Fellows provide direct patient care during all rotations under the supervision of a teaching attending physician.

A. Clinical components consist of the following rotations:

• Ambulatory Palliative Care: 1/2 day per week for 11 months
  • Site: Comprehensive Cancer Center at Rhode Island Hospital
• Inpatient Palliative Care: 7 months
  • Adult Palliative Care: Rhode Island Hospital (4 months), Miriam Hospital (2.5 months)
  • Pediatric Palliative Care: Hasbro Children’s Hospital (2 weeks)
• Hospice: 3 months
  • Inpatient/Home/Long Term Care
  • Chaplaincy, Bereavement, Social Work
• Elective: 4 weeks of elective of fellow’s choice. International electives can be arranged and should be pre-approved by the program director. Multiple electives can be coordinated for the 1-month block.
• Flex: 3 weeks. Fellow’s choice of inpatient consults at RIH, inpatient consults at RIH or hospice. Scheduled during the second half of the year so that fellows can tailor their fellowship experience.
• Chaplaincy: fellows will spend 1 week with inpatient hospital chaplains
• Research: 4 weeks (3 one week blocks and weekly longitudinal sessions)
• Rotation Sites

Fellows have 4 weeks dedicated to completing a research project and submitting papers for publication. Fellows will have dedicated research didactics and mentoring throughout fellowship.

A. Orientation Lectures/Workshops:
Fellows will learn basic HPM symptom management and communication skills from core faculty members. Orientation will span several days during the first week of fellowship and will also include team-building activities.

B. Arts and Ethics in Palliative Care:
Arts and Ethics is a medical humanities course that was established as a required part of the fellowship curriculum in 2018. Fellows meet twice monthly with Arts and Ethics faculty leaders to explore the intersection between the humanities, ethics, and medicine with an emphasis on serious illness, death and dying. One monthly session will be in a small group format and will focus on critical reading of texts and/or ethical case discussions. Small group sessions will conclude with shared narrative reflection. Faculty leaders are also available to provide additional feedback on content and composition of narratives. The other monthly session will feature guest speakers representing various artistic disciplines. Fellows will also attend an interactive workshop designed especially for them at the RISD Museum.
https://risdmuseum.org

C. Division Lecture Series:
This half-day weekly conference with faculty and fellows of HPM, Geriatrics and Geri-Psych will cover the principals of palliative care, geriatrics and psychiatry. It will also cover topics such as research methodology, study design, and healthcare administration.

D. Balint Group:
Hospice and palliative care clinicians meet monthly to confidentially discuss difficult cases, to support one another and to better understand the patient-clinician relationship. This group is facilitated by a certified grief counselor.

E. Palliative Care Tumor Board:
Fellows meet with palliative care faculty, medical oncology, radiation oncology, interventional oncology, psychiatry, pediatric palliative care, and PM&R twice monthly to discuss the care and treatment plans of palliative care patients.

F. Journal Club:
HPM fellows and faculty meet monthly to discuss 1-2 articles relevant to hospice and palliative care from peer-reviewed general medicine or HPM journals.

G. Inpatient Team Meeting:
Faculty and fellows will meet every Wednesday morning for reflection, case discussion, and review of a relevant journal article.

H. Research Mentorship/Dedicated Research Time:
Fellows will meet weekly to discuss projects with research faculty. Fellows have the option of joining existing research projects, working with co-fellows on a group research project, or initiating an individual research project using the VA data set. Fellows have 4 non-clinical weeks dedicated to research endeavors which can be scheduled when convenient for their projects. No prior research experience is required.

I. Opioid and Advanced Symptom Management Workshop:
Fellows will meet with program leadership weekly to participate in an opioid and advanced symptom management curriculum.

J. Inpatient Didactics:
Fellows on inpatient consult months will meet twice weekly for inpatient didactic and role play sessions covering topics relevant to inpatient palliative care.

K. Pediatric HPM Lecture Series and Additional Pediatric Opportunities
Monthly lectures by members of the pediatric interdisciplinary team exploring the medical, psychosocial, and emotional aspects of caring for seriously ill children.

Fellows will also have opportunities to participate in pediatric palliative care home visits and pediatric hospice care while on their hospice rotation. Fellows with an interest in pediatrics will have opportunities to do additional pediatric palliative care and hospice work.

L. Hospice Regulations Meeting and Board Review:
This monthly meeting covers aspects of hospice administration and the Medicare Hospice Benefit and will provide fellows with the opportunity to learn the administrative responsibilities required of hospice medical directors. These sessions end with board review questions followed by discussion.

M. Brown Minority Housestaff Association (BMHA):
Fellows are invited to become members of BMHA which aims to promote the advancement of underrepresented housestaff. Mentoring is provided through BMHA faculty, the Office of Diversity and Multicultural Affairs, and the GME Department.
https://diversity.med.brown.edu/resources-information/trainees

N. Complex Care Conversations:
This physician-led training is an intensive 1-day course during the first month of fellowship that will focus on building communication skills, as well as bioethics and prognostication. This session also seeks to explore techniques for reducing burnout and compassion fatigue.  Fellows will have an additional opportunity to participate in this course towards the end of fellowship.
https://cme-learning.brown.edu/complexcare#group-tabs-node-course-default4

O. Camp Braveheart:
Two-day summer bereavement camp held at Camp Jori in Wakefield, RI to support children (ages 4-17) who have lost a loved one. Fellows will attend a planning session and will be excused from clinical duties to work as camp counselors.
HopeHospiceRI.org/CampBraveHeart

P. SurgTalk:
In collaboration with the general surgery department, fellows will lead didactics and small group role-play with surgery residents to teach communications skills. This series of four workshops in the second half of the academic year focuses on how to teach communication skills.

Q. HopeHealth Diversity, Equity and Inclusion Committee:
Fellows are encouraged to join the HopeHealth DEI committee to improve patient access and experience of hospice and palliative care, strengthen employee education and diversification, and address workplace culture and policy. Fellows are also encouraged to participate in a DEI committee subgroup to develop targeted interventions.

R. HopeHealth Diversity, Equity and Inclusion Discussion Group:
Fellows are encouraged to participate in the monthly DEI discussion group open to all HopeHealth employees. The group discusses books, essays, movies, TED talks, etc. about DEI topics and strives to facilitate discussion to promote open dialogue.

S. Bereavement Group:
The fellows will attend several bereavement groups during their hospice rotation. Bereavement groups include Loss of Spouse/Partner, Loss of Child, Loss of Parent, Children’s Grief Support, and Teen Grief Support.

T. End of Year Lecture Series:
Core faculty will teach advanced HPM topics in the second half of the academic year. Sessions will include topics such as program development and transitioning from learner to teacher.

U. Ethics Committee:
Fellows will participate in the Hospice Ethics Committee, a multidisciplinary group to discuss various ethical concerns related to hospice care. Fellows are also encouraged to join the hospital ethics committees if they are interested.

V. Department of Medicine Grand Rounds are held every Tuesday morning at RIH (also broadcast at TMH)

W. Morbidity and Mortality Conference is held every Wednesday morning at TMH

X. Schwartz Center Rounds are held several times per year at RIH, TMH and HopeHealth

Y. Additional Teaching Opportunities:
Fellows will regularly engage in teaching with Brown medical students and residents at various points throughout the year. Fellows are encouraged to partake in formal teaching (lectures, workshops) with other departments at Brown and within the medical school and can have protected time to participate in such endeavors. Fellows will also mentor students from Brown University Students for Hospice Volunteering (BUSH). Fellows will have the opportunity to partner with students from Rhode Island School of Design (RISD) to provide mentoring around palliative care for palliative care virtual reality projects.

Z. Speaking Engagements:
Fellows are expected to present an M&M, two case conference presentations, an interdisciplinary case presentation, and two journal club sessions for the Division lecture series. Fellows will also be expected to present cases and journal club articles at the weekly inpatient teaching sessions. Fellows are encouraged to submit abstracts for presentation at the AAHPM annual conference. Fellows can partake in talk review and feedback through the Program in Educational Faculty development.