Children's Hospital Los Angeles Program

The Hospice and Palliative Medicine Fellowship at Children's Hospital Los Angeles is a comprehensive one-year program accredited by the Accreditation Council for Graduate Medical Education (ACGME). Focused on developing physicians' expertise in symptom management, medical decision-making, and enhancing quality of life for patients with life-threatening and life-limiting illnesses, this fellowship integrates clinical training and interdisciplinary collaboration.

Located at a state-of-the-art 413-bed quaternary care facility, which has been distinguished as one of the top 10 children’s hospitals by U.S. News & World Report, the fellowship offers a rich learning environment. The program aims to nurture pediatric palliative care providers who demonstrate a commitment to quality care.

Curriculum Highlights

Within this program, fellows have access to one of the largest and most active pediatric palliative care services in the United States. The curriculum emphasizes hands-on clinical experience across various settings.

Inpatient Palliative Consult Service

Fellows dedicate 6.5 months to the busy inpatient pediatric palliative care consultation service at Children's Hospital Los Angeles. They work with a comprehensive interdisciplinary team consisting of physicians, advanced practice nurses, social workers, and psychologists. The service handles approximately 500 new consults every year, covering a spectrum of needs from symptom management to goal-concordant care discussions for advanced illnesses.

Outpatient Palliative Care Clinic

The outpatient clinic enables fellows to engage in longitudinal care, spending a half-day weekly participating in the interdisciplinary team. The program also incorporates a telemedicine pilot, initiated in 2018, enhancing the connection between providers and families.

Hospice and Home-Based Palliative Care

Collaborating closely with Providence Home Care and Trinity Kids Care, fellows devote five weeks to inpatient home hospice and home-based palliative care. They routinely manage around 20 pediatric patients weekly while gaining exposure to the adult hospice program for a comprehensive understanding of hospice care. This experience includes learning the nuances of Medicare and Medicaid regulations regarding hospice services.

Long-Term Care and Inpatient Rehab

A two-week rotation at All Saints Sub-Acute Facility focuses on managing both pediatric and adult patients, while an additional two weeks are spent caring for pediatric patients in the inpatient Acute Rehabilitation unit at Children's Hospital Los Angeles. These rotations aim to illuminate the complexities of caregiving within the U.S. healthcare system.

Elective Rotations

To broaden their expertise, fellows select three one-week elective rotations in areas closely aligned with palliative care, such as pediatric oncology, neurocritical care, and maternal-fetal medicine. This allows them ample exposure to various specialties.

Quality Improvement and Research

The fellowship features a robust quality improvement (QI) program, integrating the Institute for Healthcare Innovation's QI modules. Fellows can dedicate elective time towards research or quality improvement projects, contributing to their professional development and Maintenance of Certification (MOC) credit.

Well-Being and Leadership

A strong emphasis is placed on personal well-being, crucial for effective clinical practice. The program fosters a culture of well-being and compassion through organized reflection activities, wellness check-ins, and narrative medicine. Also, fellows engage in a leadership curriculum, promoting personal growth and development as future leaders in their field.

Program Locations

The primary training sites include:

• Children’s Hospital Los Angeles - Division of Palliative Care
• Providence Trinity Kids Care and Trinity Home Hospice
• All Saints Sub-Acute Facility
• Kaiser Permanente Southern California Palliative Medicine Service

Mentorship

Fellows receive support through mentorship in various capacities, including career development and well-being mentoring, allowing for personalized guidance throughout the fellowship duration.

Application Process and Qualifications

Applying for the Palliative Medicine Program involves participation in the National Resident Matching Program (NRMP). It is recommended that interested candidates submit their applications via the Electronic Residency Application Service (ERAS). The program follows specific application requirements and timeline, ensuring a thorough selection process for fellows.

Visa Support

The program provides visa sponsorship for international medical graduates, facilitating the opportunity for qualified candidates to undertake their fellowship. Commonly supported visa types include the J-1 and H-1B visas.

Competitiveness

The fellowship is known for being highly competitive. However, it remains welcoming to applicants from diverse backgrounds, including DO and international medical graduates (IMGs).

Overall, the fellowship at Children's Hospital Los Angeles offers a detailed, supportive, and comprehensive approach to education in pediatric hospice and palliative medicine.