Hospice and Palliative Medicine Fellowship

Clinical rotations: There are 13 blocks, each block being four weeks.

Inpatient palliative care

This rotation will mainly be at Corewell Health Butterworth Hospital (part of Corewell Health Grand Rapids Hospitals), a 556-bed, level 1 trauma center, referral center for advanced cardiac therapies including extracorporeal membrane oxygenation and left ventricular assist devices (LVADs), and transplant center for heart and lung transplants. Palliative care is involved as part of the pre-assessment for all heart and lung transplants and LVADs, playing an integral role on the LVAD selection committee. There is a robust oncology inpatient service including a bone marrow transplant service. Fellows will experience collaboration with interventional radiology and anesthesia services regarding procedures to minimize suffering and optimize quality of life. The experience will include working with interdisciplinary palliative and hospice teams and collaborating with multiple specialties, participating in goals of care discussions, and complex symptom management. We incorporate one week of addiction medicine experience during inpatient palliative care months. Fellows will also have the opportunity to care for patients at Corewell Health Blodgett Hospital (part of Corewell Health Grand Rapids Hospitals) during their inpatient rotations. Located in East Grand Rapids, it provides inpatient care in 248 private patient rooms and outpatient services for medical, surgical, and specialty care.

Community hospice

In their community hospice experience, fellows will work with the interdisciplinary hospice team and participate in goals of care discussions and symptom management during home visits as well as perform face-to-face visits. They will learn the role of a hospice medical director, hospice regulations, hospice eligibility, and actively participate in interdisciplinary groups, and learn how to write hospice certification and re-certification notes.

Inpatient hospice

The inpatient hospice experience includes collaborating with an inpatient interdisciplinary hospice team, participating in goals of care discussions and symptom management for general inpatient hospice patients including symptom management after withdrawal from LVAD and other advanced cardiac therapy support as well as withdrawal from mechanical ventilation, BIPAP, and high flow nasal cannula. Fellows will assess hospice eligibility for new hospice referrals for inpatients. In addition to this experience in the hospital setting, fellows will round in the supportive care unit which is our six-bed inpatient hospice unit located within a local nursing facility.

Home-based palliative care

Fellows are part of the interdisciplinary team visiting patients in their homes and skilled nursing facilities. Participation in goals-of-care discussions, thorough home environment assessments, establishing symptom management plans, recognizing safety components for both staff and patient/family, exploring outside community resources, support to families, and collaboration with various providers are essential functions in this rotation. Throughout the 11-county service territory, fellows will learn the physician role in this ever-changing program and the unique challenges and opportunities that being out in the community brings. The ability to participate in and lead Interdisciplinary Group meetings, break down barriers to hospice transitions, deep dive into social determinants of health, brainstorm creative support needs, and communicate efficiently with internal and external partners will be the focus of expanding knowledge of palliative care services in this track.

Geriatrics

Under the supervision of a geriatrics attending physician, fellows will evaluate patients and then discuss findings to gain a greater understanding of geriatric syndromes including delirium, cognitive impairment and dementia, gait disorders and falls, and polypharmacy. This rotation emphasizes transitions in care and understanding different healthcare settings as microsystems. Focusing on the older adult population that displays significant heterogeneity of health status, the rotation will make it possible to learn how to distinguish frail from healthy older adults and their differing levels of vulnerability. Fellows will also understand how care for older adults evolves from an intent that is curative to a strictly palliative intent for patients who may transition from independent living at home or a life care community to a hospital, home with home care, subacute rehabilitation or long-term care, and eventually hospice. Fellows will also spend time at Butterworth Hospital with the Geriatric Trauma Service.

Pediatric hospice and palliative medicine

Fellows participate in daily rounds with the interdisciplinary pediatric palliative care team caring for children at Helen DeVos Children’s Hospital. Fellows will see a variety of medically complex and critically ill children in multiple settings, including the neonatal intensive care unit, pediatric intensive care unit, pediatric cardiac intensive care unit, inpatient oncology unit, and general pediatric units. Fellows will participate in pre-natal consults with expectant mothers whose children have severe anomalies diagnosed in utero. They will also follow patients in a dedicated ambulatory palliative care clinic and provide home visits when appropriate. They will provide end-of-life care for children admitted to the hospital from hospice when inpatient services are required. Fellows will spend time with a dedicated pediatric team of a local community-based hospice to gain experience with home hospice care of pediatric patients.

Elective

Many elective experiences are available to fellows and the experience will be tailored to their goals and objectives. Options include, though are not limited to, clinical ethics, leadership and administration, medical education, addiction medicine, child life, anesthesia and pain service, and interventional radiology.

Ambulatory clinics

Fellows will have a weekly half-day continuity clinic throughout the fellowship. During the majority of blocks, this will occur in the adult palliative oncology clinic at Corewell Health Lemmen-Holten Cancer Pavilion. There will also be opportunities to spend time in the palliative advanced heart failure clinic and lung transplant clinic during the community hospice and palliative care rotation and geriatrics clinic during the geriatric rotation. Pediatric fellows will have additional pediatric pain and palliative clinic experience built into their pediatric rotations. Each of these clinics has an interdisciplinary approach.

Fellows have protected time to complete a scholarly activity during their fellowship and will be provided mentorship for their scholarly activity by our faculty. Examples of options for scholarly activity include presenting at a local or regional conference, submission of a case report or other article, or a quality improvement project. Corewell Health in West Michigan provides many opportunities in clinical, quality, and safety-based research. Corewell Health and Michigan State University have a growing interest in multi-center collaborative research networks.

We participate in the Electronic Residency Application Service application process. We require the following information:

• A completed application/profile
• At least three letters of recommendation
• Curriculum vitae
• Medical school transcript and dean’s letter
• Personal statement describing career goals and reasons for selecting continued training
• USMLE transcript
• For international medical graduates, an Educational Commission for Foreign Medical Graduates status report

For more information on our program, contact Jennifer Bruno, program coordinator.

Corewell Health in West Michigan provides a comprehensive and very competitive benefits package for our residents, staff, and their families. In addition, our program provides educational monies to support your ongoing education. Download our salary and benefits document to learn more.