Explore the curriculum for the Hospice & Palliative Medicine Fellowship.

Hospice and palliative medicine core competencies

The American Academy of Hospice and Palliative Care Medicine (AAHPM) has developed a list of core competencies for palliative care specialists (pdf).

The competencies are organized around six areas:

  1. Patient & Family Care
  2. Medical Knowledge
  3. Practice-Based Learning & Improvement
  4. Interpersonal & Communication Skills
  5. Professionalism
  6. Systems-Based Practice

These competencies stress the importance of interdisciplinary care for patients and caregivers at the end-of-life.

In addition to the skills and competencies developed by the AAHPM, our core curriculum includes didactic lectures and small group discussions that complement the HPM core competencies.

Palliative care emergencies

Competency: Medical Knowledge

  • Identify practical “emergencies” in end-of-life care and treatment options, including pain crises, hemorrhage, seizures, airway obstruction or severe dyspnea, acute delirium, superior vena cava obstruction, spinal cord compression, bone fractures, or other unrelieved symptoms
  • Distinguish between emergency treatment in general medical care (where death is to be prevented), and emergency treatment in end-of-life care (where death is expected and inappropriate intervention could cause additional suffering)
  • Discuss how to evaluate patient and family/caregiver desires for care during palliative care emergencies
Death and dying in modern times

Competency: Patient & Family Care

  • Evaluate data related to end-of-life care in the U.S., including common cause of death, cost of care, and where people die
  • Describe the normal grief reaction and bereavement process
  • Identify/differentiate characteristics of a dysfunctional grieving process, including depression, anxiety, guilt, and substance abuse for family/caregivers
Illness trajectories and prognostication

Competency: Medical Knowledge

  • Describe natural history, including death, of various diseases, including pediatric conditions
  • Understand the limitations of prognosticating on the basis of survival or length of life
  • Propose additional potential outcomes of interest when prognosticating
  • Distinguish between common tools used for prognostication and limitations of each tool
Symptom management overview

Competency: Medical Knowledge

Pain management

  • Describe concept of “total” pain
  • Understand how to assess pain
  • Understand opioid pharmacologic options for pain management, including indications, clinical pharmacology, alternate routes, analgesic conversions, toxicities, and common side effects
  • Understand non-opioid pain options including adjuvant medications (NSAIDs, steroids, antidepressants)
  • Understand non-pharmacologic pain treatment modalities, including physical (physical therapy, massage, TENS, acupuncture) and psychosocial (relaxation, psychotherapy, peer support, counseling).

Non-pain symptom management

  • Describe assessment methods and treatments for common physical symptoms of advanced disease: dyspnea, nausea and vomiting, constipation, diarrhea, cough, oral secretions, bladder dysfunction and anorexia
  • Describe assessment and treatment of psychiatric symptoms associated with advanced disease: depression, anxiety, insomnia, and delirium
Hydration, nutrition, and antibiotics in end-of-life care

Competency: Medical Knowledge

  • Review options and evidence base for nutrition and hydration in terminally ill, including artificial feeding and intravenous fluids
  • Summarize physiological bases for withholding feeding and fluids
  • Explain indications for antibiotics and risks of prescribing antibiotics for the terminally ill
  • Model patient-centered communication to patients and families/caregivers regarding hydration, nutrition and antibiotics in end-of-life care
Legal & ethical issues in end-of-life care

Competency: Professionalism

  • Describe ethical and legal issues in palliative care and their clinical management
  • Discuss ethical principles and frameworks for addressing clinical issues
  • Understand when clinical ethicist consult is necessary
  • Define common legal issues at end-of-life, include assessing a patient for capacity, advance directives, do-not-resuscitate (DNR) orders, durable power of attorney for healthcare, living will, physician orders for life-sustaining treatment (POLST) forms, withholding and withdrawing life support, pronouncement of death and completion of death certificate
Psychosocial & spiritual aspects of care

Competency: Patient & Family Care

  • Demonstrate how to incorporate a  psychosocial history and spiritual history into the assessment of a dying patient
  • Recognize common social problems experienced by patients and families facing life-threatening conditions
  • Recognize common experiences of distress around spiritual, religious and existential issues for patients and families facing life-threatening conditions
  • Describe the role of hope, despair, and meaning in the context of severe and chronic illness
  • Identify the indications for referral to other allied health professionals (social work, chaplains)
Patient safety, quality, & systems of care

Competencies: Professionalism, Systems-Based Practice

  • Describe the fundamental principles of patient safety and quality improvement.
  • Discuss models for improving healthcare quality and be familiar with techniques to measure their efficacy.
  • Appreciate how the culture of safety can impact quality improvement efforts.
  • Become familiar with the mechanisms for detecting, reporting and learning from medical errors
  • Discuss how to report an adverse event to a patient and their family/caregivers
CMS & hospice regulations

Competency: Systems-Based Practice

  • Understand relationship between hospice and palliative care
  • Understand myths of hospice and Hospice Medicare Benefit
  • Understand indications and eligibility guidelines for hospice care
Hand-offs, hand-overs, and continuity of care

Competencies: Interpersonal & Communication Skills, Systems-Based Practice

  • Identify elements of care important for successful patient handoff
  • Discuss patient safety issues related to handoffs and poor continuity of care
  • Demonstrate how to perform a safe, effective, and complete handoff
Professional self-care and reflection in end-of-life care

Competencies: Practice-Based Learning & Improvement, Professionalism

  • Describe characteristics of resilience
  • Identify signs of physician burn-out and identify methods to prevent burn-out
  • Discuss fatigue management and normal sleep requirements, the causes and signs of fatigue and its effects on human performance.
Time management

Competencies: Practice-Based Learning & Improvement, Professionalism

  • Identify how to effectively manage resources
  • Discuss how to gain a balance between professional goals and personal time
Palliative Care Consults

Competency: Interpersonal & Communication Skills

  • Describe ideal behaviors of a consultant
  • Distinguish between role of consultant and treating team
  • Identify roles of interdisciplinary team members in the palliative care consult
The final 48 hours

Competencies: Patient & Family Care, Medical Knowledge, Interpersonal & Communication Skills

  • Construct an appropriate comfort care plan for symptoms encountered by patients
  • Recognize components of management for the syndrome of imminent death
  • Identify common symptoms, signs, complications and variations in the normal dying process and describes their management
  • Describe strategies to communicate with the patient and family about the dying process and to provide support
Research design & palliative care

Competency: Practice-Based Learning & Improvement

  • Define, describe and discuss principles of evidence-based medicine, including developing focused clinical questions and using electronic databases to locate quality information
  • Define different statistical tests and terms commonly used in research
  • Define challenges in conducting palliative care research
  • Classify types of study designs
  • Describe how to critically review literature
Intensive communication training

Competency: Interpersonal & Communication Skills

Patient-centered communication

  • Recognize challenges in communicating effectively with dying patients and their families/caregivers
  • Demonstrate how to use patient-centered communication to enhance the physician-patient relationship
  • Communicate with team members and consulting providers in supportive fashion

Introduction to communication and teamwork for health-care professionals

  • Describe the importance of inter-professional teamwork in palliative care and the characteristics of effective team players
  • Review reasons for poor communication and teamwork in the current healthcare system
  • Identify how poor communication can lead to adverse patient outcomes