Palliative care is a rapidly growing medical specialty focused on enhancing the quality of life for patients and their families facing serious illness. For physicians seeking advanced training in this rewarding field, ACGME-accredited palliative care fellowship programs offer structured, comprehensive education and clinical experience. Corewell Health in Grand Rapids, Michigan, provides exceptional Acgme Palliative Care Fellowship Programs designed to develop skilled and compassionate palliative medicine physicians. This article delves into the rich learning environment and diverse clinical rotations offered within Corewell Health’s fellowship, highlighting why it stands out as a premier choice for aspiring palliative care specialists.
Inpatient Palliative Care: Mastering Complex Hospital-Based Care
The inpatient palliative care rotation at Corewell Health Butterworth Hospital, a renowned 556-bed Level 1 trauma and referral center, forms a cornerstone of the fellowship experience. Butterworth Hospital’s advanced capabilities, including its status as a transplant center for heart and lung transplants and its expertise in advanced cardiac therapies like extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs), provide fellows with exposure to a high acuity patient population.
Fellows gain invaluable experience collaborating with multidisciplinary teams in complex scenarios. Palliative care’s integral role in pre-assessment for heart and lung transplants and LVADs, including participation on the LVAD selection committee, ensures fellows understand the critical integration of palliative principles in advanced medical decision-making. The robust inpatient oncology service, featuring a bone marrow transplant unit, further broadens the fellows’ exposure to diverse palliative care needs.
Collaboration with interventional radiology and anesthesia services enhances the fellows’ skills in procedural palliative care, focusing on minimizing patient suffering and optimizing quality of life during complex interventions. Throughout this rotation, fellows actively participate in interdisciplinary palliative and hospice teams, collaborating across multiple specialties to conduct goals of care discussions and manage complex symptoms effectively. A unique element of this inpatient experience is a dedicated week focused on addiction medicine, recognizing the significant overlap and need for expertise in managing addiction within palliative care. Fellows may also rotate through Corewell Health Blodgett Hospital, expanding their inpatient experience within a different community hospital setting and its 248 private patient rooms.
Community Hospice: Delivering Compassionate Care in Home Settings
The community hospice rotation immerses fellows in the crucial aspects of providing palliative care in patients’ homes. Working alongside an interdisciplinary hospice team, fellows actively participate in goals of care discussions and symptom management during home visits, gaining firsthand experience in the unique challenges and rewards of community-based care. This rotation emphasizes the multifaceted role of a hospice medical director, enabling fellows to learn hospice regulations, eligibility criteria, and the essential documentation requirements, including hospice certification and re-certification notes. Active participation in interdisciplinary group meetings further refines their collaborative and communication skills in the hospice context.
Inpatient Hospice: Specialized Care within Dedicated Units
The inpatient hospice experience provides fellows with expertise in managing palliative needs within a dedicated inpatient setting. Fellows collaborate with an interdisciplinary hospice team to address goals of care and manage complex symptoms for general inpatient hospice patients. This includes specialized skills in symptom management following withdrawal of life-sustaining therapies such as LVADs, mechanical ventilation, BIPAP, and high flow nasal cannula, situations requiring sensitive and expert palliative care. Fellows also develop proficiency in assessing hospice eligibility for new inpatient referrals. Complementing the hospital-based inpatient hospice experience, fellows rotate through a supportive care unit, a six-bed inpatient hospice unit located within a local nursing facility, providing a diverse perspective on inpatient hospice delivery models.
Home-Based Palliative Care: Navigating Care in the Community
The home-based palliative care rotation extends the fellows’ learning into the broader community setting, encompassing patients’ homes and skilled nursing facilities across an 11-county service territory. As integral members of an interdisciplinary team, fellows conduct home visits, focusing on thorough home environment assessments, establishing effective symptom management plans, and identifying crucial safety considerations for both staff and patient/family. This rotation highlights the importance of exploring and leveraging community resources to support patients and families, fostering collaboration with diverse providers across the care spectrum. Fellows gain a deep understanding of the physician’s evolving role in this dynamic program and the unique challenges and opportunities inherent in community-based palliative care. Leading and participating in Interdisciplinary Group meetings, addressing barriers to hospice transitions,深入 exploring social determinants of health, and developing creative support strategies are key learning objectives. Efficient communication with both internal and external partners is emphasized to ensure seamless and comprehensive palliative care delivery within the community.
Geriatrics: Addressing the Unique Needs of Older Adults
The geriatrics rotation provides fellows with specialized training in the palliative care needs of older adults, a population with unique complexities. Under the supervision of experienced geriatrics attending physicians, fellows evaluate patients and engage in detailed discussions to deepen their understanding of common geriatric syndromes. These include delirium, cognitive impairment and dementia, gait disorders and falls, and polypharmacy – all frequently encountered in palliative care for older adults. This rotation emphasizes care transitions and the understanding of different healthcare settings as interconnected microsystems, crucial for effective palliative care delivery across the continuum. Recognizing the significant heterogeneity in health status among older adults, fellows learn to differentiate between frail and healthy older adults and their varying levels of vulnerability, informing tailored palliative approaches. The rotation illuminates the evolution of care for older adults, transitioning from curative to strictly palliative intents as patients progress through different living situations, from independent living and life care communities to hospitals, home care, rehabilitation, long-term care, and ultimately hospice. Fellows also gain specialized experience with the Geriatric Trauma Service at Butterworth Hospital, further broadening their expertise in geriatric palliative care.
Pediatric Hospice and Palliative Medicine: Specialized Skills for Young Patients
The pediatric hospice and palliative medicine component of the fellowship provides specialized training in the unique aspects of palliative care for children. Fellows participate in daily rounds with the interdisciplinary pediatric palliative care team at Helen DeVos Children’s Hospital, a dedicated children’s hospital within the Corewell Health system. They encounter a diverse range of medically complex and critically ill children across various settings, including the neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), inpatient oncology unit, and general pediatric units. Fellows participate in prenatal consults with expectant mothers facing diagnoses of severe fetal anomalies, providing early palliative care support. They also follow patients in a dedicated ambulatory palliative care clinic and conduct home visits when appropriate, extending their care beyond the hospital walls. Providing end-of-life care for children admitted to the hospital from hospice when inpatient services are needed is another critical learning experience. To further enhance their expertise in pediatric hospice, fellows spend dedicated time with a pediatric team from a local community-based hospice, gaining practical experience in home hospice care for pediatric patients.
Elective Opportunities: Tailoring the Fellowship to Individual Interests
Corewell Health’s ACGME palliative care fellowship programs offer a wide array of elective experiences, allowing fellows to personalize their training and delve deeper into areas of specific interest. These elective options are designed to align with individual fellows’ goals and objectives, fostering specialized expertise within palliative medicine. Elective opportunities include, but are not limited to, clinical ethics, providing a framework for navigating complex ethical dilemmas in palliative care; leadership and administration, developing skills for future leadership roles in palliative care programs; medical education, fostering teaching and mentorship skills; addiction medicine, building upon the foundational week during inpatient palliative care; child life, understanding the psychosocial needs of children and families; anesthesia and pain service, enhancing pain management skills; and interventional radiology, focusing on advanced procedural pain and symptom management techniques.
Ambulatory Clinics: Continuity of Care and Diverse Palliative Settings
Ambulatory clinic experiences provide fellows with crucial continuity of care and exposure to diverse palliative care settings beyond the inpatient environment. Fellows participate in a weekly half-day continuity clinic throughout their fellowship, primarily based in the adult palliative oncology clinic at Corewell Health Lemmen-Holten Cancer Pavilion, a comprehensive cancer center. This provides consistent experience in managing palliative needs within the oncology setting. Additional ambulatory clinic opportunities include rotations in the palliative advanced heart failure clinic and lung transplant clinic during the community hospice and palliative care rotation, and in the geriatrics clinic during the geriatric rotation. Pediatric fellows gain further ambulatory experience in dedicated pediatric pain and palliative clinics integrated within their pediatric rotations. Each of these clinic settings emphasizes an interdisciplinary approach, mirroring the collaborative nature of palliative care practice and reinforcing the importance of team-based care.
Corewell Health’s ACGME palliative care fellowship programs offer a robust and multifaceted training experience, preparing future leaders in palliative medicine. Through diverse rotations, comprehensive didactics, and personalized elective opportunities, fellows develop the expertise, experience, and compassionate approach necessary to excel in this vital medical specialty.
