ABSTRACT
Context
Few individuals have fellowship training in both hospice and palliative medicine (HPM)
and a surgical specialty including general surgery, general obstetrics and gynecology,
or affiliated subspecialties. There is a paucity of data to explain why some surgeons
choose to pursue HPM fellowship training.
Objective
Identify facilitators and barriers to palliative medicine fellowship training among
physicians from a surgical specialty.
Methods
We conducted individual semi-structured interviews with 17 surgeons who were also
fellowship-trained in HPM. Interviews were recorded, transcribed, and thematic analysis
was conducted to identify themes.
Results
Participants reported pivotal experiences—either positive exposure to palliative care
or suboptimal surgical care experiences—as a key motivator for pursuing specialty
palliative care training. Additionally, participants chose HPM training because they
felt that practicing from a HPM perspective aligned with their personal care philosophy,
and in some cases, offered professional opportunities to help achieve career goals.
Participants reported encountering bias from both HPM and surgical faculty, and also
found that some HPM fellowship programs did not accept surgical trainees. Surgeons
also reported logistical concerns related to coordinating a one-year fellowship as
a barrier to formal HPM training.
Conclusions
Understanding the motivations of surgeons who pursue HPM training and identifying
challenges to completing fellowship may inform solutions to expand surgeon representation
in palliative care. Both HPM and surgical faculty should be educated on the benefits
of specialty HPM training for surgical trainees and practicing surgeons. Further research
should explore HPM fellowship best practices for welcoming and training surgeons and
other underrepresented specialties.
KEY WORDS
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References
- Utilization of palliative care consultation service by surgical services.Annals of Palliative Medicine. 2015; 4: 194-199
- Concurrent Palliative Care for Surgical Patients.Surg Clin North Am. 2019; 99: 823-831
- A Profile of New Hospice and Palliative Medicine Physicians, in Results from the Survey of Hospice and Palliative Medicine Fellows Who Completed Training in 2018.The George Washington University Health Workforce Institute; American Academy of Hospice and Palliative Medicine, 2019
- ACGME Program Requirements for Graduate Medical Education in Hospice and Palliative Medicine.ACGME, Editor, 2020
- Using thematic analysis in psychology.Qualitative Research in Psychology. 2006; 3: 77-101
- Hospice and Palliative Medicine Fellowship after Surgical Training: A Roadmap to the Future of Surgical Palliative Care.J Surg Educ. 2022; 79: 1177-1187
- Value of Hospice and Palliative Medicine Fellowship After Surgical Training: Bridging the Gap for Improved Patient Care.American Journal of Hospice and Palliative Medicine®. 2022; 10499091221128966
- web application for managing, analyzing, and presenting qualitative and mixed method research data.SocioCultural Research Consultants, LLC Los Angeles, CA2021
- Thematic analysis of qualitative data: AMEE Guide No. 131.Med Teach. 2020; 42: 846-854
- Obstetrics and Gynecology Milestones.ACGME, Editor, 2022
- Surgery Milestones.ACGME, Editor, 2019
- Surgical palliative care training in general surgery residency: An educational needs assessment.Am J Surg. 2019; 217: 928-931
- Palliative Care Rotations in Obstetrics and Gynecology, Internal Medicine, and Family Medicine Residency Programs [14I].Obstetrics & Gynecology. 2017; 129: 96S
- Debriefing decreases mental workload in surgical crisis: A randomized controlled trial.Surgery. 2017; 161: 1215-1220
Dingfield, L., Addressing a Workforce Crisis: Innovations in Training for HPM Specialists, C.t.A.P. Care, Editor. 2020, CAPC.
- Mid-Career Training to Advance Palliative Care.J Palliat Med. 2022; 25: 705-711
AAHPM. Continuing HPM Certification. 2022 January 2nd 2023]; Available from: https://aahpm.org/career/moc-occ.
- Surgery, palliative care, and the American College of Surgeons.Annals of Palliative Medicine. 2015; 4: 5-9
- Future of the Palliative Care Workforce: Preview to an Impending Crisis.Am J Med. 2017; 130: 113-114
- Surgical Palliative Care-Where Are We in 2020?.Am Surg. 2020; 86: 1436-1440
Article info
Publication history
Accepted:
January 10,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Editorial Comment: Amy A. Case, MD, FAAHPM. Associate Editor.
A timely and important piece exploring surgeons pursuing Hospice and Palliative Medicine training.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
