Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S

Jillian L Gustin; Holly B Yang; Steven M Radwany; Tomasz R Okon; Laura J Morrison; Stacie K Levine; Jennifer M Hwang; Gary T Buckholz; Michael D Barnett; Nicole Verbeck; Lindy H Landzaat

doi:10.1016/j.jpainsymman.2019.02.013

Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S

J Pain Symptom Manage. 2019 May;57(5):1009-1017.e6. doi: 10.1016/j.jpainsymman.2019.02.013. Epub 2019 Feb 18.

Authors

Affiliations

¹ Division of Palliative Medicine, Department of Internal Medicine, Hospice and Palliative Medicine Fellowship Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Electronic address: jlgustin@hotmail.com.
² University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship Program, Scripps Health, San Diego, California, USA.
³ Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁴ Marshfield Clinic Palliative Medicine Fellowship, Marshfield Clinic, Marshfield, Wisconsin, USA.
⁵ Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁶ Palliative Medicine Programs, University of Chicago, Chicago, Illinois, USA.
⁷ Pediatric Advanced Care Team and Hospice and Palliative Medicine Fellowship, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁸ University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA.
⁹ University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ The Ohio State University College of Medicine, Columbus, Ohio, USA.
¹¹ Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.

PMID: 30790721
DOI: 10.1016/j.jpainsymman.2019.02.013

Abstract

Context: A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education.

Objectives: The objective of this study was to develop and vet CMs for HPM fellowships in the U.S.

Methods: A draft of CMs was developed through an iterative consensus group process with repeated cycles of drafting, analyzing, and revising by a broadly representative expert workgroup who then gained input from HPM educators at a national meeting workshop. The CM draft was subsequently revised and then vetted through a national survey to 203 fellowship educators. Respondents were asked to "keep," "revise," or "exclude" each proposed CM with space for comments. An agreement of 75% among respondents was set as the criteria a priori for keeping a CM. Eighty-four of the 203 potential respondents participated in the survey. All items met the minimum agreement level of 75% or greater recommending keeping the CM. Greater than 85% of the respondents agreed to keep 19 of the 22 CMs with no revisions. Comments for revisions on other CMs were primarily related to changes in language and formatting, not conceptual underpinnings.

Conclusion: A group consensus method strengthened by inclusion of a national survey to HPM fellowship educators resulted in a CM document that is both carefully developed and broadly vetted. Along with entrustable professional activities and new specialty-specific RMs, these CMs offer educators and trainees tools to create more comprehensive curricula and behaviorally based assessment tools for HPM fellowships and their stakeholders.

Keywords: Curricular milestones; fellowship; graduate medical education; hospice; palliative care.

MeSH terms

Adult
Aged
Aged, 80 and over
Consensus Development Conferences as Topic
Curriculum* / standards
Education, Medical, Graduate* / standards
Female
Hospice Care*
Humans
Male
Middle Aged
Palliative Care
Palliative Medicine / education*
Palliative Medicine / standards
Physicians
Societies, Medical
United States