Section of Palliative Care and Medical Ethics

Hospice and Palliative Medicine Fellowship

The University of Pittsburgh’s Fellowship in Hospice and Palliative Medicine offers two options:

  • A one-year clinical fellowship offered by the Section of Palliative Care and Medical Ethics and accredited by the Accreditation Council for Graduate Medical Education (ACGME) that includes a high-volume, interdisciplinary clinical program
  • A two-year fellowship option that extends beyond the clinical year to prepare individuals for an academic career in the growing specialty of palliative medicine, enabling fellows to earn a master’s degree either in medical education or clinical research
Program Structure

The Hospice and Palliative Medicine Fellowship provides fellows a rigorous and clinically intense training experience that will prepare them for a successful palliative medicine career in the ambulatory, hospice, or hospital setting. We focus on symptom assessment and management, as well as communication skills with patients, families, and other health care providers. The one-year fellowship program has been fully accredited through the ACGME.

For fellows who want to pursue further training for a career in academic palliative medicine—either as a clinical investigator or educator—we offer an elective second year. The two-year program combines the palliative medicine program’s own research and educational resources with the opportunities offered by the Institute for Clinical Research Education (ICRE) degree programs in clinical research and medical education at the University of Pittsburgh. These programs provide fellows with didactic training in a broad spectrum of research and educational methodologies, technologies, and tools; exposure to multidisciplinary research and educational teams; hands-on mentored experience in conducting patient-oriented research; and the conceptual and writing skills necessary to submit competitive grant applications for successful, long-term patient-oriented research or education careers. By the end of the second year, fellows will obtain a master’s degree from the University of Pittsburgh in clinical research or medical education, with a special focus on palliative care.

Clinical Program

The fellows’ clinical experiences span a diverse array of settings, including our quaternary care transplant program, the region’s largest cancer and hospice program (Family Hospice and Palliative Care), and our children’s and community hospitals. The clinical focus of the fellowship is on acquiring skills in providing comprehensive care to patients with life-limiting illnesses in acute care, ambulatory care, home care, and long-term care settings. Fellows will spend substantial time in each of these settings and will follow patients longitudinally as they move between different settings. The role of the physician as a member of an interdisciplinary care team will be emphasized in all clinical settings and encounters. The individual aspects of the clinical program are:

  • Inpatient Palliative Care Consultation Service – Fellows spend a minimum of one month each at UPMC Presbyterian-Montefiore Hospitals, UPMC Shadyside Hospital, and Magee-Womens Hospital of UPMC, for a total of five months in the inpatient setting. Fellows also spend at least two weeks on the inpatient supportive care consult service at Children’s Hospital of Pittsburgh.
  • Home Care and Hospice – Fellows will gain extensive experience managing home care and hospice patients through time spent with Family Hospice and Palliative Care, the largest hospice program in western Pennsylvania. Fellows will spend one month doing hospice home visits and six weeks at an inpatient hospice facility.
  • Long-Term Care – Fellows will spend at least one month working in a long-term care facility.
  • Outpatient Clinic – Fellows will maintain their own outpatient clinic practice under the supervision of the palliative care faculty, spending at least one half-day a week for 12 months in one of two clinics—the Pittsburgh AIDS Comprehensive Treatment Center (PACT) or the Hillman Cancer Center Palliative Care Clinic. As part of a multidisciplinary team, fellows will manage patients at all disease stages with multiple physical, psychosocial, spiritual, and existential issues. Fellows will follow new patients longitudinally in the ambulatory setting as well as across settings if patients are admitted to the hospital or go to hospice.
  • Elective and Supplemental Clinical Experiences – Fellows will spend three months on clinical elective experiences. Additional elective time is available to individual fellows based on their own needs and interests. Formal elective experiences are available in ethics, oncology, radiation oncology, behavioral medicine, HIV care, neurology, geriatrics, geriatric psychiatry, chronic pain, pediatrics, liver transplantation, critical care, cardiology, and pulmonary care and can easily be arranged in other areas of special interest. Fellows will also have the opportunity to arrange experiences at any of our specialty palliative care clinics, including the Palliative Congestive Heart Failure Clinic, the Magee-Womens Hospital Palliative Care Clinic, and the Multidisciplinary Pancreatic Cancer Clinic.
  • Other Experiences – Fellows attend all the relevant ongoing teaching conferences, including Journal Club, Psychosocial Conference, Fellows’ Process group, and Palliative Care Grand Rounds.
Structured Didactics

Embedded in the Hospice and Palliative Medicine Fellowship are longitudinal didactics, which provide a fundamental knowledge base for the clinical practice of palliative care and focus on research skills relevant to palliative care.

  • Principles and Practice of Palliative Care – This course provides fellows with a thorough introduction to the evidence base and skill set needed for the clinical practice of palliative care. This clinical knowledge base not only prepares fellows for their clinical work in palliative care but also guides and informs their choice of a research interest. The course meets for one hour each week from September through March.
  • Research Methods in Palliative Care – This special methods course provides a critical bridge between the more general research skills covered in the ICRE clinical research training programs and the particular challenges of performing patient-oriented research in palliative care. This course, along with the clinical course, is a cornerstone of the concentration in palliative care.
  • Teaching Communication Skills – Over the past 10 years, studies have provided increasing data regarding the efficacy of educational interventions to improve physician communication skills. This course ensures that medical educators have the practical skills needed to design and teach communication courses with simulated patients and teach communication skills in real time in the clinical setting.
  • Communication Skills – In addition to the Teaching Communication Skills course described above, fellows also attend a three-day intensive communication retreat with palliative medicine and geriatric fellows from the region, during which they practice their own communication skills. Following completion of the retreat, fellows participate in a series of sessions involving professional-simulated patients, facilitated by faculty with extensive expertise in communication skills training focused on difficult communication tasks such as responding to a request for hastened death, discussing opioid misuse, disclosing medical errors and motivational interviewing.
  • Chief’s Rounds – This educational series meets weekly for one hour and includes practical application of palliative care skills including opioid conversions and pain management cases, case-based ethics discussions, reflective reading and writing and mindfulness training.

Fellows in the two-year program can choose additional elective courses, based on their individual interests and planned research program. Electives that suit the individual fellow’s goals can be selected from courses offered by the ICRE, as well as from other locations, including the Center for Bioethics and Health Law, the Graduate School of Public Health, the School of Social Work, and the School of Nursing.

Scholarly Activities
  • Quality Improvement and Patient Safety Project – All fellows complete a quality improvement project. Fellows are paired with faculty mentors as well as quality improvement experts to help investigate and address quality improvement issues encountered in the inpatient, ambulatory, or hospice setting.
  • Research/Education Project – Fellows in the two-year program will complete a research/education project during their fellowship. To help in this process and with career counseling, each fellow will select at least one primary research or education mentor whose experience and interests complement the fellow’s. A diverse group of experienced mentors from multiple departments has been assembled to encourage the development of an effective mentoring relationship. The group includes funded researchers in the departments of medicine, psychiatry, and critical care medicine, as well as researchers at the University of Pittsburgh Cancer Institute.
  • Case of the Month – All fellows contribute to this monthly publication and collaborative effort between the Palliative and Supportive Institute and the University of Pittsburgh Palliative Care faculty members. In addition to being distributed through the Pitt/UPMC community, the Case of the Month articles are posted on Pallimed: Arts & Humanities, a blog focusing on the many themes in palliative medicine that intersect with film, music, paintings, books, and other artistic media.

Depending on their level of interest, fellows also have the opportunity to work on smaller projects, such as “Fast Facts,” article reviews, or presentations at local or national meetings.

Academic Environment

The fellowship program is housed in the Section of Palliative Care and Medical Ethics, and we have active research programs with millions of dollars in grant support, as well as active relationships with educators and researchers in oncology, ethics, anesthesia, and geriatrics.

Fellows

Carla Khalaf McStay, MD is a first-year fellow in the Hospice and Palliative Medicine Fellowship. Dr. Khalaf McStay received a BA with Honors in Biology and a minor in Mathematics from Austin College in 2012, and her MD from Texas A&M College of Medicine in 2016. She completed residency in Internal Medicine with Baylor Scott and White in Temple, Texas, where she also served on the hospital’s ethics committee. She has completed research on how to increase rates of advance care planning completion and discussion in primary care clinic. Dr. Khalaf McStay is also  professionally interested in the intersection of government affairs and the practice of palliative care and hospice, and was involved with the Texas Medical Association throughout residency.

Gabrielle Langmann, MD is a first-year fellow in the Hospice and Palliative Medicine Fellowship. Dr. Langmann graduated summa cum laude with a BA in English Literature and Anthropology in 2011 from the University of Pittsburgh, where she was elected to Phi Beta Kappa in her junior year. She received her MD from the University of Pittsburgh School of Medicine in 2015 and went on to complete her residency in Internal Medicine-Pediatrics at UPMC in 2019. She served as Med-Peds Chief Resident during her final year of residency. Dr. Langmann is interested in medical education and providing comprehensive palliative care for patients with chronic illnesses with childhood onset across the lifespan, such as congenital heart disease and cystic fibrosis.

Rachel Rodenbach, MD is a first-year fellow in the Hospice and Palliative Medicine Fellowship. A native of northern Minnesota, Dr. Rodenbach received a BA in English and neuroscience from Amherst College in 2010 and her MD with distinction in research from the University of Rochester School of Medicine and Dentistry in 2016. She completed her Internal Medicine residency at the University of Pittsburgh Medical Center in 2019. Her research interests include communication in patients with advanced cancer.

Alicia Topoll, MD is a first-year fellow in the Hospice and Palliative Medicine Fellowship. Dr. Topoll received a BS in Combined Sciences from Youngstown State University.  She received her MD from the Northeast Ohio Medical University in 2008. After completing a military internship in Internal Medicine at Naval Medical Center San Diego, she was attached to Heavy Marine Aircraft Group 463 stationed at Marine Corps Base Hawaii, Kaneohe Bay, Hawaii.  After completing her military service, she completed Internal Medicine residency at Texas Health Presbyterian Hospital of Dallas in 2016 where she was a Chief Resident.  Most recently, she completed Cardiology fellowship at University of Pittsburgh Medical Center in 2019.  Dr. Topoll has an interest in specialty palliative care as it relates to heart failure and complex cardiac diseases in addition to medical education.

Fellowship Application and Additional Information

Post-residency physician fellows must meet the following criteria:

  • Have completed an ACGME or AOA-accredited residency program in anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry, radiation oncology, or surgery
  • Be board-certified or board-eligible with demonstration of active pursuit of certification
  • Demonstrate interest in pursuing an academic career with palliative care as a primary focus

Fellowship applicants submit applications through the Electronic Residency Application Service (ERAS). Of note, the specialty of Hospice and Palliative Medicine participates in the match process. Applications will be accepted through ERAS the summer prior to fellowship start. Please contact us directly if you have any questions about the application process.

All completed applications will include:

  • A personal statement (a statement of the applicant’s interest in and commitment to an academic career in palliative care)
  • At least three letters of support, one of which should be from the applicant’s department head, program director, or division chief
  • Scores from USMLE Step 1, 2, and 3
  • A curriculum vitae
  • Medical school transcripts
  • MSPE

For more information, contact:

Rene Claxton, MD, MS Associate Professor of Medicine Program Director, Hospice and Palliative Medicine Fellowship Section of Palliative Care and Medical Ethics Montefiore 933W 200 Lothrop Street Pittsburgh, PA 15213 E-mail: claxtonrn@upmc.edu

Sara Carter UPMC Montefiore Hospital Suite N715| 200 Lothrop Street | Pittsburgh, PA 15213 Phone: 412-683-7647 Fax: 412-692-4944 E-mail contact: carters10@upmc.edu

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