Hospice & Palliative Medicine Educational Curriculum

The core topics consist of lecture- and discussion-based didactics that are curated to prepare fellows for board certification according to the latest ABIM exam content blueprint. In the latter half of the year, we invite subspecialty experts and field leaders across HMS and other institutions, to give our fellows a state-of-the-art overview of palliative care integration in varied disease states and health systems. Fellows will also attend Harvard Medical School-wide clinical case presentations and Grand Rounds lectures.

Topics Covered

The Serious Illness Communication curriculum occurs monthly, incorporating a blend of lecture-, discussion-, and roleplay-based skills practice. Fellows begin the year by learning communication skills that are foundational to the practice of hospice and palliative medicine. As they hone their skills through clinical practice, the curriculum shifts toward advanced techniques, including how to debrief challenging situations and how to teach serious illness communication. Fellows also participate in Powered by VitalTalk workshops, which are taught by trained VitalTalk faculty facilitators drawn from our program’s faculty and faculty across Harvard Medical School.

Topics Covered

Serious Illness Communication 1 (Consult Etiquette)
Serious Illness Communication 2 (Responding to Emotion)
Serious Illness Communication 3 (Building Prognostic Awareness)
Serious Illness Communication 4 (Mapping Goals and Values)
Serious Illness Communication 5 (Making Recommendations and Discussing Dying)
Serious Illness Communication 6 (Discussing Prognostic Uncertainty)
Serious Illness Communication 7 (Fostering Hope)
Serious Illness Communication 8 (When Open-ended Questions and Empathic Statements Don't Work)
Serious Illness Communication 9 (Talking about Miracles)
Serious Illness Communication 10 (Communicating with Hesitant Patients)
Serious Illness Communication 11 (Responding to Trauma and Distress)
Serious Illness Communication 12 (Re-Thinking Advance Care Planning)
GeriTalk/OncoTalk (Powered by VitalTalk workshops with interdisciplinary learners)

Once a month, fellows will join the learning community of the HMS Multicampus Geriatric Medicine fellowship for a half-day of joint didactics. Fellows will learn from leading experts in gerontology and aging research, including topics in Medical Education, fellow-led cases in Clinical Reasoning, and fellow-presented seminars on specialty topics related to aging and palliative care.

Medical education is an institutional focus at BIDMC. Upon graduation, our goal is for fellows to be ready to teach hospice and palliative care skills to the next generation of healthcare professionals. Fellows receive graduated independence during the year, culminating in a “pre-attending” experience during their final month of inpatient palliative care consultation at BIDMC, when fellows will precept a junior learner and receive faculty guidance and feedback on their teaching.

Fellows will learn and refine pedagogical techniques through topics covered in the Geriatrics Co-Curriculum, and will have multiple opportunities to participate in mentored teaching experiences, including in developing lectures and precepting established communication skills workshops for undergraduate and graduate medical learners at BIDMC and Harvard Medical School. Motivated fellows may also consider additional training opportunities in medical education through BIDMC and through the Boston VA.

The field of hospice and palliative medicine needs graduates who can improve serious illness care by leading team operations and generating substantive change within healthcare systems. We prepare our fellows for this crucial work through a longitudinal curriculum in Quality Improvement and Patient Safety, which will teach fellows about the principles and frameworks used in healthcare quality and safety assessment, analysis, and intervention.

Fellows participate in a mentored group project (either ongoing or new), and will be encouraged to submit appropriate projects to national meetings such as the AAHPM Annual Assembly, and local conferences such as the annual Silverman Symposium, which showcases quality improvement work across BIDMC.

Topics Covered

Quality Improvement 1 (Introduction to the Course)
Quality Improvement 2 (Forming a Project Team)
Quality Improvement 3 (Understanding the Problem)
Quality Improvement 4 (Designing an Intervention)
Quality Improvement 5 (Studying the Results)
Quality Improvement 6 (End-of-Year Presentation)
Patient Safety 1 (Introduction to Patient Safety)
Patient Safety 2 (Event Analysis Workshop)

Fellows will practice evaluating the hospice and palliative medicine literature by presenting at regular Journal Clubs at both BIDMC and the Boston VA. Interested fellows can be connected with research mentors to participate in ongoing clinical research projects at BIDMC and the Boston VA. At BIDMC, the Section of Palliative Care is housed in the same Division as the Section of General Medicine Research, which includes leading researchers in aging, end-of-life care, and delirium. These researchers have mentored many fellows and junior faculty into successful clinician-investigators. Motivated fellows can also consider applying for the General Medicine Research fellowship after completion of their fellowship year.

As we prepare graduates to become educators, leaders, and changemakers in serious illness care, it is crucial that our fellows learn to view the field through an equity lens, and walk away from their training year with concrete frameworks, language, and skills needed to advocate for health care equity. As part of this curricular thread, fellows will participate in discussion sessions, self-reflective exercises, and invited lectures that highlight serious current disparities and ongoing equity work in hospice and palliative care. Fellows are also invited to participate in the Social Justice Curriculum developed by leaders within the Department of Medicine, for BIDMC's wider GME community (schedule varies year-to-year).

Example Topics

• Structural Competency
• Bias in Palliative Care
• Clinical Outcomes and Research Disparities in Palliative Care
• Caring for Persons with Substance Use Disorder
• Trauma-Informed Hospice and Palliative Care
• Words Matter: Bias and Documentation in Palliative Care
• Serious Illness Communication Across Languages / Role of Medical Interpretation
• Serious Illness Care for LGBTQIA+ Persons
• Serious Illness Care for Persons Experiencing Incarceration
• Principles of Community-Based Participatory Research

Care for the Caregiver is a biweekly event which formalizes our program’s commitment to caring for ourselves and our colleagues, and building a community of support within the fellowship – the same commitments that we make to the wider healthcare system as we become HPM practitioners. This includes fellows-only sessions to process and reflect on the training experience with guidance from a chaplain or clinical psychologist, and monthly sessions shared by fellows and program leaders, where we engage in exercises around self-care, reflective listening, and personal and professional identity formation.