Global Directory of Educational Programs in Palliative Care

Course affiliated with (name of Organization/University)	Princess Margaret Cancer Centre, University Health Network
Country	Canada
State	Ontario
City	Toronto
Address	610 University Avenue, 5th floor, Toronto, ON M5G 2M9
The program leads an official or formal degree?	Yes
Degrees	Fellowship
Target audiences	Physicians
Fields	Geriatric Palliative Care Grief and Bereavement Oncology Opioid Availability/Accessibility/Policy Pain Management Palliative Care Research
Languages	English
Frequency	Once per year
Length	2 years
Modalities	Bedside teaching Classroom Hands-on Training Long distance
Cost of full tuition and fees	Free for selected applicants/regions
Director	Dr. Breffni Hannon and Dr. Camilla Zimmermann
Website	https://www.uhn.ca/PrincessMargaret/Education/Trainee_Programs/Department_Supportive_Care/Pages/fellow.aspx#ClinicalResearchFellowshipinPalliativeMedicine
Contact name	Norine Mark, Education Coordinator
Learning objectives 1	Medical Expert Fellows will learn to perform palliative consultations for patients with malignant and non-malignant illnesses and develop diagnostic and formulation skills through observation and practice with ongoing clinical supervision. Fellows will learn to identify and respond to relevant ethical issues arising from the care of patients with chronic or life threatening illnesses and patients’ families and demonstrate skills in developing a shared understanding of patient-centred goals of care. Fellows will be able to describe the pathophysiology and management principles for physical symptoms; the pharmacokinetics, pharmacodynamics and side effects of medications used in pain management; nonpharmacologic approaches to pain management; and the etiology and approach to management of anxiety, depression, suffering, existential and spiritual distress. Fellows will develop advanced knowledge of the therapies used in the symptom management of patients with advanced cancer and non-malignant illnesses; knowledge of the role of radiation and chemotherapy in the management of cancer patients and knowledge of side-effects of these treatments and basic management of these side-effects; and skills to manage multiple clinical issues simultaneously, both acute and chronic, often in a context of medical uncertainty.
Learning objectives 2	Communicator and Collaborator Fellows will develop an understanding of the value of maintaining hope when working with patients with palliative needs and patients’ families and demonstrate skills in discussing palliative and end-of-life issues with patients and patients’ families, including treatment choices, location of care, advance care planning, requests for hastened death, withholding/withdrawing of treatment, and palliative sedation. Fellows will learn to organize, participate in, and, when appropriate, lead clinical encounters or family meetings in goals of care discussion, while respecting patient autonomy and maximizing the involvement of the patients and patients’ families. They will identify challenges to effective communication such as anger, confusion, denial, culture, language, educational level, deafness, and modify approach to ensure understanding of information and explanations. They will learn to explain a palliative care philosophy proficiently to patients and patients’ families and identify patients who would benefit from assessment and management by a Palliative Medicine Specialist. Fellows will learn to participate in the interprofessional and multidisciplinary care of patients across settings of care (community, outpatient, inpatient).
Learning objectives 3	Researcher & Educator Fellows will learn how to provide evidence-based care, i.e., posing an appropriate learning question related to the care of patients with palliative needs and patients’ families, and answering it using an appropriate research or literature review approach. Fellows will complete a scholarly research, quality assurance or educational project relevant to Palliative Medicine that is suitable for peer reviewed publication or presentation at an academic meeting. Fellows will develop skills to provide effective teaching to trainees in a clinical environment.
Description	A clinical and research fellowship in palliative care is offered at the Department of Supportive Care at the Princess Margaret Cancer Centre. Affiliated with the University of Toronto, the Department of Supportive Care at the Princess Margaret Cancer Centre provides fellows with an outstanding clinical experience. Typically, fellowships are for a 2-year duration, contingent on a successful evaluation after one year. The Clinical Component: Fellows will primarily work in the outpatient oncology palliative care clinic. They will also have the opportunity to work on the Acute Palliative Care Unit and the palliative care consultation service. Fellows are required to participate in the on-call rota.Fellows will have the opportunity to observe and perform assessments, develop treatment plans, and follow patients longitudinally, with ongoing clinical supervision from a wide rage of supervisors. Typically, 40% of the fellow’s time will be spent working clinically. The Research Component Fellows will have the opportunity to develop research proposals, prepare presentations for international meetings, and write papers suitable for peer-reviewed journals. Fellows will acquire research skills while working in an interdisciplinary academic environment with ample opportunity for feedback and presentation at local rounds, including the Manuscript Review Seminar, Pain and Symptom Management Rounds and Departmental Grand Rounds. There is 60% protected time for research.

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This directory is partially funded by a grant from the US Cancer Pain Relief Committee.

Clinical & Research Fellowship Palliative Care Program

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