Section of Palliative Care and Medical Ethics

Hospice and Palliative Medicine Fellowship

TESTIMONIALS

UPMC GME HOSPITAL TOUR

UPMC GME PROGRAM OVERVIEW

WELL-BEING CURRICULUM

PEDIATRIC TRACK

COMMUNICATION

FACULTY COMMITMENT

MENTORSHIP

PITTSBURGH

CHILDREN’S HOSPITAL TOUR

The University of Pittsburgh’s Fellowship in Hospice and Palliative Medicine offers three 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 one-year pediatric-track clinical fellowship offered by the Section of Palliative Care and Medical Ethics in conjunction with the Division of Palliative Medicine and Supportive Care at UPMC Children’s Hospital of Pittsburgh 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, hospital, or academic setting. In addition to teaching symptom assessment and management in a wide variety of disease processes, we have developed a rigorous and highly regarded communication curriculum that equips fellows to excel in their communication 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.

      We also offer a separate fellowship track in pediatric palliative care.

      Training Sites
      UPMC Presbyterian Hospital; Level I Regional Resource Trauma Center and a renowned quarternary center for organ transplantation. UPMC Shadyside Hospital is a nationally ranked tertiary care hospital specializing in medical and surgical oncology care.
      UPMC Mercy Hospital is home to the UPMC Rehabilitation Institute’s Centers of Excellence in stroke rehabilitation, spinal cord injury, and brain injury. UPMC Children’s Hospital of Pittsburgh is a nationally ranked in all 10 pediatric subspecialties surveyed by US News & World Report.  It is also recognized as a top pediatric hospital for innovation and technology and has been praised as one of the nation’s most creatively beautiful hospitals.
      Hillman Cancer Center is the region’s only comprehensive cancer center designated by the National Cancer Institute. Family Hospice is the leading not-for-profit, community-based hospice organization in the region. It’s 12-bed inpatient unit is housed within UPMC Canterbury nursing facility.

       

      Adult Fellowship Clinical Program
      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 2 months each at UPMC Presbyterian-Montefiore Hospitals, UPMC Shadyside Hospital, and UPMC Mercy hospital, for a total of six months in the inpatient setting. Adult medicine 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 10 weeks within the hospice setting with a flexible structure between inpatient and home hospice depending on educational value and patient need. The first 4 weeks will be primarily at the inpatient unit with dedicated 1:1 teaching by the academic hospice attending. During this time, fellows will be allowed to perform home hospice visits when this provides educational value or patient continuity.  The second 4 weeks will be primarily home hospice visits. The fellows will be encouraged to make visits with various members of the interdisciplinary team and also to make independent visits. If there is educational value in spending additional time at the inpatient unit, fellows will be encouraged to do so. Fellows may also have teaching opportunities with residents and medical students during the second 4-week block. The remaining 2 weeks will be dedicated to a bereavement and spiritual care experience within the hospice setting and will be facilitated by the hospice bereavement and chaplaincy staff.
      • Long-Term Care – Fellows will receive 1 month of a long-term care experience. This includes rounding at a UPMC nursing facility with 1:1 teaching with a geriatrician. It may also include wound care, geriatric psychiatry, and outpatient programs such as the Advanced Illness Care Program and Community Life.  These programs focus on holistic care for elderly adults and keeping them healthy and at home.
      • Outpatient Clinic – Fellows will maintain their own outpatient clinic practice of one half-day a week under the supervision of palliative care faculty.  The primary site is Hillman Cancer Center Pain and Supportive 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 2 months on clinical elective experiences.  Many formal elective experiences are available.  Most notably among these is a non-malignant palliative care experience which includes time spent in dedicated renal, cardiac, and pulmonary palliative care clinics as well as some time spend in relevant areas of neurology such as Multiple Sclerosis and Huntington’s Disease.  A robust elective experience in Behavioral Medicine is also offered. Additional electives are available in ethics, addiction medicine, integrative medicine, geriatrics, chronic pain, pediatrics, liver transplantation, critical care, cardiology, and pulmonary care and can easily be arranged in other areas of special interest.
      • Other Experiences – Fellows attend all the relevant ongoing teaching conferences, including Journal Club (in which they present biannually), 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.
      • 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. This course occurs for 3 hours/week for 6 weeks in October and November.
      • Chief’s Rounds – This educational series meets weekly for one hour and includes a wide variety of topics including early communication skills, case-based ethics discussions, reflective reading and writing, mindfulness training, music therapy, dignity therapy, social justice, navigation of legal matters, and career advisement, and open case discussion.
      • Communication Skills – Fellows receive a rigorous and comprehensive communication training in various settings. A summer intensive communication series occurs in Chief Rounds which introduces the fundamentals of our communication mental model.  The fellows also receive sessions in the important skills of Motivational Interviewing by highly trained palliative care faculty.  Importantly, fellows attend a three-day intensive communication retreat (Pallitalk) 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, and disclosing medical errors.
      • Well-Being Curriculum – In order to provide a comprehensive fellowship training that lays the foundation of a long and fulfilling career in Palliative Care, we strongly believe that our fellows need to develop sustainable skills in coping and resiliency.  We have created a Well-Being curriculum that supports our fellows as both a bonded group and as individuals. This includes a monthly process group, a robust mentorship program, reflective reading and writing sessions, mindfulness-based self-care, and a 4-session museum-based education (MBE) curriculum in partnership with the Carnegie Museum of Art. The MBE curriculum focuses on such areas as perspective-taking, the culture of medical training, sitting with our own difficult emotions, and building skills in resiliency such as self-compassion, meaning, connection, and gratitude.

      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.

      Pediatric Track

      A one-year pediatric focused clinical fellowship is offered to applicants preparing for an academic and/or clinical career in pediatric hospice and palliative medicine.  Fellows in this track will receive rigorous training in pediatric palliative care with a focus on pain and symptom management, decision making support, care coordination, end-of-life and hospice care, and bereavement care for children and young adults with life-threatening and life limiting illness.  This fellowship program is fully accredited by the ACGME, and graduates will be board eligible for Hospice and Palliative Medicine via their primary boarding organization. 

      The inpatient pediatric experience is hosted by UPMC Children’s Hospital of Pittsburgh, a premier pediatric institution which is nationally ranked as a top 10 children’s hospital by US News and World Report.  Established in 2003, the palliative care program at UPMC Children’s Hospital of Pittsburgh is consulted by multiple services including: oncology, neonatology, cardiology, hospital medicine, critical care medicine, cardiac transplant, gastrointestinal transplant, neurosurgery, and cardiac critical care medicine.  A continuity clinic is offered in conjunction with the complex care clinic which cares for children who have complex medical issues.  The program has 3 full time faculty members, a nursing manager, 3 advanced practice providers, a social worker, a bereavement coordinator, and a sibling bereavement coordinator.

      Pediatric based electives include perinatal palliative care, music therapy, art therapy, child life, bereavement care, sibling bereavement camp, pediatric physical medicine & rehabilitation service (inpatient or outpatient), outpatient complex care clinic, and pediatric neurology consult service.  The pediatric team is also willing to design electives to meet the needs of our fellows.

      Pediatric fellows will participate in the same structured didactics, scholarly activities, and other learning opportunities as adult fellows. Fellows also have access to both adult and pediatric faculty who have won numerous awards for both clinical care and teaching.

      Notably, applicants who have trained in pediatrics may apply to the pediatric track, the traditional fellowship track, or both.

      Pediatric Faculty:

      Scholarly Activities
      • Quality Improvement and Patient Safety Project – All fellows complete a quality improvement project. Fellows work together as a group and are able to choose from a variety of quality improvement projects that are ongoing within the Section of Palliative Care and Medical Ethics. Fellows work 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.
      • Root Cause Analysis Case Presentation – Fellows will become familiar with the process of RCA through a dedicated curriculum within Chief Rounds. In 5 short sessions throughout the year, fellows will work through choosing a case, creating fishbone diagrams, identifying stakeholders, and brainstorming recommended actions . These sessions are facilitated by physician faculty experienced in patient safety and quality improvement. The mini-series approach will allow fellows to start to incorporate this type of critical thinking into their daily practice.
      • 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 theirs. 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 within the Division of General Internal Medicine and the Department of Medicine. Our active research program has been successful in obtaining millions of dollars in grant support and have collaborative relationships with educators and researchers in oncology, ethics, anesthesia, and geriatrics.

      Fellows

      First Year Fellows

      Kathryn Wunderle

      Medical School: University of Rochester School of Medicine and Dentistry
      Residency: Oregon Health & Science University

      Dr. Wunderle is a first-year fellow in the Hospice and Palliative Medicine Fellowship. Dr. Wunderle graduated graduated magna cum laude with a BA in Psychology from Amherst College. She completed her premedical requirements at the post-baccalaureate program at Bryn Mawr College, and then graduated from the University of Rochester School of Medicine and Dentistry in 2015. After finishing residency in Internal Medicine at Oregon Health and Science University in Portland, Oregon, she completed a fellowship in Critical Care Medicine at UPMC. Dr. Wunderle is interested in medical education, in particular teaching others how to lead conversations about goals of care for critically ill patients. She enjoys baking, running so that she can enjoy what she has baked, hiking, traveling, reading, and spending time with her husband, Dylan, and new daughter, Brienne.

      Kelly Wolenberg Harris

      Medical School: Vanderbilt University School of Medicine
      Residency: Vanderbilt University Medical Center – Pediatrics

      Dr. Kelly Wolenberg-Harris is a first-year fellow in the Hospice and Palliative Medicine Fellowship. A native of Richmond, Virginia, Dr. Harris received a BA with Honors in both Religious Studies and Biology from the University of Chicago in 2011. She received her MD with a Certificate in Biomedical Ethics in 2016 from Vanderbilt University School of Medicine. She completed residency in Pediatrics at Vanderbilt University Medical Center in 2020, after dedicating an extra year of training as a V-StARR Resident Scholar through the NIH R38 grant to research the longitudinal experience of parents who receive a prenatal diagnosis of congenital heart disease. Her other research projects have involved qualitative, quantitative, and historical methods on topics such as clinical ethics consultation and the intersection between medicine and religion. She looks forward to a career as a physician-scientist within the fields of pediatric palliative care and medical ethics. Additionally, she enjoys reading, traveling, and experiencing new restaurants with her husband Dr. Nick Harris, who is currently a resident in Pediatrics at UPMC, and spending time with their adopted dogs, Brandy and Maxwell.

      Alyssa Buckenheimer

      Medical School: Creighton University School of Medicine     
      Residency: Wake Forest Baptist Medical Center

      Dr. Buckenheimer is a first-year fellow in the Hospice and Palliative Medicine Fellowship.  Dr. Buckenheimer is originally from St. Louis, MO. She graduated summa cum laude with a BS in Cell and Molecular Biology from Missouri State University in 2012 and received her MD from Creighton University School of Medicine in 2016. She completed residency in Internal Medicine at Wake Forest Baptist Medical Center in 2019 followed by a year as Chief Resident. Professional interests include symptom management in advanced cancer and social media in medical education. Outside of medicine she enjoys hiking, camping, baking, and spending time with her husband, toddler, and furbabies.

      Cathal Delaney

      Medical School: Royal College of Surgeons in Ireland
      Residency: UPMC Children’s Hospital of Pittsburgh

      Dr. Delaney is a first-year fellow in the Hospice and Palliative Medicine Fellowship.  is from Dublin, Ireland. He completed medical school at the Royal College of Surgeons in Ireland, earning a first-class honours degree. He completed a year of training in Beaumont Hospital in Dublin in general medicine, pediatrics and surgery before coming to Pittsburgh for Pediatric residency at UPMC Children’s Hospital of Pittsburgh. Dr. Delaney has undertaken research regarding pediatric resident’s knowledge and attitudes related to spiritual care. He is interested in communication research and the practice of pediatric palliative care. He is also interested in music, he plays the trombone and Irish flute, as well as travelling and spending time with family and friends.

      Second Year Fellows

      Carla Khalaf McStay, MD is a second-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 second-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.
      Alicia Topoll, MD is a second-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.

       

      Leadership

      Rebecca Sands, DO

      Program Director, Hospice and Palliative Medicine Fellowship

      Section of Palliative Care and Medical Ethics

      E-mail: sandsrl@upmc.edu

      Scott Maurer, MD

      Pediatric Site Director, Hopsice and Palliative Medicine Fellowship

      Supportive Care Program

      UPMC Children’s Hospital of Pittsburgh

      E-mail: scott.maurer@chp.edu

      Amanda Brown, MD, MS

      Pediatric Site Director, Hospice and Palliative Medicine Fellowship

      Supportive Care Program

      UPMC Children’s Hospital of Pittsburgh

      E-mail: amanda.brown@chp.edu

      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 or COMLEX Level 1, 2, and 3
      • A curriculum vitae
      • Medical school transcripts
      • MSPE

       

      For more information, contact:

      Rebecca Sands, DO
      Assistant 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: sandsrl@upmc.edu

      Joey Pizzuti
      UPMC Montefiore Hospital Suite N715
      200 Lothrop Street
      Pittsburgh, PA 15213
      Phone: 412-683-7647
      Fax: 412-692-4944
      E-mail: pizzutijm@upmc.edu

      The University of Pittsburgh Hospice and Palliative Medicine Fellowship is fully committed to anti-racism and social justice. Our mission includes the recruitment and training of a diverse community of fellows that will contribute to providing outstanding palliative care to all members of our society without bias or discrimination.

      Contact Us

      Division of General Internal Medicine Academic Offices

      UPMC Montefiore Hospital
      Suite W933
      Pittsburgh, PA 15213
      412-692-4821

      Patient/clinical inquires

      412-692-4888

      Administrative office

      412-692-4889