Harvard Medical SchoolCenter for Palliative Care

Mission

The Harvard Medical School Center for Palliative Care (HMS CPC) aims to ease suffering and enhance the quality of care for patients and their families dealing with life-threatening and/or serious illness, through fostering leadership and supporting outstanding educational programs in palliative care. By educating future generations of physicians, nurses, and other health care professionals, the Center serves as a national and international resource for the best practices in palliative care education and practice.

Mission

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Harvard Palliative Care Fellowship

The Harvard Palliative Care Fellowship is devoted to training leaders in academic Palliative Care. This one-year interprofessional program offers a diverse clinical experience at Massachusetts General Hospital (MGH), Dana-Farber Cancer Institute (DFCI), Brigham and Women's Hospital (BWH), Boston Children's Hospital (BCH), Hospice of the North Shore and Greater Boston (HNS) and Merrimack Valley Hospice (MVH).

Educational Mission Program Structure Curriculum Clinical Training Sites Application Process Program Leadership

Educational Mission

The Harvard Palliative Care Fellowship Program aims to establish a standard of excellence in the field of palliative care training with specific emphasis placed on comprehensive, interdisciplinary end-of-life care. Our goal is to train clinicians in the interdisciplinary care of patients with serious illness and their families.

We offer an extensive clinical, psychosocial, and communication curriculum taught by experienced and committed clinician-educators. Fellows train with interdisciplinary teams and acquire skills in the comprehensive care of patients seen in diverse inpatient, outpatient, and home settings. We also offer extensive training in a pedagogical approach to teaching palliative care. We feel privileged to work in such a rewarding field and are eager to share this experience with others. Our commitment to self-care is stressed through role modeling, primary mentor assignments, and a yearly day-long retreat. The faculty is committed to the professional and personal growth of each trainee.

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Program Structure

Adult Medicine Fellowship

The program is accredited by the ACGME and the American Board of Hospice and Palliative Medicine. Physician fellows spend their first inpatient consult rotation at MGH or DFCI/BWH and then rotate throughout the year for a total of 4 months at each site. The fellowship consists of the following rotations:

Rotation Institution(s) Time
Inpatient consultation MGH/BWH 8 months
Inpatient Palliative Care Unit BWH 3 weeks
Hospice rotation
Personal/rental car required
HNS 8 weeks
Pediatric palliative care BCH 2 weeks
Psycho-oncology BWH/DFCI 2 weeks
Elective   4 weeks
Vacation   4 weeks
Outpatient clinic MGH/DFCI Biweekly half a day session

Pediatric Medicine Fellowship

The pediatric fellowship is based at BCH and DFCI and consists of the following rotations:

Rotation Institution(s) Time
Inpatient consultation BCH 8 months
Hospice rotation
Personal/rental car required
HNS 8 weeks
Inpatient Palliative Care Unit BWH 2 weeks
Pediatric Psycho-oncology DFCI and BCH 2 weeks
Outpatient clinic BCH, DFCI, and home visits Biweekly half a day session
Elective   4 weeks
Vacation   4 weeks

Adult Nurse Practitioner Fellowship

The adult nurse practitioner fellowships are site specific and consist of the following rotations:

Rotation Institution(s) Time
Inpatient consultation MGH or BWH Maximum 8 months
Hospice rotation
Personal/rental car required
MVH or HNS Maximum 2 months
Outpatient clinic MGH or DFCI Site specific, minimum 3-8 weeks
Elective MGH or BWH Site specific, minimum 3 weeks total
Vacation MGH or BWH Site specific per Department of Nursing Policy

Pediatric Nurse Practitioner Fellowship

The pediatric nurse practitioner fellowship consists of the following rotations:

Rotation Institution(s) Time
Inpatient consultation BCH Maximum 8 months
Hospice/Chronic Care rotation
Personal/rental car required
Chronic care facility/hospice Maximum 2 weeks
Outpatient clinic BCH/DFCI Site specific, minimum 3 weeks total
Elective BCH/DFCI Site specific, minimum 4 weeks total
Vacation BCH/DFCI Site specific per Department of Nursing Policy

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Curriculum

The fellowship offers a well-developed curriculum taught by faculty from many disciplines. The year begins with intensive summer lectures that focus on the fundamentals of palliative care and includes weekly half-day sessions on the following topics: approach to palliative care consultation, care of the imminently dying patient, talking about resuscitation status, working with an interdisciplinary team, and symptom management. Beginning in September, fellows meet monthly for a half-day session. These half-days include a faculty case conference, a fellow teaching session, participation in a Balint group where applicable, and a communication session. Fellows are offered mentorship for their teaching session, which is an opportunity for fellows to develop curricular material and receive feedback on their teaching. The communication curriculum has been developed and refined over the past eight years and emphasizes a cognitive approach to communication taught with demonstrations and interactive role play. In addition to the fellowship curriculum, the program also offers year-long educational opportunities such as weekly palliative care grand rounds, as well as site specific sessions such as pain rounds and psycho-oncology grand rounds. For additional curricular information, please see our fellowship website.

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Clinical Training Sites

Massachusetts General Hospital (MGH)

One of the oldest programs in the country, the MGH palliative care service has been providing inpatient consultation since 1996. Fellows spend up to 4 months on the inpatient consult service and in the outpatient clinic. Consults involve assisting with goals-of-care discussions and advanced care planning, as well as providing expert symptom management associated with advanced disease processes. Over one-half of the patients have a cancer diagnosis, and a substantial minority has primary cardiac, renal, pulmonary, or neurological problems. Fellows therefore learn to care for a diverse group of patients and become expert in understanding and forecasting disease trajectories for a wide range of illnesses. This diversity is further enhanced through the inpatient hospice program, where fellows care for symptomatic hospice patients admitted directly to MGH.

Brigham and Women's Hospital and Dana-Farber Cancer Institute

The adult palliative care service at BWH/DFCI, has been providing consultation services since 2001. Fellows spend approximately4 months caring for patients on the inpatient consult service and in the outpatient oncology palliative clinic at DFCI. Fellows also spend time caring for patients on the Inpatient Palliative Care Unit at BWH. The majority of consults are done for patients with cancer, who often require complex symptom management during all phases of illness, from diagnosis to death. Simultaneous attention is given to these patients' and family members' challenging psychosocial and spiritual concerns. The team also provides services for an increasing number of BWH inpatients with advanced life-limiting diseases other than cancer and in particular, has a strong relationship with the Division of Cardiology. Many of these consults focus on goals of care, comfort for patients at the end of life, and providing support for the medical and nursing teams.

Boston Children's Hospital and Dana-Farber Cancer Institute

Fellows work with the interdisciplinary Pediatric Palliative Care team/Pediatric Advanced Care Team (PACT) at the Boston Children's Hospital and Dana-Farber Cancer Institute to gain exposure to the care of pediatric patients with life threatening illness. PACT is one of the oldest pediatric palliative care programs in North America. The fellowship is focused on advanced pediatric pain and symptom management, decision making, and quality of life concerns in both the inpatient and outpatient settings. The trainee will become familiar with comprehensive, interdisciplinary evaluation and management of children with diverse advanced illnesses and their families. Additional information can be found on the BCH pediatric palliative medicine website.

Home Care and Hospice

Fellows will gain experience caring for patients in the home while completing an 8-week rotation with Hospice of the North Shore and Greater Boston or at Merrimack Valley Hospice. During this time, fellows participate in interdisciplinary team meetings and begin to learn the skills required to be a hospice medical director. Fellows who spend time with Hospice of the North Shore and Greater Boston will also care for patients at the Kaplan House, a free-standing inpatient hospice facility. Fellows training at Merrimack Valley Hospice will care for hospice inpatients at the Merrimack Valley Hospice House.

Psycho-oncology at the Brigham and Women's Hospital and Dana-Farber Cancer Institute

Fellows spend 2 weeks rotating with the psycho-oncology team at DFCI to refine their psychological assessment skills and develop a better sense of patients who may benefit from referral to this specialized service.

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Application Process for Physicians

Applications are accepted through the Electronic Residency Application service (ERAS) http://www.aamc.org/students/eras/.

Program Requirements

Applicants must meet the following criteria:

  • Have completed an ACGME accredited residency program.
  • Applicants for the adult fellowship must be board certified in Internal Medicine or Family Medicine or board eligible with demonstration of active pursuit of certification.
  • Applicants for the pediatric fellowship must be board certified in Pediatrics or board eligible with demonstrations of active pursuit of certification.
  • Applicants from residency programs other than Internal Medicine, Family Medicine, or Pediatrics need to have completed an intern year in Internal Medicine and admission will be at the discretion of the fellowship director.

Application Requirements

  1. Curriculum Vitae
  2. A personal statement describing the applicant's interest in and commitment to an academic career in palliative care.
  3. Three letters of recommendation, one of which should be from the applicant's department head, program director, or division chief.

Timeline

The program will download and review applications from ERAS starting December 1. Interviews will be scheduled in January and February. The Harvard Palliative Medicine Fellowship does not currently take part in a match but rather offers admission on a rolling basis.

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Application Process for Nurse Practitioners

Program Requirements

Applicants must meet the following criteria:

  • Masters of Nursing from an accredited program.
  • Licensed or eligible for license in MA as an advanced practice nurse.
  • For Adult Applicant: Certification in one of the following populations: Adult/Geriatric Primary Care, Adult Acute Care, or Family.
  • For Pediatric Applicant: Certification in one of the following populations: Pediatric Primary Care, Pediatric Acute Care, or Family.
  • Applicant must have the authority to prescribe controlled substances to adults.

Application Requirements

  1. Curriculum Vitae
  2. Transcript from graduate school
  3. A personal statement describing the applicant's interest in palliative care and commitment to advancing palliative care in the nursing field.
  4. Three letters of recommendation.

Timeline

Applications to MGH are to be sent electronically to Todd Hultman, PhD, ACNP, ACHPN at thultman@partners.org. The application process opens January 1 and closes February 28 for the upcoming academic year that begins July 1.

Applicants interested in the BWH/DFCI nurse practitioner fellowship should apply online. Additional application materials required for the BWH/DFCI nurse practitionerfellowship, including including transcript, personal statement, and 3 letters of recommendation, should be sent electronically to Ashley Lewis at alewis4@partners.org. The application process opens in February for the upcoming academic year that begins July 1.

Applications to BCH/DFCI Pediatric Fellowship are to be sent electronically or by mail to Marcie Brostoff, MSN, Staff Development, 300 Longwood Ave. Boston, MA 02215 or marcie.brostoff@childrens.harvard.edu. The application process opens January 1 and closes February 1 (please note earlier deadline than above) for the upcoming academic year that begins July 1.

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Program Leadership

Juliet Jacobsen, MD
Director
Harvard Palliative Medicine Fellowship
c/o James F. Fitzgerald
Fellowship and Education Coordinator
Massachusetts General Hospital
Palliative Care Service
165 Cambridge Street, Suite 304
Boston, MA 02114
Telephone: (617) 724-9509
Fax: (617) 643-6722
Email: jffitzgerald@partners.org

Jane deLima Thomas, MD
Associate Director
Harvard Palliative Medicine Fellowship
Dana-Farber Cancer Institute
450 Brookline Avenue
Boston, MA 02215
617-632-6464

Joanne Wolfe, MD, MPH
Site Director, Boston Children's Hospital
Harvard Palliative Medicine Fellowship
Dana-Farber Cancer Institute
450 Brookline Avenue
Boston, MA 02215
617-632-5286

Todd Hultman, PhD, ACNP, ACHPN
Director of the MGH APN Fellowship
55 Fruit Street, Founders 600
Boston, MA 02114
thultman@partners.org

Katie Fitzgerald, APN, ACHPN
Director of DFCI/BWH APN Fellowship
450 Brookline Avenue
Boston, MA 02215
kfjones@partners.org

Janet Duncan, MSN, CPNP
Nursing Director, Pediatric Advanced Care Team
450 Brookline Avenue
Boston, MA 02215
jduncan2@partners.org
617-582-7442

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