Clinical Training

The unparalleled clinical component of the Hospice & Palliative Medicine Fellowship Training Program includes the following experiences:

• Inpatient care
• Pediatric care
• Hospice home care
• Ambulatory care

Caring for Patients from Diverse Socioeconomic and Cultural Backgrounds

The Cleveland area is home to multiple different ethnic groups and University Hospitals serves this population. UH Cleveland Medical Center created a comprehensive program to ensure the well-being our entire community – from the homeless to LGBTQIA+ to executives. The program cares for a diverse array of conditions including transplants, LVAD, COVID19+, advanced cancers, and end of life care.

Inpatient Service with Acute Care

The fellow will participate with an inpatient consultation team at UH Cleveland Medical Center and UH Seidman Cancer Center, both located in an urban setting. UH Cleveland Medical Center offers:

• A comprehensive heart failure program including an active LVAD, ECMO and heart transplant program
• A wide range of consultants including heart failure and cancer pain management
• A large training program including around 900 trainees at different levels

Initially, the fellow will be supervised by the attending physician for all new patient encounters. Over time, the fellow will become increasingly independent: leading family meetings and initiating orders for symptom management. The fellow also collaborates with nurses, social workers, pastoral care staff, and other staff to implement team recommendations. The fellow will maintain contact with the patient's referring physician as well as the patient’s caregiver or patient support system. Fellows will present their patients at our IDT meetings and may follow discharged patients at clinic or hospice home visits when the disposition makes that an option.

In addition, fellows will also have four weeks of inpatient experience at a dedicated David Simpson Hospice at Hospice of the Western Reserve.

Providing Care to Pediatric Patients

Fellows will have a dedicated 2-week pediatric palliative medicine rotation at UH Rainbow Babies & Children’s Hospital, supervised by hospice and palliative medicine (HPM)-board certified pediatricians. The fellow will be an active member of the Pediatric Palliative Medicine interdisciplinary team which provides primary and consultative symptom management and a full range of palliative services to children with a wide range of life-limiting or life-threatening conditions or advanced chronic illness.

Within this pediatric patient population, palliative consultation is provided at any age (prenatal to adult) and at any stage of illness (potential recovery to end of life). This pediatric-focused palliative care experience includes pain and symptom management with pediatric dosing, communication skills with children and families, advance care planning for minors, ethical and social issues in pediatrics, grief and bereavement issues, spiritual care for children/families, complex care coordination and perinatal palliative care.

The fellow will see patients in a variety of inpatient and outpatient settings, and will have exposure to caring for pediatric patients enrolled with Hospice of the Western Reserve, with a dedicated pediatric team. Under the supervision of the pediatric palliative medicine physician, the fellow will attend hospice Interdisciplinary Team (IDT) meetings during hospice blocks of rotations and may attend home visits and hospice inpatient visits when available during pediatric block rotation. The fellow may do additional elective rotation in pediatric palliative medicine, if desired.

Hospice Home Care

The fellow will work with Hospice of the Western Reserve for inpatient, home care, and long-term care hospice experiences. Hospice of the Western Reserve was established in 1978 and is Medicare Certified and accredited by the JHACO. Fellows will participate in home visits under supervision of the hospice medical director. As they gain more experience, they do home visits independently. Faculty are available to answer questions, debrief, and review care plans. There will be visits to assisted living facilities, extended care facilities and homes in urban setting. Fellows will participate in formal IDT team meetings and participate in both certification and recertification of hospice eligibility in collaboration with the medical director and will develop a plan of care.

Ambulatory Care

Our program designate a protected "outpatient day" for 10 months of the year for fellows to maximize continuity with clinic patients and to enhance feedback and teaching from faculty. This helps to avoid conflict between same day inpatient rotations and outpatient obligations. The fellow will see patients in outpatient palliative care settings with an attending and will assist with care coordination.

In the outpatient palliative medicine clinic, fellows will have the opportunity to see 1-2 new patients and longitudinal follow-up care for 2-4 patients. The fellows are supervised directly by the attending faculty. Additional ambulatory experiences in various subspecialty clinics will be available during electives.