Clinical Training Sites
Massachusetts General Hospital (MGH)
One of the oldest programs in the country, the Massachusetts General Hospital Division of Palliative Care and Geriatric Medicine was established in 1996. Over time, it has grown from an inpatient-only consult service to now include an inpatient consult team, an ED-based team, an inpatient Palliative Care unit, an outpatient clinic for both Oncology and non-Oncology patients, and a home-based Palliative Care team. The patient population includes those with cancer as well as primary cardiac, renal, pulmonary, hepatic, or neurological problems. Fellows, therefore, learn to care for a diverse group of patients and become experts in understanding and forecasting disease trajectories for a wide range of illnesses.
Brigham and Women's Hospital and Dana-Farber Cancer Institute (BWH/DFCI)
The Adult Palliative Care Division at BWH/DFCI has been providing inpatient and outpatient palliative care services since 2001. The Inpatient Consult Service consists of four branches: one branch caring for patients with cancer diagnoses, one branch caring for patients with non-oncology diagnoses, and two population based, specialty-aligned programs: KidneyPal (caring for patients with end-stage renal disease) and HeartPal (caring for patients with end-stage heart failure). Fellows also help care for patients on the Intensive Palliative Care Unit (IPCU), a 12-bed unit for inpatients with cancer at any stage who have intensive palliative care needs, including symptom management, clarification of goals of care, or complex psychosocial support.
In addition, fellows participate in weekly clinic sessions at DFCI, caring for outpatients with oncologic diagnoses and palliative care needs. The clinic experience includes working closely with a clinic preceptor and with palliative care pharmacists, who sometimes make co-visits for patients with complicated medication regimens or side-effect sensitivities.
All branches of the DFCI/BWH clinical service emphasize interdisciplinary care and have interdisciplinary team meetings, including case-based teaching, and a weekly half-hour Remembrance reflecting on the experience of caring for patients who have died.
Pediatric Palliative Care at either MGH or Boston Children's Hospital/ Dana-Farber Cancer Institute (BCH/DFCI)
Fellows work with interdisciplinary pediatric palliative care teams at either MGH or BCH/DFCI to gain experience caring for pediatric patients with life-threatening illness. Both services focus on advanced pediatric pain and symptom management, decision making, and quality-of-life concerns in both the inpatient and outpatient settings. Fellows will become familiar with comprehensive, interdisciplinary evaluation and management of children with diverse advanced illnesses and their families.
Care Dimensions Hospice (CD) and the Brockton VA Medical Center (BVA)
Fellows gain experience caring for patients in hospice units and/or in the home and long term care facilities during their rotations with Care Dimensions and the Brockton VA Medical Center. During this time, fellows participate in interdisciplinary team meetings and home visits. While physician fellows begin to learn the skills required to be a hospice medical director, nurse practitioner fellows collaborate with other team members to direct complex end-of-life care. All fellows who spend time with Care Dimensions also care for patients at the Lincoln House or the Kaplan House, which are freestanding inpatient hospice facilities.