Palliative Care

Introduction

The Palliative Medicine Residency is a coordinated one-year (13-rotation/year) training program that provides the trainee with a broad clinical experience in a variety of institutional and community settings.

It is accredited by the College of Family Physicians of Canada and is under the Family Medicine Department at McGill University.

The program includes rotations on the palliative care services at McGill University’s teaching hospitals. Each is somewhat different in their approach and services and should provide a good range of clinical experiences, including in-patient palliative care, outpatient clinics (lymphedema/day hospital/cancer rehab, cancer cachexia/cannabis and cancer pain clinics), consult service and home care. Rotating through these settings, the trainee develops clinical skills in dealing with pain and various symptom management situations, as well as the psychological, emotional, and spiritual needs of terminally-ill patients and their families. The trainee sees patients who have access to the full spectrum of cancer care from diagnosis, to cure, to terminal care. Non-cancer patients with challenging symptom control problems are also seen.

Trainees will also do continuity of care clinics within family medicine as part of their year with us.

There is a mandatory month in medical oncology and one in radiation oncology for those trainees who have not had training in these previously.

There are two (2) elective months in palliative care. (three or four for trainees who have already completed training in medical oncology and/or radiation oncology). A popular elective has been pain service but can also be organized in geriatrics, neuro-palliative care, family medicine with POCUS (point of care ultrasound), home care and other rotations of choice relevant to your future career plans.

During the selective month, the resident will have the possibility of pursuing a particular aspect of palliative medicine of his/her choice. Possible rotations could take place in a hospice, at the outpatient palliative care clinic (Day Hospital), on consult service, a palliative care unit, pediatric palliative care or be a research month as part of your research project. The rotation can be organized either at a McGill affiliated hospital, another university affiliated hospital or in a community hospice. The overall goal of this rotation is for the resident to be able to explore various settings of palliative care to aid in the resident’s career choices.

The resident will be able to:

• Develop expertise dealing with pain, symptom management, psychological, emotional & spiritual needs of those with advanced life-threatening illness to be able to provide primary and consultant palliative care services.
• Gain experience on inpatient units, consultation service, home care and clinics.
• Pursue basic academic and research goals with a network of residents and professionals from across Canada.

Being able to speak in both French and English are assets to be able to apply to this program.

Specific Objectives

Competencies of the Enhanced Skills Year in Palliative Medicine

General Goals

The overall goals of the program are:

1. To train physicians with added competency in the area of palliative medicine who will provide primary and consultant palliative care services.
2. To provide clinical and basic academic training for physicians who will be going on to academic careers in palliative medicine.

Educational Objectives of the Program

Successful residents will acquire a broad-based understanding of the principles, philosophy, and core knowledge, skills and attitudes of palliative care medicine, superimposed on the principles and competencies of generalist family medicine.

Four Principles of Family Medicine

• The family physician is a skilled clinician.
• Family medicine is a community based discipline.
• The family physician is a resource to a defined practice population.
• The patient-physician relationship is central to the role of the family physician.

Six Essential Skill Dimensions

• Patient-centered approach
• Clinical reasoning skills
• Communication skills
• Professionalism
• Selectivity
• Procedures

CanMeds FM Key Competencies

1. Family Medicine Expert

• Practices generalist medicine within their defined scope of professional activity
• Performs a patient-centered clinical assessment and establishes a management plan
• Plans and performs procedures and therapies for assessment and/or management
• Establishes plans for ongoing care and timely consultation when appropriate
• Actively facilitates continuous quality improvement for health care and patient safety, both individually and as part of a team
• Establishes an inclusive and culturally safe practice environment
• Contributes generalist abilities to address complex, unmet patient or community needs, and emerging health issues, demonstrating community-adaptive expertise

2. Communicator

• Develops rapport, trust, and ethical therapeutic relationships with patients and their families
• Elicits and synthesizes accurate and relevant information from, and perspectives of, patients and their families
• Shares health care information and plans with patients and their families
• Engages patients and their families in developing plans that reflect the patient’s health care needs, values and goals
• Documents and shares written and electronic information about the medical encounter to optimize clinical decision making, patient safety, confidentiality, and privacy

3. Collaborator

• Works effectively with others in a collaborative team-based model
• Cultivates and maintains positive working environments through promoting understanding, managing differences, minimizing misunderstandings, and mitigating conflicts
• Recognizes and facilitates necessary transitions in care with other colleagues in the health professions, including but not limited to shared care, transfer of care, and/or handover of care to enable continuity and safety

4. Leader

• Contributes to the improvement of comprehensive, continuity-based, and patient-centered health care delivered in teams, organizations, and systems
• Engage in the stewardship of health care resources
• Demonstrate collaborative leadership in professional practice to enhance health care
• Manages career planning, finances, and health human resources in practice

5. Health Advocate

• Responds to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment
• As a resource to their community, assesses and responds to the needs of the communities or populations served by advocating with them as active partners for system-level change in a socially accountable manner
• Identifies specific needs of underserved patients and populations, including reducing barriers and improving access to culturally appropriate care

6. Scholar

• Engages in the continuous enhancement of their professional activities through ongoing learning
• Teaches students, residents, the public, and other health care professionals
• Integrates best available evidence into practice considering context, epidemiology of disease, comorbidity, and the complexity of patients
• Contributes to the creation and dissemination of knowledge relevant to family medicine

7. Professional

• Demonstrates a commitment to patients through clinical excellence and high ethical standards
• Demonstrates a commitment to society by recognizing and responding to societal needs in health care
• Demonstrates a commitment to the profession of adhering to standards and participating in physician-led regulation
• Demonstrates a commitment to physician health and well-being to foster optimal patient care
• Demonstrates a commitment to reflective practice

Priority Topics in Palliative Medicine

1. Pain
2. Families
3. Advance Planning & Goals of Care
4. Working as a Team
5. Nausea/Vomiting/Bowel Obstruction
6. Imminent Death
7. Despair and Suffering
8. Community Resources
9. Breathlessness
10. Delirium
11. Anxiety & Depression
12. Palliative Sedation Therapy
13. Maintaining the Clinician’s Well-Being
14. Emergencies
15. Medical Assistance in Dying
16. Anorexia/Cachexia/Nutrition/Fatigue
17. Non-malignant illness

Core Professional Activities

• Most Responsible Physician
• Consults
• Being a Teacher and Scholar
• Being a Researcher
• Ethical Dilemmas
• Prognostication
• Resiliency in Practice
• Community Setting
• Family Meeting
• Symptom Management
• End-of-Life Care
• Team Integration

Program Description

Apply/Contact Us

For information regarding the program
Dr. Golda Tradounsky
Director Palliative Care Fellowship

For information regarding the application process
Karen French
Student Affairs Coordinator
514-934-1934 ext. 43879

Applicants can apply via CaRMS: https://www.carms.ca/match/family-medicine-enhanced-skills-match/

Please refer to the CaRMS website for details pertaining to the application period.