Training of palliative medicine fellows: a report from the field.

BACKGROUND: The escalating demand for palliative care physicians has led to the proliferation of postgraduate fellowship programs to train physicians in the United States and Canada. There is currently little data regarding the extent to which clinical, research, educational or administrative skills and competencies have been incorporated into fellowship training.

OBJECTIVE: The survey aims were to describe: (1) fellows' interests and relative priorities for receiving training in the clinical, educational, research, and administrative aspects of palliative medicine; (2) quantity of training received in each area; (3) fellows' satisfaction with the teaching received in each area; (4) post-fellowship employment experiences.

DESIGN: A survey was conducted via mail and in person, with e-mail utilized for reminders.

SETTING/SUBJECTS: All palliative medicine fellows from the United States and Canada between 1997 and 2002 were surveyed.

MEASUREMENTS: The survey instrument was based on a Health Resources Services Administration (HRSA) survey designed to assess research fellows' educational experiences and training satisfaction and modified to ensure sufficient focus on clinical, education, research and administrative activities; specific palliative medicine content was added.

RESULTS: One hundred one fellows from 24 programs were identified; contact information was obtained from program directors for 89 fellows (88%). Sixty-seven valid surveys were received for a response rate of 75%; 22 programs (14 U.S., 8 Canadian, 92% of active fellowships) are represented. The vast majority of fellows (94%) identified clinical training as very important; 63% identified educational training as important and only few (33% and 21%, respectively) identified research or administrative training as very important. Fellows reported receiving less training on research and administrative topics than they did on clinical or educational topics. Sixty-eight percent of fellows reported spending 10% or less of their time on research activities, and subsequently fellows reported low levels of research competence. Fellows were very satisfied with their clinical training (mean rating = 4.51 on a 5-point scale), intermediately satisfied with their educational training (mean rating = 3.61) and less with their research (mean rating = 3.1) and administrative training (mean rating = 2.24). The largest proportion of fellows (73%) described their first post fellowship position as "clinician/educator" or "full time clinician"; only 14% were "clinician/researchers."

CONCLUSION: Clinical training appears to be both the focus and strength of most palliative care fellowships surveyed. Fellows appear less interested in educational, research, and administrative training and programs appear to be less focused on these aspects of palliative medicine. Fellows also express a lower level of satisfaction with their training in these areas. The scope of fellowship programs must broaden to provide fellows opportunities to develop the research, education and administrative skills necessary to strengthen the research base of the field and provide academic leadership for the future.