Program Structure

• Site: Lieutenant Colonel Charles S. Kettles VA Medical Center for adult HPM fellows; C.S. Mott Children’s Hospital for pediatric HPM fellows
• Goals: Improve knowledge and skills in providing palliative care in the outpatient setting, partner with outpatient clinic interdisciplinary team.
• Duration: One half-day per week throughout the fellowship year

• Site: Arbor Hospice in Ann Arbor, MI
• Goals: Work with interdisciplinary hospice team, provide care to patients receiving home hospice services, understand hospice eligibility and certification, gain expertise in end-of-life care.
• Site Director: Joseph Dixon, MD
• Duration: Ten weeks for adult and pediatric HPM fellows

• Site: University Hospital (UH)
• Goals: Provide subspecialty palliative care consultation to adult inpatients which includes complex pain and symptom management, introduction to palliative care and hospice philosophies, provision of expert serious illness communication skills, and end-of-life care. Will directly manage two inpatient palliative care beds in partnership with members of the interdisciplinary team.
• Site Director: Laura M. Marsh, DO
• Duration: Three months for adult HPM fellows; one month for pediatric HPM fellows

 

• Site: C.S. Mott Children's Hospital
• Goals: Provide inpatient palliative care consultation to pediatric patients including complex pain and symptom management, advance care planning and values-guided decision support, introduction to palliative and hospice philosophies, care transitions, and end-of-life care.
• Site Director: D’Anna Saul, MD
• Duration: one month for adult HPM fellows; six months for pediatric HPM fellows 

• Site: Lieutenant Colonel Charles S. Kettles VA Medical Center
• Goals: Provide subspecialty palliative care consultation to adult inpatients in the acute care hospital and the VA extended care unit, which includes complex pain and symptom management, introduction to palliative care and hospice philosophies, provision of expert serious illness communication skills, and end-of-life care.
• Site Director: Ellen Hummel, MD
• Duration: Four months for adult HPM fellows; one month for pediatric HPM fellows

• Site/Faculty: Variable based on trainee interests
• Options: Elective rotations offered in but not limited to the following areas: Anesthesia/Pain, Cardiology, Clinical Ethics, Hematology & Oncology, Radiation Oncology, Physical Medicine & Rehabilitation, Psychiatry, Psychology. Individual electives are typically focused on trainee’s goals and may include a variety of experiences.
• Duration: One month for both adult and pediatric HPM fellows

• Core Topic Didactics: Just as the name implies these are core topics in Hospice and Palliative Medicine covered in the ACGME Hospice and Palliative Medicine Curricular Milestones.  These lectures cover a wide range of topics, including (but not limited to) symptom management; disease-specific palliative care delivery models; effective communication and conflict management; and psychosocial/grief support.
• Case Discussions/Journal Club: Fellows will prepare and summarize two HPM-relevant journal articles of personal interest based on cases they were personally involved in. Fellows then present the cases and article to their fellowship class and HPM faculty/staff and lead the discussion.
• Communication Training: Throughout the year, HPM fellows will engage in a variety of training activities aimed at improving the communication skills related to goals of care and advance care planning discussions. Adapted from the Vital Talk curriculum, this interdisciplinary approach to emotional communication skills provides HPM fellows with practical tips and techniques which can be utilized across clinical settings when addressing goals of care for patients with a serious disease. 
• Facilitated Peer-Networking Sessions: Once a month our fellows participate in a guided peer-support session, to allow for reflection and debriefing on the clinical work being done and support one another during their fellowship training. 
• Quality Improvement Curriculum: Under the guidance of Dr. Laura Taylor and other core faculty, HPM fellows will participate in a longitudinal QI-curriculum that consists of quarterly lectures and meetings to design and implement a QI project aimed at alleviating or resolving a identified QI-related patient issue. 

Fellows also have the opportunity to attend regional palliative care conferences as available. Furthermore, learners are provided with a stipend to attend the annual assembly of the American Academy of Hospice and Palliative Medicine (AAHPM).

Additional Monthly Research Seminars are also available for those interested.

In order to encourage and foster a life-long interest in learning and teaching, Hospice and Palliative Medicine (HPM) fellows are required to complete a scholarly activity during their fellowship. This project does not necessarily need to involve novel research, but can include development of an educational curriculum; completion of a draft of a HPM-related journal article; or presentation at a regional or national convention. 

HPM Fellows are provided with protected time to complete this scholarly activity, and meet with Dr. Victoria Powell to identify a project and mentor. At the end of the academic year, HPM fellows have the ability to present their scholarly activity to their co-fellows and HPM faculty/staff. 

Examples of past scholarly activities:

• Chargot, Jane - Voluntary Stopping of Eating and Drinking in the Terminally Ill
• Gunther, William - Buprenorphine for Chronic Pain in a Pediatric Patient with Sickle-Cell Disease
• Hills, Tracey - Truth Telling in Pediatric Patients: Challenges and Opportunities. Concurrent Session, AAHPM Annual Assembly, Houston TX
• Silbert, Sara - How Should We Determine the Value of CAR T-Cell Therapy? 
• Razavi Z, Zerfas I, Brazier LJ, Marks A - Pain in Heart Failure, Health Equity, and Healthcare Biases. AAHPM Annual Assembly, Montreal CA
• Tondo-Steele K, Uppal S, Marsh L, Denny R, Chen C, Taylor L - Triggered Inpatient Palliative Care Consultation (TIPCC) for Patients with Gynecologic Malignancy. AAHPM Annual Assembly, Montreal CA
• Russell AE, Silveira MJ - Suboxone Rotation: A Case of Improved Analgesia and Less Sedation. AAHPM Annual Assembly, Montreal CA

2nd & 3rd Year Fellowship Opportunities: VA Special Fellowship in Advanced Geriatrics

For physicians who have completed their year of palliative medicine fellowship training, geriatric medicine, or geriatric psychiatry, there is an opportunity for up to two additional years of academic training in palliative care. This opportunity is offered to fellows who are interested in an academic career with 75% of their time protected for research/scholarly activities.

The goal of this advanced fellowship is to develop outstanding academic and/or health care system leaders with vision and knowledge in geriatrics who are committed to leading the discipline in the 21st century.

This VA fellowship provides outstanding geriatric medicine, palliative medicine, or geriatric psychiatry research training, interdisciplinary educational opportunities, and advanced clinical and program administration learning opportunities.

Fellows have the flexibility to personalize the curriculum based on their interests, and can further their development toward careers as researchers, clinician educators, and/or medical directors.

Maria Silveira, MD, MPH, FAAHPM directs the Ann Arbor site for this program.

Send questions to the U-M Palliative Medicine Fellowship Program.

Medical Education Scholars Program

Fellows also have the opportunity to participate in the University of Michigan's Medical Education Scholars Program, a 10-month program designed to further develop the teaching and leadership skills necessary for a career as a clinician educator.