University vs Community programs

[Frazier]

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Any thoughts on how this juxtaposition compares at the HPM fellowship level?

I went to a hyper-academic medical school and then switched it up with residency at a traditional community program.

Curious if there is a sentiment regarding the differences across university programs and community programs in HPM... Guessing the standard "more research opportunities, more teaching opportunities, and more zebra diagnoses" at the university programs still applies.

Any further thoughts, or experiences, from what people have seen/heard?

 

[geripalgal]

What I noticed when i was applying for fellowship a few years back, the big name academics - specifically harvard - had great palliative programs, but subpar hospice experiences. Harvard did not own their own hospice, and contracted with a large community hospice - when fellows rotated in hospice it was seemed more of an observer type experience.

 

[Houmd]

Many big name centers tend to have much more emphasis on complex symptom management as opposed to hospice or the psychological components whereas community programs tend to have more of a purist approach with not as in depth "symptomatology" by comparison.

 

[Phase1Phase2]

At the HPM fellowship level, your training will be highly dependent on the select few individuals that you train under. Consider it an apprenticeship with a handful of physicians responsible for your education and try to best select those individuals who will teach you and help you succeed. Brand name institutions are helpful for your CV, but do not guarantee a particular training experience. Additionally, it is my belief that HPM programs are inherently clinically focused due to the economics of the specialty as a cost saver, so I don't see a significant value in training at a program known for research in other departments... it doesn't translate the same way.

Things that matter:

1. Board pass rate.
2. Quality of attending physicians responsible for your education. Ask about didactic curriculum and degree of supervision/latitude for independent decision making in the second half of the year.
3. Longitudinal palliative care clinic where you are responsible or at a minimum directly involved in outpatient symptom management associated with malignancies.
4. Inpatient consult service where you will follow patients for symptom management and transition to hospice care or administer end-of-life care on the medical ward or ICU.
5. Clinical experiences that expose trainees to the medical/legal issues surrounded with death and dying.
6. Opportunity to moonlight as a hospice physician outside of fellow duty hours, not only for additional income but also for the experience.
7. Exposure to the business aspects of hospice care.
8. Opportunities for teaching. In reality, most physicians should be (but often are not) equipped to handle much of the realm now covered by HPM. As such, the HPM-trained physician has a role as a physician educator and this should be incorporated into the curriculum.

The boards have a lot of questions that day to day practice as a fellow and attending do not prepare you for - you just need to prepare by doing the questions. The UNIPAC series is also very helpful. A good strategy is to read one textbook longitudinally during the 6 months of the year and do the board review questions and UNIPAC during the second half. Note, HPM boards have been offered every other year, with the most recent exam held 11/2018.

If you have other questions, feel free to message directly.

Phase1Phase2

 

[Frazier]

At the HPM fellowship level, your training will be highly dependent on the select few individuals that you train under. Consider it an apprenticeship with a handful of physicians responsible for your education and try to best select those individuals who will teach you and help you succeed. Brand name institutions are helpful for your CV, but do not guarantee a particular training experience. Additionally, it is my belief that HPM programs are inherently clinically focused due to the economics of the specialty as a cost saver, so I don't see a significant value in training at a program known for research in other departments... it doesn't translate the same way.

Things that matter:

1. Board pass rate.
2. Quality of attending physicians responsible for your education. Ask about didactic curriculum and degree of supervision/latitude for independent decision making in the second half of the year.
3. Longitudinal palliative care clinic where you are responsible or at a minimum directly involved in outpatient symptom management associated with malignancies.
4. Inpatient consult service where you will follow patients for symptom management and transition to hospice care or administer end-of-life care on the medical ward or ICU.
5. Clinical experiences that expose trainees to the medical/legal issues surrounded with death and dying.
6. Opportunity to moonlight as a hospice physician outside of fellow duty hours, not only for additional income but also for the experience.
7. Exposure to the business aspects of hospice care.
8. Opportunities for teaching. In reality, most physicians should be (but often are not) equipped to handle much of the realm now covered by HPM. As such, the HPM-trained physician has a role as a physician educator and this should be incorporated into the curriculum.

The boards have a lot of questions that day to day practice as a fellow and attending do not prepare you for - you just need to prepare by doing the questions. The UNIPAC series is also very helpful. A good strategy is to read one textbook longitudinally during the 6 months of the year and do the board review questions and UNIPAC during the second half. Note, HPM boards have been offered every other year, with the most recent exam held 11/2018.

If you have other questions, feel free to message directly.

Phase1Phase2

Thanks for the tips and key points to look out for! Plan on revisiting this guide as we get closer to interviews.