Palliative Medicine Fellowship - Adult and Pediatric Tracks

Palliative Medicine Fellowship

History

In 2009, UW physicians specializing in Palliative Medicine developed the UW Palliative Fellowship Medicine Program to train physicians to meet the health care needs of both an aging population as well as individuals affected by severe and chronic illness.

The Pediatric Track was initiated in 2012, evolving over the years to train physicians in caring for patients and families affected by all pediatric conditions while also having the opportunity to work with and learn from outstanding adult models of care. In 2025, the integrated geriatrics and palliative medicine program will begin recruitment.

Welcome

The University of Washington Palliative Medicine Fellowship Program is a one year fellowship that trains fellows to become experts in delivering palliative medicine care for severe and chronically ill patients of all ages.

Our program trains up to 6 (4 adult track and 2 pediatric track) post-residency physicians per year. Clinical rotations include inpatient consult services, inpatient palliative care units, affiliated long term care facilities, home-based palliative care experiences including hospice care, and ambulatory outpatient clinics. Elective rotations include geriatrics, oncology, pulmonary/ICU, interventional pain management, interventional radiology, radiation oncology, ethics, fetal care, dementia units, and AIDS/HIV care settings.

We provide a mentored training experience in clinical skills and provide exposure to research and quality improvement for our fellows, who will become future leaders in palliative care medicine.

Introduction

The University of Washington Palliative Medicine Fellowship Program utilizes comprehensive inpatient, outpatient, long term care, hospice, and community experiences in several facilities to support fellow education.

By rotating at multiple sites, fellows learn from diverse patient populations which enhances their experience and training and supports the fellows in learning to provide culturally responsive and trauma informed care. Fellows have the opportunity to work with and learn from transplant patients, immigrant and refugee patients, historically marginalized patients, patients from diverse socio-economic backgrounds, unhoused patients. 

We have strong faculty and interprofessional team role models in research, education, and clinical care for our fellows, who will be the future leaders of palliative medicine. Previous fellows have a 100% HPM board pass rate. 

There are 3 clinical training pathways:

• Adult Track
• Pediatric Track
• Geri-Pal Track (under development)

Interdisciplinary Team

Fellows work closely with interprofessional team members at all rotation sites. This enables fellows to broaden their depth and scope of palliative care in order to best support patients and families. It also offers fellows the opportunity to build skills as team members and as team leaders.

Fellows will work with interprofessional team members from many different disciplines including, but not limited to, social work, nursing, nursing aides, chaplaincy, pharmacy, occupational and physical therapy, bereavement support, music, writing and art therapy, child life and psychology.

Wellness

We recognize the emotionally intense nature of working in hospice and palliative medicine. In order to sustain longevity in the field, which is what we hope for all our fellows, it is important for fellows to identify and cultivate their own unique wellness skills. In order for fellows to have the bandwidth to focus on their own wellness, we feel it important that they have time. As such there is no required night or weekend call aside from 1-2 acting attending experiences at the end of the fellowship. We hope that fellows use their time to explore their interests, explore the PNW and participate in whatever brings them fulfillment. 

Fellows also have facilitated monthly meetings to support reflection and a space for debriefing.

Teaching Skills

Fellows gain important teaching skills during the fellowship. During consultation and hospice visits, they gain experiential knowledge by seeing teaching skills modeled by hospice staff and faculty. These skills are expanded in more formal settings such as grand rounds, professional development seminars, team meetings and journal club.

By experiencing the talents of faculty and hospice team members during consultation and visits with patient and families, and by engaging in these activities as an active team member, fellows improve their skills through modeling and feedback from other team members. Formal feedback is also available in formal evaluation via MedHub.

General Fellowship Curriculum

Please see info provided for the individual training pathways for details

• 6-7 months of inpatient palliative care consultation service

• 2.5 months of home hospice
• 1-month long-term care/inpatient hospice
• 2 weeks Pain Service
• Outpatient Continuity
• Ethics Curriculum
• Elective/Scholarly Time

Conferences

• Palliative Medicine Grand Rounds
• Fellow Didactic Conferences (More intensive during July and August to promote learning key palliative medicine concepts)
• Cambia Research Conference
• Journal Club
• Challenging Case Series
• Ethics Seminar
• Professional Development Series
• Vital Talk Training

Adult Track

More information coming.

Pediatric Track

The Pediatric Track of the fellowship started in 2012 and has consistently provided excellent training for pediatricians in palliative care. The program has trained fellows recently out of residency or an executive resident year, fellows who recently completed another fellowship (Hem-Onc, NICU, PICU) as well fellows who have transitioned from previous jobs in primary care and hospital medicine.  The track provides pediatricians 9-10 months of pediatric specific palliative care training. Pediatric fellows rotate through 2-3 adult inpatient palliative care services to gain additional experience across several hospital settings with varying patient populations and palliative care team structures. The pediatric fellows spends 2.5 months working in home hospice. Fellows participate in Interdisciplinary team meetings, home visits with IDT members and learn about the role of the hospice medical director. Two months of the hospice experience are with a pediatric specific team while 2 weeks are with an adult team which provides increase opportunities for exposure to complex symptom management.

The ambulatory clinic experience for the pediatrician is the same experience as the adult fellows, which is met through the Fred Hutchinson Cancer Center: Adult Oncology Palliative Care Clinic. Pediatric Fellows also have the opportunity to rotate with the Pediatric Palliative Care Clinic at Seattle Children’sFellows also have the opportunity to work with the Pain Service at Seattle Children’s both in the inpatient about outpatient setting to increase knowledge of acute and chronic pain. Fellows also gain knowledge and experience in bioethics through their clinical work as well as through working with dual trained palliative and bioethics faculty.

Learn more about the University of Washington Pediatrics Bioethics and Palliative Care Division:

Pediatrics Bioethics and Palliative Care DivisionTreumen Katz Center @ Seattle Children's

Curriculum

• 6 months Inpatient Palliative Care at Seattle Children’s
• 2-month Home Hospice through Providence Hospice at Home with Compassus Pediatric Team
• 2 weeks Adult Hospice with Kline Galland
• 1 month UW Inpatient Palliative Care (Adult Service with NICU and Prenatal Palliative Care Opportunities)
• 1 month VA Community Living Center – Current Required Long Term Care Rotation. (The location of this rotation may change in 2025-2026 to be more pediatric specific)
• 1 month HMC Inpatient Palliative Care (Adult Service with Pediatric opportunities in the PICU)
• Continuity Clinic throughout the year at Fred Hutchinson Cancer Research Center. Fellows will also spend time with the outpatient Pediatric Palliative care Clinic at Seattle Children’s

Program goals

• To train a diverse group of individuals who will succeed in clinical, educational, and academic roles in the scope of palliative medicine, while maintaining resilience and professionalism.
• Through exposure to outstanding interdisciplinary palliative medicine providers, graduates will excel as palliative medicine consultants, providers, and clinician-educators.
• Through patient care in community settings, graduates will utilize their palliative medicine skills as leaders.

Mission Statement

The mission of the program is to foster the development of a diverse group of graduates, who can succeed in any clinical, educational, or academic role in the scope of palliative medicine, while maintaining resilience and professional fortitude, through exposure to a multitude of outstanding interdisciplinary palliative medicine providers, and through exposure to a highly-varied number of patient encounters in multiple clinical settings.

Fellowship Training Sites

Fellows rotate through four affiliated University of Washington Hospitals. UW Medicine hospitals and programs consistently rank highly in U.S. News and World Report’s annual “Best Hospitals” issues.

Harborview Medical Center

HMC is a is a 413-bed hospital owned by King County and managed by the University of Washington. Harborview is a world-renowned Level 1 adult and pediatric trauma center. HMC Palliative Care Consultation Service (PCCS) sees patients referred from inpatient services, helping patients, family and primary care teams with care planning and symptom management. Fellows will be part of PCCS teams, which include division faculty. Patients are also referred to the outpatient clinic.

Fred Hutchinson Cancer Center - Palliative Care Clinic

The outpatient Palliative Care clinic at the Fred Hutchinson Cancer Center (FHCC) is a consultation service. FHCC, University of Washington Medicine, and Seattle Children’s form the only NCI-designated comprehensive cancer center in Washington State.

Our service consists of a medical and administrative director, program coordinator, 3 nurse practitioners, 2 nurses, chaplains, social workers, child-life specialist, nutritionist, and other representatives of FHCC supportive services. Any clinician can refer patients to our service. Patients can also self-refer. The vast majority of our referrals are for pain and symptom management. Preceptors are ACHPN- certified ARNPs. Fellows are assigned to clinic once every other week.

Seattle Children's Hospital

Seattle Children's Hospital serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children's hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Seattle Children's has been delivering superior patient care and advancing new treatments through pediatric research. Seattle Children's is a 407-bed children's general facility and is consistently identified as one of the nation’s top pediatric hospitals. Seattle Children's serves as the primary teaching and clinical and site for the Pediatric Track fellow as the fellow will spend approximately 6 months rotating with the inpatient palliative care team. The Palliative Care Team at Seattle Children’s works throughout the hospital and cares for patients with the full spectrum of pediatric life limiting and life-threatening conditions

University of Washington Medical Center

The UWMC PCCS sees patients referred from the inpatient services, aids patient, family and care teams with goal setting and care directives, assesses patient appropriateness for and interest in hospice care, advises the primary care team on symptom management and care planning, provides information and emotional support to patients and families, and facilitates discharge planning to community hospices and other agencies.

PCCS teams follow patients from initial referral until death or discharge to community-based services. Core PCCS team members include social workers, chaplains and trainees; medical students, residents, fellows, working closely with primary providers. Other services such as pharmacy, pain service, psychiatry, speech, physical and occupational therapy are available as needed. PCCS teams meets bi-weekly to review service goals and particular patients.

Pediatric Track fellows have an opportunity to gain experience in prenatal palliative care during their UWMC rotation as the UWMC is the delivery location for many patients with prenatally diagnosed complex conditions.

VA Puget Sound Health Care System

The VA Puget Sound Health Care System Palliative Care and Hospice Service (PCHS) provides a full range of consultative services addressing patients' physical, psychological, social, and spiritual needs. PCHS advises primary care teams on symptom management, goal setting, discussion of code status, communication issues, decision-making, management of spiritual and existential distress, disposition issues, management of psychosocial issues, and care in the last hours of life.

PCHS provides information and emotional support to patients and their families, assesses patients’ appropriateness for and interest in hospice care, and facilitates discharge planning and referrals to community hospice programs. Consultative support is provided for veterans receiving inpatient end of life care in the Community Living Center (CLC) 10 hospice beds. The PCHS team includes physicians, nurses, care coordinators, nurse practitioners, social workers, psychologists, chaplains, and administrative support personnel.

Other professionals including pharmacists, psychiatrists, dietitians and physical therapists. Occupational and recreation therapists are available by consultation. The PCHS team meets weekly in Inter-Disciplinary Team format to review all active patients on the service, as well as to debrief recently deceased patients. 

Affiliated Training Sites

Providence Hospice of Seattle at Home with Compassus

Providence Hospice at Home with Compassus provides home hospice care for Pediatric patients in Snohomish, King and Pierce Counties. Hospice clients are discussed every other week regarding clinical and psychosocial condition. Fellows learn the dynamics of interdisciplanary teams (IDT), the function of members, and provide direct input as a team member in the role of Medical Director and hospice physician. Pediatric fellows will complete home visits with all IDT team members during their rotations.

Kline Galland Hospice

More Information Coming

Commitment to Inclusion and Diversity

The Palliative Medicine Program is committed to fostering a diverse and inclusive workplace. We strongly encourage applicants from diverse backgrounds as we believe that our faculty and fellows should reflect the incredible diversity of the patients we care for.