Advanced Training in Palliative Medicine:
Some Fellowship Opportunities

    This section presents information about opportunities for hands-on postgraduate (specialist) training in academic palliative medecine in the UK, Canada and the US. Clinical fellowships (often combined with research opportunities) give fellows direct patient-care responsibilities and prescribing privileges.  Fellowships are generally competitive, linked with a teaching hospital, and provide a high standard of academic training.

    This section does not include observerships, a distinct type of educational experience allowing trainees to spend from one day to two weeks observing patient wards with seminars, discussion, patient care studies and/or lectures.

    Readers are invited to submit to Cancer Pain Release information about academic programs offering advanced hands-on training in palliative medicine.


Cantel/Overton Fellowship in palliative medecine

Where: Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
Type of fellowship: clinical/research.
Emphasis on: (1) management of pain and other symptoms; (2) research in pain relief and palliative care; (3) psychosocial support. Setting: homecare, hospital outpatient clinics, specialized inpatient palliative care unit, consultation team in three teaching hospitals.
Patients' characteristics: advanced cancer; some AIDs patients.
Training formats: experiential learning at bedside; journal club; case-based small group discussions; lectures.
Accreditation: Fellowship is accredited by the University of Alberta.
Offered since: 1991.
Eligible: licensed physicians post-residency.
Length: one year minimum.
Size of training program: 1 fellow/year.
Disciplines represented: Family medecine, medical oncology.
Funding: Fellow receives salary based on level of training. Fellowship is fully funded by the University of Alberta.
Comments: Non-Canadian applicants are accepted only if there are no qualified Canadian applicant; opportunity for hands-on learning and research in palliative medicine. Past fellows have come from North America, Europe, and South America. Competitive recruitment in progress for July 1997 start date.
Additional information from: Eduardo Bruera, MD, Division of
Palliative Care Medicine, Edmonton General Hospital, 11111 Jasper Avenue, Edmonton, AB T5K 0L4, CANADA. Tel: 403-450-7730; Fax: 403-450-7700.


Fellowship in palliative medicine

Where: Institute of Palliative Care, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
Type of fellowship: clinical.
Emphasis on: (1) management of pain and other symptoms; (2) drug use, dosage and side effects; (3) teaching skills in palliative care.
Setting: acute care cancer hospital; consultation service
Patients' characteristics: advanced cancer.
Training formats: experiential learning at bedside; clinical rounds; journal club; case-based small group discussions; lectures; role-playing; videotapes; teaching residents.
Accreditation: Fellowship accredited by Institute of Palliative Medicine of the University of Ottawa; no national accreditation yet.
Offered since: 1990.
Eligible: licensed physicians after specialty training.
Length: One year, renewable.
Size of training program: 3 fellows/year.
Disciplines represented: Family medicine, internal medecine, and oncology.
Funding: Fellows receive salary matching level of training.
Comments: Individualized program, fellows have to obtain an educational license to be able to prescribe; this is not difficult if candidates come from accredited medical schools. English and French-speaking applicants welcome. Past fellows from North America and Europe. All graduates are employed in palliative medicine. Competitive recruitment in progress for July 1997 start date.
Additional information from: John Scott, MD, Director, Institute of Palliative Care, University of Ottawa, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, CANADA. Tel: 613-560-6301; Fax: 613-560-1487. Email: jscott@scohs.on.ca


A.V. Davis Foundations Visiting Fellowship in Hospice and Palliative Medicine

Where: Northwestern University School of Medicine, Chicago, IL, USA.
Type of fellowship: clinical.
Emphasis on: (1) management of pain and other syndromes; (2)inpatient hospital care; (3) homecare; (4) providing consultative services to others in hospital.
Setting: acute care cancer hospital; consultation service.
Patients' characteristics: 500 inpatients/year; 50 percent with metastatic cancer; 25 percent with AIDS.
Training formats: experiential learning at bedside; clinical rounds; case-based small group discussions; handbook; role-playing; videotapes; teaching residents.
Accreditation: none.
Offered since: October 1995.
Eligible: licensed physicians post-residency.
Length: 1 or 2 months.
Size of training program: 1 fellow per session.
Disciplines represented: Internal medicine.
Funding: Salary based on level of training; financial support comes from the AV Davis Foundations.
Comments: Fellow must be licensed to practice in the state of Illinois. Integration of teaching with practice.
Additional information from: Charles Von Gunten, MD, PhD, Hematology/Oncology, Northwestern University Medical School, 303 East Chicago Avenue, Chicago, IL 60611, USA. Tel: 312-908-1640. Fax: 312-908-4070.


Fellowship in pain and palliative care

Where: Pain and Palliative Care Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
Type of fellowship: clinical/research.
Emphasis on: (1) management of pain and other symptoms; (2) drug use, dosage and side effects; (3) psychosocial support; (4) team approach to care; (5) substance abuse issues; (6) issues related to nonmalignant pain.
Setting: acute care cancer hospital; consultation service.
Patients' characteristics: 8 to 10 patients/week; metastatic cancer; some AIDs patients.
Training formats: experiential learning at bedside; clinical rounds; journal club; case-based small group discussions; lectures.
Accreditation: none.
Offered since: 1982.
Eligible: licensed physicians post-residency.
Length: two years.
Size of training program: 5 to 8 fellows/year.
Disciplines represented: Internal medicine, neurology, psychiatry, rehabilitation medicine, pediatry.
Funding: Salary based on level of training, plus subsidized housing.   The fellowship is supported by grants and philanthropy.
Comments: Past fellows from North America, Europe, Eastern Mediterranean, Western Pacific. Hands-on clinical responsibility, on call 24 hr, strong academic program, exposure to large number of pain problems, excellent opportunity for research in palliative medicine.
Competitive recruitment in progress for July 1997 start date.
Additional information from: Mary Callaway, ME, Pain and Palliative Care Service, Box 52, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. Tel: 212-639-2421; Fax: 212-717-3081.


Palliative medicine fellowship

Where: Cleveland Clinic Cancer Center, Cleveland, Ohio, USA.
Type of fellowship: clinical.
Emphasis on: (1) management of pain and other symptoms; (2) cancer care; (3) psychosocial support; (4) multidisciplinary approach to care; (5) acute medical care; (6) internal medicine.
Setting: Comprehensive palliative care program (acute care, hospice, homecare service, outpatient clinic, consultation).
Patients' characteristics: 200/day requiring acute palliative care; patients stay an average of 8 days; the majority die at home.
Training formats: experiential learning at bedside; clinical rounds; journal club; case-based small group discussions; lectures, teaching residents.
Accreditation: none.
Offered since: 1991.
Eligible: licensed physicians post-residency.
Length: one year, renewable.
Size of training program: 3 fellows/year.
Disciplines represented: Internal medicine, family medicine, medical oncology, anesthesiology, surgery, radiotherapy.
Funding: Fellows receive salary matching level of education.
Comments: Focus is to educate practitioners in principles of palliative medicine; strong link with teaching hospital is a way to institutionalize the program. Past fellows from North America, Mexico, Europe. Competitive recruitment in progress for July 1997 start date.
Additional information from: T. Declan Walsh, MSc, FACP, Palliative Care Program T10, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Tel: 216-444-7793. Fax: 216-444-9464.


Cancer Pain Fellowship

Where: Section of neuro-oncology and anesthesiology, MD Anderson Cancer Center, Houston, Texas, USA.
Type of fellowship: clinical.
Emphasis on: (1) diagnosis of pathophysiology of pain; (2) drug use, dosage and side effects; (3) invasive anesthesia and neurosurgery.
Setting: acute care cancer hospital; outpatient clinic; hospice.
Patients' characterictics: 8 to 10 /week; metastatic cancer; some AIDs patients.
Training formats: experiential learning at bedside; clinical rounds; journal club; case-based small group discussions; lectures.
Accreditation: Fellowship is accredited by the American Board of Anesthesiology.
Offered since: 1991.
Eligible: licensed physicians post-residency.
Length: one year, renewable.
Size of training program: 4 fellows/year.
Disciplines represented: Internal medicine, oncology, anesthesiology, rehabilitation, neurology.
Funding: Fellows receive salary based on level of training. The fellowship is supported by the state of Texas and is institutionalized in two departments: neuro-oncology and anesthesiology.
Comments: Past fellows from North America, Europe (Italy), South America (Brazil), South East Asia (India), Africa (Nigeria). Foreign fellows can obtain an institutional license to practice; opportunity for integrating research and clinical practice in palliative medecine. Competitive recruitment in progress for July 1997 start date.
Additional information from: Robert Allen, MD, Training Fellowship Committee, Neuro-Oncology Section, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4095, USA. Tel: 713-745-1736; Fax: 713-794-4999.


International School for Cancer Care fellowship

Where: St. Peter's College, Oxford, and Princess Alice Hospice, Esher, United Kingdom.
Type of fellowship: classroom and clinical mixed.
Emphasis: (1) Attitudes toward death and dying; (2) management of pain and other symptoms.
Setting: hospital palliative care units, community support teams.
Patients characteristics: advanced cancer.
Training formats: student-centered learning; multiprofessional team approach; observation of patients, classroom lectures.
Accreditation: none.
Offered since: 1993.
Eligibility: Board eligible or board certified physicians.
Length: four weeks.
Size of training program: 15-25 fellows/session.
Disciplines represented: Internal medicine, neurology, psychiatry, rehabilitation medicine, pediatry.
Funding: Support available from UK cancer charities and/or pharmaceutical companies.
Comments: Doctors and nurses from the same institution are encouraged to apply jointly for fellowship. Past fellows have come from Africa, South America, Europe, Eastern Mediterranean, South East Asia.
Additional information from: International School for Cancer Care, Sir Michael Sobell House, Churchill Hospital, Oxford OX3 7LJ, UK. Tel: 44-186-522-5886. Fax: 44-186-522-5599.


Postgraduate palliative care education in the UK

The Hospice Information Service in London has identified providers of palliative education throughout the United Kingdom. A fact sheet describes about 30 full degrees/diplomas.
Additional information from: Fact sheet on Palliative Care Education, Hospice Information Service, St. Christopher's Hospice, 51-59 Lawrie Park Road, London SE26 6 DZ, UNITED KINGDOM. Tel: 44-181-778-9252. Fax: 44-181-776-9345.