A Novel Competency-Based, Time-Variable Mid-Career Fellowship Program in Hospice and Palliative Medicine

Area of Science:

• Medical Education
• Palliative Care
• Physician Workforce Development

Background:

• The hospice and palliative medicine (HPM) field faces a significant workforce shortage.
• Mid-career physicians represent an underutilized resource for HPM specialist training and certification.

Purpose of the Study:

• To describe a pilot competency-based, time-variable (CBTV) fellowship program designed for mid-career physicians.
• To evaluate the feasibility and initial outcomes of the Mid-Career Fellowship program.

Main Methods:

• The pilot program, approved by ACGME, enrolled fellows starting in 2019 and expanded to seven sites.
• Training involved part-time, interrupted clinical rotations accommodating fellows' existing responsibilities.
• Competency assessment utilized direct observation, validated tools, and the ACGME HPM milestones framework.

Main Results:

• From 2019 to 2024, 22 individuals enrolled, with 14 graduates across seven sites.
• Eighty-six percent (12/14) of graduates entered full- or part-time practice in HPM.
• Two fellows achieved HPM board certification, with more eligible.

Conclusions:

• The CBTV fellowship model shows promise for addressing HPM workforce shortages.
• The program's adaptable structure could benefit other specialties facing similar challenges.
• Further research is needed on long-term impacts and broader applicability.