Hospice and Palliative Medicine Fellowship Program

Division of Hematology and Oncology

Andrew Putnam, M.D., Program Director

Program Contact

Adrian Hameed, Fellowship Program Coordinator
Hospice & Palliative Medicine Fellowship Program
Georgetown University Hospital
Lombardi Comprehensive Cancer Center, Podium B
3800 Reservoir Rd NW
Washington, DC 20007

(202) 444-7036 office
(202) 444-7046 fax
email: AH@gunet.georgetown.edu

Program Certification

The Palliative Care fellowship program was first offered at Georgetown University during the 1999-2000 academic year and has the approval of our institutional Graduate Medical Education Committee. Beginning in 2010-2011 academic year, accreditation was granted by the Accreditation Council of Graduate Medical Education (ACGME).

Program Duration

The length of the training program is currently structured as a one-year graduate medical education experience.

Program Prerequisites

The Hospice and Palliative Medicine fellowship program is offered at Georgetown University hospital to a physician who has completed an accredited three-year training program in a primary care specialty. It is administered by the Division of Hematology/Oncology, which also provides an ACGME-accredited residency education (fellowship) program in the sub-specialty of Hematology-Oncology under the aegis of our parent accredited residency program in Internal Medicine. 

Board Certification

ABHPM had discontinued its certification program after 2006 and a new certification exam administered by ABMS started in 2008. Starting in 2013, only applicants who have completed an ACGME-accredited hospice and palliative medicine fellowship will be eligible to take the certification exam.

It is expected that graduates of this fellowship program will sit for the HPM certification exam, which occurs once every 2 years.

Goals and Objectives

The overall goal of the Hospice and Palliative Medicine Fellowship Program is to provide training and experience that is sufficient to enable the physician fellow to acquire the competency of a clinical specialist in Hospice and Palliative care. Goals are based on the competencies required by ACGME in a quality program are fulfilled by the experiences offered to fellows at each rotation. Competencies include: Patient & Family Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice.

Toward this end, the curriculum will seek to provide fellows with attitudes, knowledge and skills that will result in them being able to meet the following objectives:

  • Comprehensively assess complex medical problems related to severe medical illness.
  • Comprehensively assess symptoms and distress in patients and families.
  • Apply basic communication skills in the setting of advanced disease (including among others, those skills related to breaking bad news, working with patients and families to establish goals of care, working within an interdisciplinary team, providing care in a diverse multicultural environment, and addressing conflict in the setting of patient, family and team interactions).
  • Explain the basic physiologic processes associated with common physical symptoms, including, among many others pain, fatigue, and nausea.
  • Describe and apply an array of strategies to assist with the alleviation of physical and psychological distress (including, among other strategies, pain and symptom management, psychological support, referring patients for support or care delivered by interdisciplinary team members).
  • Provide care for, and appropriately refer, patients with psychiatric co-morbidities associated with advanced illness.
  • Define and implement strategies to address the practical needs of patients and families living with advanced illness.
  • Discuss, identify and, where appropriate, implement a variety of approaches to the cultural, ethical and legal concerns that commonly exist within the contest of advanced illness in a diverse and multicultural environment.
  • Explain the function of the interdisciplinary team approach to care and the respective roles of individual team members and demonstrate an ability to work within that context.
  • Discuss, identify and, where appropriate, implement a variety of approaches to promote well-being for patients and families/caregivers living with advanced illness.
  • Describe, appropriately refer to, and work in effective collaboration with a variety of community-based “care systems” to provide care for patients who are nearing the end of life (hospice care, home nursing programs, nursing home facilities etc).
  • Comprehensively assess, and coordinate and provide care for the imminently dying patient.
  • Describe the natural history of bereavement and the array of bereavement interventions that can be directed towards assisting families and care givers, and provide support and appropriate referral during the bereavement process.
  • Demonstrate an ability to function as a consultant
  • Demonstrate an ability to teach the basic principles of palliative care.
  • Implement and follow through on quality improvement activities, describe approaches to fostering institutional change in relation to palliative care, and describe effective approaches to outcomes assessment in palliative medicine.
  • Demonstrate a basic understanding of research methodologies related to palliative medicine by formulating an accurate interpretation of the literature in the field.
  • Describe the national and international issues that interface with the optimal delivery of palliative care (attitudinal, economic, regulatory, legal, ethical etc).
  • Reach a level of knowledge that enables achievement of a “pass” in the America Board of Hospice and Palliative Medicine Examination.

Resources

Current Teaching Staff

  • Andrew Putnam MD, Program Director, Georgetown University Hospital
  • Margot G. Wheeler, Assistant Professor, Georgetown University Hospital
  • Cynthia Williams, DO, Medical Director, Washington Home & Community Hospices
  • Joanne Assarsson, LCSW, Social Work, Lombardi Comprehensive Cancer Center
  • Leonard Ellentuck, LCSW, Social Work, Lombardi Comprehensive Cancer Center
  • Cheryl Hughes, MSW, Social Work, Lombardi Comprehensive Cancer Center
  • Sara Moore, MA, Chaplain for Adult Oncology, Georgetown University Hospital
  • Kimberly Davis, PhD, Assistant Professor of Psychology, Georgetown University School of Medicine

Facililities

  • Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC
  • The Lombardi Comprehensive Cancer Center at Georgetown University. The Cancer Center received its designation of “Comprehensive” in 1990 by meeting strict research, clinical trials and community outreach criteria. In 2003, Lombardi’s comprehensive cancer center status was renewed by the National Cancer Institute
  • Washington Home and Hospice, 3720 Upton Street, NW, Washington, DC

Educational Program

Clinical Components

The fellowship program consists of an initial year of clinical palliative medicine with training occurring in a variety of environments including acute inpatient and outpatient care at Georgetown University Hospital and the Lombardi Comprehensive Cancer Center, and hospice care at the Washington Home and Hospice. The palliative care program at Georgetown fosters an interdisciplinary approach to patient care around all patient and family interactions. The interdisciplinary team around each patient consists of the primary team attending, a palliative medicine attending physician and fellow, as well as nursing, social work, and discharge planning. In addition, if requested by the patient or by the core staff of the interdisciplinary team, the team is expanded to include representatives from Pastoral Care, Physical Medicine and Rehabilitation, Nutrition, Psychiatry, hospice liaisons, and other staff. The patient population represents a broad range of diagnoses and palliative care needs of adults and children with advanced clinical conditions.

Research/Scholarly Project

Fellows are expected to develop at least one academic/scholarly project during the year. Projects may involve participation in research (e.g. quality improvement projects, clinical research), program development, collaboration in paper writing (e.g. case reports, review articles, book chapters), and education (e.g. teaching, curriculum development). Quarterly seminars on research, quality improvement, and scholarly projects are held to advance the fellows’ knowledge of the basic principles of clinical research, including how such research is conducted, evaluated, explained to patients, and applied to patient care.

Supervisory and Patient Care Responsibilities

Fellows have opportunities to observe and manage patients with a wide variety of conditions on an inpatient and outpatient basis and in the home care setting. Initially with close supervision by the attending Palliative Medicine physician, and later with increasing autonomy, the fellow assumes responsibility for acutely and chronically ill patients receiving palliative care.

  • Inpatient Care: Georgetown University Hospital is a 609-bed tertiary care clinical facility. The Palliative Care fellow may work with a number of services on rounds including Medicine, Neurology, Psychiatry, Pediatrics and Clinical Bioethics. Throughout the year, the fellow increasingly assumes responsibility for planning the patient’s discharge to ensure that proper support is in place for the patient and family.
  • Outpatient Care: The fellow and Palliative Medicine attending may see patients on a one-time basis to address a particular problem, or on an ongoing basis to treat complex symptoms and to provide consistent support to the patient and family during various stages of illness.
  • Hospice Home Care and Long-Term Care: While on rotation at the Washington Home and Community Hospices, the fellow participate in patient/family care planning with members or the hospice interdisciplinary team and provide continuity of care for patients referred from Georgetown University Hospital.

Procedural Requirements

The Palliative Medicine fellow participates with the attending as an active participant in the Program’s clinical service, attends daily meetings of the interdisciplinary palliative team, and provides care for inpatients and ambulatory outpatients at Georgetown University Hospital and patients who are homebound or reside in nursing homes with Washington Home & Community Hospices. The fellow teaches medical students and residents about palliative care topics and receives mentoring from attending physicians in palliative care.

Didactic Components

The curriculum is organized around the set of competency-based goals and objectives developed by the hospice and palliative medicine community and presented on the ACGME website as “Companion Document: Core Competencies for Hospice and Palliative Medicine Fellowship Training.” These objectives are provided to the fellow at the beginning of fellowship and are reviewed as appropriate throughout the academic year.

Conferences and didactic workshops include:

  • Tuesday/Fridays, weekly (9:30-10:30am): Palliative Care Interdisciplinary Team meeting at Georgetown University Hospital - A meeting with interdisciplinary team members to review the acute issues involved in caring for each of the patients on the team.
  • Thursday, weekly (9-10am): Fellows’ Didactic Lecture Series / Research & Scholarly Project Meetings – This educational lecture series reviews basic topics in palliative care including pain and symptom management, communication skills, ethics, and research methodologies.
  • Thursday, weekly (8-9 am) – Department of Medicine Grand Rounds features speakers with nationally recognized expertise presenting a variety of topics.
  • Monday, monthly (12-1pm): Palliative Care Challenging Case Conference – Open to all staff (including nursing, chaplaincy, social work) and trainees, specific cases from the inpatient service are selected to highlight challenging palliative care issues.
  • Friday, monthly (12-1pm): Palliative Care Forum – Also open to all staff (including nursing, chaplaincy, social work) and trainees, this is a lecture series directed towards the management of common symptoms and end-of-life concerns of patients and families.
  • Fridays, monthly (8:30-9:30am): City-wide Hospice & Palliative Medicine Journal Club – Physicians and fellows review original articles from the literature in a city-wide sponsored teleconferenced journal club sponsored by Capital Caring.
  • Wednesday, quarterly (6-8pm): City-wide DC Pediatric Palliative Care Collaboration Grand Rounds – Prominent practitioners in the field of pediatric palliative care are invited to speak at this multi-disciplinary conference.

Progression in Responsibilities

At the beginning of the academic year, the fellowship director and other faculty work closely with the Palliative Care fellow to help him or her acquire needed clinical skills pertaining to the physical, psychological and spiritual suffering of patients and families faced with life-limiting conditions. As the year progresses, the fellow begins to assume an active teaching role in this regard with members of the Palliative Care team, including medical students and internal medicine residents. This may include helping team members prepare for patient presentations to the team leader, involving them in literature searches on palliative care topics, or assisting team members in communication with the patient and family. Throughout the year, the fellow assumes increasing responsibility for assisting patients and families with their medical decision-making. At the conclusion of the fellowship, the fellow should have the knowledge and skills to function independently and competently as a Palliative Care specialist.