Hospice and Palliative Medicine Fellowship

Cardiovascular Disease Fellowship Header

The hospice and palliative medicine fellowship at Spectrum Health, in partnership with Michigan State University College of Human Medicine, is an ACGME-accredited one-year program located in Grand Rapids, Michigan. The first two fellows begin in July 2021. This fellowship offers both an adult and pediatric track. Fellows will spend a significant portion of their adult inpatient experience at Spectrum Health Butterworth Hospital, a 556-bed, level 1 trauma center. The pediatric palliative care blocks will be at Spectrum Health Helen DeVos Children’s Hospital, a 234-bed regional referral center and teaching hospital, ranked in eight specialties by U.S. News and World Report 2020-2021, and is located on the same campus as Butterworth Hospital.

From The Program Director

Thank you for your interest in the hospice and palliative medicine fellowship at Spectrum Health, in partnership with Michigan State University College of Human Medicine! Our mission is to provide exceptional training focused on interdisciplinary, patient-directed care across the health care continuum. Upon completion of training, fellows will have the experience and training to work in any environment within the field of hospice and palliative medicine. This program focuses on practicing evidence-based medicine, seeking innovative solutions to optimize patient care, understanding the impact of health disparities and the complex relationship with social determinants, and continual quality improvement. We view medical care through the lens of equity and this is reflected in all that we do. Working in urban and community environments, fellows in our program will serve patients in alignment with our institution’s mission of improving health, inspiring hope and saving lives. This includes the quality of lives.

This is an ACGME-accredited one-year program located in Grand Rapids, Michigan. The first two fellows begin in July 2021. This fellowship offers both an adult and pediatric track. Fellows will spend a significant portion of their adult inpatient experience at Spectrum Health Butterworth Hospital, a 556-bed, level 1 trauma center. The pediatric palliative care blocks will be at Spectrum Health Helen DeVos Children’s Hospital, a 234-bed regional referral center and teaching hospital, ranked in seven specialties by U.S. News and World Report 2021-2022, and is located on the same campus as Butterworth Hospital.

Our adult and pediatric teams provide a comprehensive educational experience. Working with high functioning interdisciplinary teams, fellows will have exposure to a variety of advanced and serious illnesses and will develop skills in complex symptom management and communication and goals of care discussions. Our interdisciplinary teams include physicians, advanced practice providers, nurses, social workers and chaplains. Throughout Spectrum Health, we have an integrated and respected inpatient palliative care service, ambulatory and virtual palliative clinics, community palliative care service, as well as inpatient and community hospice teams who provide seamless care for our patients. Fellows will follow patients across the continuum of care which enhances their learning experience and continuity with patients and families.

You will find an engaging and supportive environment in this fellowship program as we strive to provide exceptional, compassionate care to our patients in addition to focusing on team and individual wellness, resiliency and self-care. We accept applicants from diverse backgrounds and specialties and encourage applicants from all phases of their career. We hope to personalize your training, provide mentorship and career-development based on your goals and passions.

I can assure you that upon completion of this fellowship you will feel well trained for any career in the field of hospice and palliative care. We hope you find this information useful in your decision-making process. Thank you for considering us for your fellowship training and please reach out with any questions.

Gretchen Roe, MD
Program Director, Hospice and Palliative Medicine Fellowship
Site Lead – Spectrum Health Palliative Care
Assistant Professor, Michigan State University
gretchen.roe@spectrumhealth.org

  • Integrated and respected inpatient palliative care service, ambulatory palliative clinics with options for telemedicine and virtual visits, community palliative care service, as well as an inpatient and community hospice team
  • Spectrum Health Butterworth Hospital is a referral center for advanced cardiac therapies including extracorporeal membrane oxygenation and left ventricular assist devices (LVADs), and transplant center for heart and lung transplants. Palliative care is involved as part of the pre-assessment for all heart and lung transplants and LVADs, playing an integral role on the LVAD selection committee
  • Fellows will see a variety of medically complex and critically ill children at Spectrum Health Helen DeVos Children’s Hospital, a 234-bed regional referral center and teaching hospital ranked in seven specialties by U.S. News and World Report 2021-2022
  • All hospice and palliative medicine faculty are board-certified and come from diverse backgrounds and specialties, including internal medicine, pediatrics, family medicine and emergency medicine and bring experiences from multiple health systems across the country
  • Spectrum Health is home to 32 ACGME-accredited residency and fellowship programs in partnership with Michigan State University College of Human Medicine
  • There are extensive opportunities to partner with other fellowship programs within our institution including the fellowship research and QI didactic series
  • Our affiliation with Michigan State University College of Human Medicine allows for a unique, hybrid community and academic practice environment
  • Fellows have research support through Spectrum Health and Michigan State University
Clinical Rotations: There are 13 blocks, each block being four weeks.
 
Inpatient Palliative Care: Adult track – six blocks, pediatric track – two blocks
This rotation will mainly be at Spectrum Health Butterworth Hospital, a 556-bed, level 1 trauma center, referral center for advanced cardiac therapies including extracorporeal membrane oxygenation and left ventricular assist devices (LVADs), and transplant center for heart and lung transplants. Palliative care is involved as part of the pre-assessment for all heart and lung transplants and LVADs, playing an integral role on the LVAD selection committee. There is a robust oncology inpatient service including a bone marrow transplant service. Fellows will experience collaboration with the interventional radiology and anesthesia services regarding procedures to minimize suffering and optimize quality of life. The experience will include working with interdisciplinary palliative and hospice teams and collaboration with multiple specialties, participating in goals of care discussions and complex symptom management. Fellows will also have the opportunity to care for patients at Spectrum Health Blodgett Hospital during their inpatient rotations. Located in East Grand Rapids, it provides inpatient care in 248 private patient rooms and outpatient services for medical, surgical and specialty care.
 
Community Hospice: Adult track – two blocks, pediatric track – two blocks
In their community hospice experience, fellows will work with the interdisciplinary hospice team and participate with goals of care discussions and symptom management during home visits as well as perform face-to-face visits. They will learn the role of a hospice medical director, hospice regulations, hospice eligibility, and actively participate in interdisciplinary groups and learn how to write hospice certification and re-certification notes.
 
Inpatient Hospice: Adult track – one block, pediatric track – one block
The inpatient hospice experience includes collaborating with an inpatient interdisciplinary hospice team, participating in goals of care discussions and symptom management for general inpatient hospice patients including symptom management after withdrawal from LVAD and other advanced cardiac therapy support as well as withdrawal from mechanical ventilation, BIPAP, and high flow nasal cannula. Fellows will assess hospice eligibility for new hospice referrals for inpatients. In addition to this experience in the hospital setting, fellows will round in the supportive care unit which is our four-bed inpatient hospice unit located within a local nursing facility.
 
Home-Based Palliative Care: Adult track – one block for adult-track fellows
Fellows will be a part of the interdisciplinary team visiting patients in their homes and skilled nursing facilities.  Participation in goals of care discussions, thorough home environment assessments, establishing symptom management plans, recognizing safety components for both staff and patient/family, exploring outside community resources, support to families and collaboration with various providers will be essential functions in this rotation.  Throughout the 11-county service territory, fellows will learn the role of MD in this ever-changing program and the unique challenges and opportunities that being out in the community brings.  Ability to participate and lead Interdisciplinary Group meetings, break down barriers to hospice transitions, deep dive into social determinants of health, brainstorm creative support needs and communicate efficiently with internal and external partners will be the focus of expanding knowledge of palliative care services in this track.

Geriatrics: Adult track – one block, pediatric track – one block
Under supervision of a geriatrics attending physician, fellows will evaluate patients then discuss findings to gain greater understanding of geriatric syndromes including delirium, cognitive impairment and dementia, gait disorders and falls and polypharmacy. This rotation emphasizes transitions in care and understanding different health care settings as microsystems. Focusing on the older adult population that displays significant heterogeneity of health status, the rotation will make it possible to learn how to distinguish frail from healthy older adults and their differing levels of vulnerability. Fellows will also understand how care for older adults evolves from an intent that is curative to a strictly palliative intent for patients who may transition from independent living at home or a life care community, to hospital, home with home care, subacute rehabilitation or long-term care and eventually hospice.
 
Pediatric Hospice and Palliative Medicine: Adult track – one block, pediatric track – six blocks
Fellows participate in daily rounds with the interdisciplinary pediatric palliative care team caring for children at Helen DeVos Children’s Hospital. Fellows will see a variety of medically complex and critically ill children in multiple settings, including the neonatal intensive care unit, pediatric intensive care unit, pediatric cardiac intensive care unit and the general pediatric units. Fellows will participate in pre-natal consults with expectant mothers whose children have severe anomalies diagnosed in-utero. They will also follow patients in a dedicated ambulatory palliative care clinic and provide home visits when appropriate. They will provide end-of-life care for children admitted to the hospital from hospice when inpatient services are required. Fellows will spend time with a dedicated pediatric team of a local community-based hospice to gain experience with home hospice care of pediatric patients.

Elective: Adult track – one block, pediatric track – one block
Many elective experiences are available to fellows and the experience will be tailored to their goals and objectives. Options include, though are not limited to, clinical ethics, addiction medicine, anesthesia and pain service and interventional radiology. 
 
Ambulatory Clinics
Fellows will have a weekly half-day continuity clinic throughout fellowship. During 10 of these blocks, this will occur in the adult palliative oncology clinic. This includes opportunities for telemedicine and virtual visits. There will also be opportunities for spending time in the palliative advanced heart failure clinic and lung transplant clinic during the community hospice and palliative care rotation and geriatrics clinic during the geriatric rotation. Pediatric fellows will have additional pediatric pain and palliative clinic experience built into their pediatric rotations. Each of these clinics has an interdisciplinary approach.
 
Didactics
  • Weekly didactics with interactive lectures, we will partner with other hospice and palliative programs in our region to have provide a joint didactic experience
  • Simulation - Several simulation sessions held throughout the year designed to help fellows master advanced communication skills
  • Monthly journal club
  • Monthly Schwartz Rounds
  • Protected time to attend the annual assembly of the American Academy of Hospice and Palliative Medicine
  • Three Questions: Curriculum on communication: Framework to Goals of Care Discussions, Checking Implicit Bias and Ensuring Equity
  • Curriculum includes Spectrum Health Clinical Teacher Program and Spectrum Health Quality and Safety curriculum
  • Two-week business of medicine curriculum offered to all fellows
  • Case presentations during daily team huddles with teaching from a diverse group of practitioners with a large depth and diversity of experience
  • Fellows have the opportunity to teach resident and medical student rotations with our hospice and palliative teams
 
Scholarly Activity
Fellows have protected time to complete a scholarly activity during their fellowship and will be provided mentorship for their scholarly activity by our faculty. Examples of options for scholarly activity include presenting at a local or regional conference, submission of a case report or other article, or a quality improvement project. Spectrum Health provides many opportunities in clinical, quality and safety-based research. Spectrum Health and Michigan State University have a growing interest in multi-center collaborative research networks. 
 
Recent Publications and Presentations
  • AAHPM Annual Assembly Poster 2016 – Medicare Care Choices Model Reduced Hospital Utilization Cost of Care
  • Intravenous Lidocaine Administered as Twice Daily Bolus and Continuous Infusion for Refractory Cancer Pain and Wound Care Pain – Journal of Palliative Medicine 2019
  • AAHPM Annual Assembly Poster 2019 - Combined Radiofrequency Ablation and Cementoplasty For the Treatment of Painful Osseous Metastases - A Highly Effective Yet Underutilized Therapy
  • AAHPM Annual Assembly Poster 2019 - Development Of A Toolkit To Evaluate Telemedicine Delivery Of Palliative Care
  • AAHPM Annual Assembly Poster 2019 - Pain Relief for The Whole Person:  The Impact Of Neuraxial Analgesia And The Interdisciplinary Team for Advanced Cancer-Related Pain
  • CAPC Annual Assembly Poster 2019 - Increasing hospital reimbursement with the use of Advance Care Planning codes in the Palliative Care setting
  • AAHPM Annual Assembly Poster 2020 – Intravenous Ketamine for Refractory Headache in Metastatic Melanoma: Fulfilling An End Of Life Wedding Wish
Innovate. Inspire. Impact.
We are proud of the relationships our physicians have built with patients and families. Through inspiring stories, Health Beat provides an editorial platform to bring patients and physicians together, sharing information on innovative care and personal journeys. Read about our innovative care and the brave families who inspire us.
 
‘Will you marry me?’
Told she doesn’t have much time to live, Rhonda White sees two wishes fulfilled in a tearful, joyful double wedding ceremony.
 Rhonda White
 
Going home, with love
Help from friends and strangers made Alfonso Guerra’s last wish come true: He returned to Nicaragua.
Alfonso Guerra
 
‘He was such a giver’
In the wake of the pandemic, the Renucci Hospitality House provides a gathering place for a family to say goodbye to a loving father.
Camerino Hiracheta
 
Billboard and television ad actor takes cancer to the big screen.
Brandon Winter
We participate in the Electronic Residency Application Service application process. We require the following information:
  • A completed application/profile
  • At least three letters of recommendation
  • Curriculum vitae
  • Medical school transcript and dean’s letter
  • Personal statement describing career goals and reasons for selecting continued training
  • USMLE transcript
  • For international medical graduates, an Educational Commission for Foreign Medical Graduates status report
 
For more information on our program, please contact Paige Parmelee, program coordinator.
Spectrum Health provides a comprehensive and very competitive benefits package for our residents, staff and their families. In addition, our program provides educational monies to support your ongoing education. Download our salary and benefits document to learn more.

  • Grand Rapids

    West Michigan - A Great Place to Call Home

    As the second largest city in Michigan, Grand Rapids is an amazing place to work, live, play and explore. This vibrant city is known for some of the best festivals in the world, like ArtPrize, and is only a short 45 minute drive to Lake Michigan. The city has been recognized by numerous sources, including The New York Times, where Grand Rapids was ranked as one of the 52 Places to Go. Additionally, Thrillist consider Grand Rapids the best food city in the state of Michigan, and in 2018, Trulia chose Grand Rapids as the Hottest Real Estate Market to Watch in the country. Grand Rapids is a city with endless experiences for people of every age. Learn more.