• J Pain Symptom Manage · Oct 2024

    Outpatient Training During Hospice and Palliative Medicine Fellowship: A National Survey.

    • Harry J Han, Michelle C Ouellette, Jonathan C Yeh, Laura E Dodge, Esme Finlay, Amelia M Cullinan, and Mary K Buss.
    • Section of Palliative Care (H.J.H, M.C.O., J.C.Y.), Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: hhan5@bidmc.harvard.edu.
    • J Pain Symptom Manage. 2024 Oct 1; 68 (4): 340351340-351.

    ContextOutpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training.ObjectivesCharacterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education.MethodsA cross-sectional survey of US adult HPM fellowship program directors (PDs) or their designee conducted between March and July, 2023.ResultsOf 161 programs, 85 participated (53% response rate) with representation across all US regions. HPM fellows spend a median of 4.8 weeks in outpatient PC compared to 24 weeks inpatient PC and 10.5 weeks in hospice settings. Over half (51%) of fellows saw outpatients from primarily one disease type with limited exposure to patients with other serious illnesses. Across programs, fellows' clinic structure, interdisciplinary team composition, and didactic experiences varied. On a 5-point rating scale, PDs reported significantly lower quality outpatient versus inpatient training (mean rating: 3.58 vs. 4.62, P<0.001) and perceived fellows as less prepared for independent outpatient practice upon graduation (mean: 4.06 vs. 4.73, P<0.001).ConclusionOur survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform.Copyright © 2024 American Academy of Hospice and Palliative Medicine. All rights reserved.

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