centers.
• Optional, preliminary training on organizing a fellowship program in palliative care is offered to fellows.
  

Eligibility

Trainees must have completed an ACGME accredited residency-training program in Internal Medicine, Family Practice, Neurology, Physical Medicine & Rehabilitation, Anesthesiology, or other qualifying specialties. Physicians who have completed Oncology or Geriatric Fellowships are also eligible. Applicants must successfully complete each step/part/level of USMLE within three attempts.

Suitable candidates should be highly motivated for a career in palliative medicine, be enthusiastic, and interested in academic inquiry. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, age, handicap, sexual orientation or veteran status.

How to Apply

Applications are only accepted through Electronic Residency Application System (ERAS) for the July cycle and utilizes the NRMP Match to fill all positions. Interviews will begin in mid-September and continue through October. All applications will be reviewed and ranked by November in preparation for the December match.

Required documents for all applicants:

• Curricula vitae
• Personal statement
• USMLE or COMLEX transcript
• (3) Letters of recommendation
• (1) Letter of recommendation from your program director
• Medical school transcript
• Photograph (optional)