Palliative Care

The Year of Added Competency (YAC) is based on a 13 rotation-year.  Nine of those rotations are on palliative medicine services. Those residents who will not have had previous exposure to medical oncology or radiation oncology will have to do a mandatory month in each of these. There is one selective which must take place in a palliative service of the resident’s choice and two electives. These three rotations are designed to complement the previous clinical experiences and respond to the resident’s anticipated career needs.

Over the course of the thirteen period residency, the trainee will gain clinical experience in homecare, community and hospice settings, pain clinics, anorexia-cachexia and lymphedema clinics, consult services and tertiary level palliative care units. This experience will take place in a variety of McGill University affiliated settings which are described below.

Sample schedule

The partner institutions include the McGill University Health Center (Royal Victoria and Lachine Hospitals), Sir M. B. Davis - Jewish General Hospital, St. Mary's Hospital, Mount Sinai Hospital, and the West Island Palliative Care Residence.

• Community and Homecare Palliative Care Mount Sinai Hospital
• Community Palliative Care St Mary’s Hospital
• Palliative Tertiary Care, Jewish General Hospital
• Palliative Care Unit - Tertiary Hospital McGill University Health Center (MUHC) Montreal General Hospital
• Palliative Care Hospital Consultation McGill University Health Centre (MUHC) Montreal General Hospital
• Medical and Radiation Oncology Rotations
• Palliative Care Hospital Consultation McGill University Health Centre (MUHC) Royal Victoria Hospital (RVH), Montreal Chest Institute (MCI) and Montreal Neurological Hospital (MNH)
• Montreal Children’s Hospital
• West Island Palliative Care Residence
• Pain Service Rotation Elective

Trainees will take part in the following small group learning activities:

• ABCs teachings at the Jewish General Hospital.
• Core teaching sessions are given by our attending physicians.
• National Academic Half Days (webinars) with Palliative Medicine residency programs across Canada.

At the undergraduate level, trainees lead:

• One "Palliative Care Visit" which are part of the 1st year Physicianship course whereby a group of six medical students accompanied by their Osler Fellow (mentor) meet with a physician (you) and patient on the Palliative Care Unit.
• An ABC session at the JGH.

We are also mandated by the Postgraduate Medical Education Office to oblige you to complete the online course, "Teaching Residents to Teach (Triple T Course)". In order to ensure excellence in your role as a teacher, this is a mandatory course as part of your residency training if not already completed in Family Medicine residency.

There will be a formative exam (at 6 months) and an evaluation exam (at 12 months) based on the core teachings that you do throughout the program.

Teaching Topics / Teaching Format

Medical and Radiation Oncology

The resident with no previous training in either oncology or radiation oncology will spend one month each in medical oncology and radiation oncology rotations. These will take place at the McGill University Health Center (Glen Site - Royal Victoria Hospital). The general goals of these rotations are to increase the resident's knowledge and skills regarding the care of cancer patients, the management of common complications of cancer, as well as to increase the resident's understanding of cancer patients' experiences at various stages of the disease.

Selective Month

During this 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 services, a palliative care unit, or be a research month as part of their 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 residents to be able to explore various settings of palliative care to aid in the resident's career choices.

Supportive Care Counselling

This training seeks to help you develop your communication skills as an end-of-life care physician. The topics covered will include psychological assessment, diagnosis, counselling skills, and case conceptualization. It is also intended to assist trainees to become aware of personal ideas, attitudes and viewpoints in order to better understand the impact of death on themselves, individuals, and the family. The training is largely an experiential learning forum following an action-reflection pedagogical model.

By the end of the course, fellows should be able to:

1. Learn about their personal beliefs, attitudes, values with respect to communication with patients at the end of life and their families.
2. Learn about the personal beliefs, attitudes, and values of other class members with respect to death, dying and bereavement.
3. Examine personal coping patterns, strategies, and behaviours.
4. Understand death, dying and bereavement from a multidimensional and interdisciplinary perspective.
5. Describe psychological aspects of death, dying, and bereavement.
6. Describe clinical approaches to working with the terminally ill and the bereaved.
7. Describe personal and professional growth.

Research is a mandatory component of our program. The program offers two levels of research training.

Level 1 is designed for Residents who wish to be palliative care clinicians but do not wish to be responsible for carrying out research projects. The objectives of Level 1 are:

1. Residents learn to critically assess the literature.
2. Residents develop an appreciation of the contribution of research to the goals of palliative care.

Level 2 is designed for Residents who wish to participate as co-investigators in research projects during their career and/or develop a better understanding of the research process than will be obtained in Level 1. The objectives of Level 2 are:

1. Residents learn to critically assess the literature.
2. Residents develop knowledge of the research process for palliative care studies and associated difficulties by participating in an ongoing research project or designing and implementing their own small project.
3. Residents develop an appreciation of the contribution of research to the goals of palliative care.

For more information, click here. 

Residents receive formal monthly and final evaluations using the palliative care specific McGill on-line evaluations (one45 ITER). These evaluations are based on collated evaluations of all palliative medicine physicians that have had contact with the resident, as well as feedback from other multi-disciplinary team members (including nurses, psychologists, music therapist). Direct observation forms filled in by attending staff also informs the site evaluator. PC residents are encouraged to ask for midway feedback and review their evaluation at the end of each block with the site evaluator.

There is a self-assessment questionnaire which residents fill in every few months which is a tool to help address progress and elaborate a learning plan for the weaker areas which the residents or staff have identified. This questionnaire is discussed with the Program Director. Progress is a standing topic at each monthly meeting with the Program Director.

Direct observation of resident teaching other health care professionals, rotating medical students and residents, and patients and families about palliative care (informally as well as formal teaching sessions) by medical staff and a PhD in education. The residents receive written reports on their teaching skills from this latter expert in education.

Residents meet regularly with the supervisor of their scholarly project in order to discuss progress. There are written quarterly reports of this progress which are reviewed by the research director.

A written exam based on the content of the core teachings is given at the 6th and 12th-period points. This exam is made up of short answers and multiple choice questions. At the 6-month mark, it is mostly intended to be formative. At the 12th –month mark, it is summative, pass/fail, and has an influence on the Final Iter, expert section.