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:
- Patient & Family Care
- Medical Knowledge
- Practice-Based Learning & Improvement
- Interpersonal & Communication Skills
- Professionalism
- 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.
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
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
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
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
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
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
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)
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
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
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
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.
Competencies: Practice-Based Learning & Improvement, Professionalism
- Identify how to effectively manage resources
- Discuss how to gain a balance between professional goals and personal time
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
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
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
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