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Being diagnosed with a serious, life-threatening illness is an incredibly stressful situation for patients and their loved ones. Palliative medicine offers a unique, holistic support that focuses on patient comfort and quality of life, in tandem with care given by a disease-specific team.
With this style of medicine, it’s important for providers to communicate and listen well to develop a trusting, respectful relationship over a longer course of treatment.
“You have to know who the patients are,” said Dr. Toby Campbell, a thoracic oncologist and Chief of Palliative Care at UW Health. “You have to know what makes them tick and what makes their family tick to give them personalized advice about treatment options and symptom management and coping with the serious illness they’re facing.”
Palliative medicine takes a multi-faceted approach that not only responds to a patient’s physical ailments, but also includes care that supports emotional and spiritual wellness. Patients are eligible for palliative care at any stage of diagnosis, including while in active curative treatment.
The University of Wisconsin Division of Hematology, Medical Oncology and Palliative Care offers a robust one-year hospice and palliative training fellowship for doctors in a broad range of specialty fields who have completed their residency. Program Director Dr. Sara K. Johnson has overseen the fellowship program since 2017.
“Palliative care is a unique specialty because we always work in integrated inter-professional teams as given fellow physicians hail from a wide array of specialties—from emergency medicine to neurology to surgery,” said Johnson. “So the care of our patients—and each team members’ learning—benefits from the variety of perspectives and areas of expertise.”
Fellows are trained in variety of patient care settings under faculty mentorship, including at UW Health’s inpatient and outpatient palliative clinic, American Family Children's Hospital, William S. Middleton Memorial Veterans Hospital and with community hospice provider Agrace.
The program also features an optional second year of training to teach hospice and palliative medical education, which is funded through philanthropic giving.
Communication and relationship-building with both patients and their loved ones are vital aspects of training. Because patients are facing life-threatening illnesses, providers need to be prepared for difficult, emotional conversations. The fellowship uses a simulation-based curriculum, with actors playing patients and family members to simulate the range of reactions and scenarios the fellows will encounter so they can practice communication strategies.
“They’re able to be angry, sad, in denial … we can capture some very real reactions,” Campbell said of the actors. “And the fellows, after our simulation, they usually say that felt so real.”
The instructors observe these scenarios and talk with each fellow about what went well and what could have been handled better. The fellows are given communication frameworks and best practice tactics from which they can adapt to fit their natural style.
Dr. Michael Rubinson is an alum of the fellowship program who now is pursuing the second-year fellowship in hospice and palliative medical education. As part of that training, he serves as a clinical instructor. Rubinson said the scenario training and instructor feedback are valuable for building those vital communication skills.
“When you’re doing (the simulation), the nerves kick in and you’re sort of thinking, ‘What’s my next line?’ or ‘What am I going to say?’ So you’re not really in the moment, whereas when you can look back at it, you’re able to put yourself in the moment and you’re able to really analyze things more objectively,” he said.
Another aspect is helping fellows cope with the emotional weight of their work. The program includes in twice-monthly group meeting with instructors where fellows can reflect on their wellbeing and learn self-care strategies, as well as taking part in narrative writing workshops.
Rubinson said his fellowship experience strengthened his resolve to focus on palliative medicine.
“I feel I’m most effective in medicine when the patients and families are dealing with difficult decisions or a difficult diagnosis, and I get a lot of satisfaction from making that process as tolerable as possible,” Rubinson said.
In addition to the fellowship, students still in the UW School of Medicine and Public Health can do a two-week elective course that includes spending time observing the work of hospice and palliative care staff and spending time with hospitalized patients. The care staff debrief the students and help them reflect on communication skills as well as symptom assessment and management.
Campbell said these experiences are designed to make students more thoughtful and intentional in their patient interactions—skills that can be useful in any specialty area they pursue.
“What we’re teaching people is skills to use in conversations, to communicate effectively, to improve their ability to notice that, if they do things a little differently, the outcome of a conversation can be different,” Campbell said. “And that allows them to see that they can develop and become increasingly skillful in communication.”