Curriculum

The curriculum of the Midwest Hospice and Palliative Medicine Integrated Fellowship ensures that fellows achieve the cognitive knowledge, interpersonal skills, professional attitudes and behaviors as well as the practical experience required of a physician in the care of patients with advanced chronic and terminal illnesses.

Written goals and objectives and a method of evaluation have been developed for each educational experience. Evaluation of the fellows includes behavioral as well as cognitive skills.

The curriculum contains the following content and skill areas:

1. Epidemiology and natural history of common chronic diseases, including cancer, HIV disease, cerebrovascular disease, dementia, heart disease, lung disease, liver disease and kidney disease, etc.
2. Whole-person assessment, including physical, cognitive, functional, social, psychological and spiritual domains, using appropriate history, physical examination and laboratory evaluation.
3. Coordination with, appreciation of and ability to work collaboratively with multiple health professionals, including physicians, nurses, social workers, dietitians, chaplains, counselors and therapists to assess and implement management decisions.
4. Management of pain and non-pain symptoms in patients with progressive chronic diseases and near the end of life. These principles include those related to the use of various pharmacologic and non-pharmacologic modalities, environmental modification, patient and family education, and psychosocial and spiritual support.
5. Psychosocial and spiritual care of patients with progressive chronic illness. The management of practical concerns, including but not limited to housing, care at home without a primary caregiver and equipment needs. Evaluation of depression, anxiety, loneliness, bereavement needs for patient and family, aspects of self-directed life closure, need for resolution and reconciliation and potential growth at the end of life, anger, fear, emotional concerns and spiritual anger. Assessment of quality of life will be included.
6. Managing emergent conditions, the process of dying, the terminal event and terminal agitation or delirium. Managing patient and family issues surrounding end-of-life care, including bereavement, funeral planning, organ donation and terminal symptom control.
7. Economic aspects of care, availability of supporting services, Medicare and the Medicare Hospice Benefit, Medicaid and the Medicaid Hospice Benefit, managed care and cost containment. Administrative aspects in the role of the medical director are included.
8. Ethical and legal issues, including but not limited to those pertinent to adults and geriatric populations, such as limitation of treatment, competency, guardianship, right to refuse treatment, advance directives, wills, durable power of attorney for healthcare, physician-assisted suicide and futility.
9. Cultural and ethnic issues and aspects of care provided to patients with advanced chronic or terminal disease and their families. Healthcare disparities and access to healthcare relating to urban and rural persons of various ethnic backgrounds will be covered.
10. Communication skills with patients, families, professional colleagues and community groups. Fellows will demonstrate effective communication techniques and appropriate utilization of medical interpreters with patients and families who do not speak English.
11. Use of technology in end-of-life care (e.g., non-oral feeding, radiation).
12. Consultation skills.
13. Research methodologies related to palliative medicine, including biostatistics, clinical epidemiology, information sciences, decision analysis, critical literature review and research design, including cross-sectional and longitudinal methods.
14. Quality improvement related to palliative care.