Curriculum - Palliative Medicine Training
JRCPTB Specialty Overview and Recruitment - http://www.st3recruitment.org.uk/specialties/palliative-medicine
Association for Palliative Medicine - www.apmonline.org
Palliative Medicine is the specialist care of patients who have a life-limiting incurable illness. It uses a holistic teamwork approach to address the physical, psychological, social and spiritual needs of patients and families/carers. A wide range of clinical skills are encompassed, including communication, ethical decision-making, and working with colleagues from different disciplines in hospital and primary care.
The focus of training is within hospice, community and hospital-based palliative care services for both cancer and non-cancer patients. There have been significant developments in palliative care services as a result of the End of Life Care Strategy and previous initiatives such as the NHS Cancer Plan, NICE Guidance for Supportive and Palliative Care for Adults with Cancer, and National Strategic Frameworks for other life-limiting diseases, creating opportunities to expand and improve services.
The number of consultant posts available has increased over the past few years and there have been a number of unfilled posts. However, the rate of expansion is now slowing down and the number of trainees has increased, so although career prospects are still good in comparison to some other specialties, there is likely to be more competition for consultant posts in future.
Will it suit me?
Palliative care involves working in a multi-professional team, working with other teams to provide the highest standard of care for patients and their families / carers. Essential qualities for a doctor specialising in Palliative Medicine are empathy, sensitivity and excellent communication and team-working skills. The palliative medicine doctor needs to be able to support patients, families and staff in dealing with complex problems, often with an ethical dimension, usually at a most difficult time.
Attractions of the specialty are the wide variety of clinical skills required, with a holistic approach to patients and their carers. There are opportunities and challenges in working alongside other specialties, with primary care teams and a wide range of other health and social care professionals. Consultant posts usually involve working across two or more settings (hospital, hospice and community), and require excellent leadership and liaison skills in coordinating care for patients and their families.
Other major aspects of the consultant role include involvement in strategic development of local services and providing palliative care education to other groups of professionals.
Pros & cons
- Interesting and varied clinical work both during training and at consultant level
- Benefit of integrating with all hospital disciplines and community services
- Working as part of a supportive multidisciplinary team
- Well structured training
- Opportunities for flexible training and careers
- Opportunities to influence service development
- Good quality of life
- Can be emotionally challenging and demanding
- Constantly dealing with great uncertainty
- Likely to be responsible for leading a service even as a new consultant
- Some consultant posts single-handed, which may be professionally isolating, though this is improving as the number of posts increases
- Few opportunities to develop a research or academic career, though this is also improving gradually
In the North West region a number of hospices and associated community specialist palliative care teams and hospital palliative care teams are accredited for Higher Medical training by the Royal College of Physicians and Health Education North West. The curriculum for palliative medicine is competency based and assessment is recorded on the e-portfolio, through regular appraisal and annual assessment.
General Professional Training
- All applicants must have had 24 months’ clinical experience after the completion of foundation training before commencing ST3 training.
- This must include at least 12 months’ experience in a range of acute medical specialties that admit acutely unwell medical patients and manage their immediate follow-up. This includes specialties such as cardiology, gastroenterology, respiratory medicine, acute elderly medicine, A&E medicine, renal medicine, acute medicine admissions unit. Trainees must have a minimum of four months’ experience of managing patients on unselected medical take that involves ongoing patient management. Emergency medicine (A&E) without an admissions unit would not fulfil this requirement.
- Beyond this, a further 12 months experience in relevant specialties is required. Those specialties may include those above but other specialty experience that is acceptable includes general practice, palliative medicine, psychiatry, intensive care medicine, oncology, haematology, HIV medicine, neurology, general paediatrics, and rehabilitation medicine. A maximum of six months in any single specialty can be counted towards the 24 months’ eligibility rule. All of the above experience can be counted whatever the specialty training programme they were part of (e.g. paediatrics and psychiatry placements may have been part of a GP programme).
- All applicants must have gained a professional postgraduate examination in relation to their training pathway (e.g. MRCPUK; MRCGP with CCT; MRCS (full); FRCS; FRCA. Alternative examinations, equivalent to any of these examinations can be taken into consideration). These exams must have been passed prior to commencing an ST3 post.
- All applicants must have CMT competencies prior to taking up an ST3 post.
- Applicants who have not undertaken CMT training are advised to check their eligibility against the current version of the Person Specification carefully and to seek advice if they are unsure whether they meet the criteria.
Please see the JRCPTB website for up-to-date information: http://www.st3recruitment.org.uk/specialties/palliative-medicine
Higher Medical Training in Palliative Medicine
The duration of Higher Medical Training is four years for a full time trainee and pro-rata for a flexible trainee.
Regional Teaching Programme
From February 2017 a Joint HENW Palliative Medicine Teaching Programme will bring together palliative medicine StRs, consultants and SAS doctors from North West and Mersey training programmes.
The teaching programme will run from February – December 2017 with a 4-year ‘rolling’ programme of topics relevant to the Palliative Medicine curriculum, particularly directed at those areas not easily covered in routine clinical placements. The sessions will be bi-monthly full day teaching, organised jointly by trainee, and consultant / senior SAS leads from North West and Mersey training programmes.
The teaching days will be held in ‘The Conference Room’ at St Rocco’s Hospice in Warrington; chosen as a central location for travel from across Liverpool and Manchester.
The teaching programme will include an annual ‘Away Day’ to be held in June 2018. The Away Day is an opportunity to focus on more innovative and topical subjects, and to promote networking and sharing of service innovation between palliative medicine trainees, consultants and SAS doctors across North West and Mersey training programmes.
The Joint HENW Teaching Programme for 2018 is attached: HENW Palliative Medicine Teaching Programme 2018
For further information about the training rotations in HENW contact one of the Training Programme Directors.
All trainees are required to complete workplace-based assessments as outlined in the 2010 Palliative Medicine Curriculum. These include Mini-CEX, Multi-Source Feedback, Case-based Discussion, DOPS, Audit Assessment and Teaching Assessment.
Are there any examinations I need to take?
Since 2011 there has been a mandatory Specialty Certificate Examination which must be passed prior to obtaining a CCT. This is held annually in November, with most trainees sitting this in ST5.
The concept of palliative care has broadened over time from ‘terminal care’ to include care of people who have a life-limiting illness but are not imminently dying. These include those with advanced cancer or other incurable diseases such as progressive neurological conditions and chronic circulatory or respiratory diseases. The majority of palliative care is provided by the primary care team for patients in the community or in other hospital specialties. Patients with more complex physical symptoms or psychological needs may be referred to the specialist palliative care team in the community, hospital or hospice.
In this specialty you will work as part of the multi-professional team comprising individuals who have undergone recognised specialist training. The core team consists of a consultant, with support from junior doctors and clinical nurse specialists, usually with access to an extended team including physiotherapist, occupational therapist, social worker, chaplain, psychologist and pharmacist. The team may have links with the local Pain Team and oncology service based within cancer centres or cancer units.
Palliative Medicine is a relatively new specialty, being recognised as an independent medical specialty by the Royal College of Physicians in 1987. Over the past 15 years or so there has been a rapid development of palliative care services on an integrated model linking community, hospice and hospital care and encouraging collaboration between the NHS and voluntary sector.
Types of palliative care services which are training sites:
Hospital Palliative Care Team – usually consists of clinical nurse specialists with medical support from a consultant in Palliative Medicine. The primary role of the team is to advise other clinical staff in the Hospital on the control of pain and other symptoms, taking account of the psychosocial needs of the patients and their family. The Hospital Palliative Care Team usually works alongside the admitting team who retain clinical responsibility. Levels of intervention may vary from telephone advice to a single visit or multiple visits to the patient.
Other roles consist of information and advice to the patient regarding their illness and treatment, liaison with family and carers including emotional support and advice, emotional support for staff caring for patients with advanced disease, education in palliative care to other staff members and linking inpatient to community based palliative care services.
Some NHS Hospitals have designated palliative care beds which are run by the Palliative Care Team, or the ongoing medical care may remain the responsibility of the original admitting Hospital team.
Hospice – is usually a free standing unit with inpatient facilities, staffed by a multi-professional team specially trained in palliative care. The majority have consultant input and other medical staff, with specialist nursing staff and a range of other professionals such as physiotherapist, OT, pharmacist, chaplain, social worker and dietitian. Patients are usually admitted for short-term assessment for symptom control, rehabilitation, terminal care and, in some units, respite care. The hospice may be funded by local or national charities or by the NHS or in combination.
Day Therapy Services – many hospices have a day therapy service attached to an inpatient unit. There are also some free-standing units. Day Therapy services offer rehabilitation, symptom control advice, psychological support and access to complementary therapies.
Outpatient Palliative Medicine Clinics – may be held either in a hospice, hospital or community base, led by a Consultant in Palliative Medicine. The major emphasis is on pain and symptom control but clinics also give the opportunity to introduce other palliative care services such as day therapy, inpatient facility and community specialist palliative care teams.
Other Outpatient Services available in some areas include:
- Breathlessness Clinics
- Complementary Therapies
Specialist Community Palliative Care Teams – usually consist of a team of clinical nurse specialists with consultant support. They work closely with primary care teams to support patients with symptom control, psychological support, advance care planning and end of life care.