New Horizons For An Innovative Program
Hospice and Palliative Medicine Fellowship In TransitionRobert | Family Medicine Jul 28, 2023
Editor's Note: As of July 1, 2023, Dr. David Nowels handed the reigns of leadership for the DFM Hospice and Palliative Medicine Fellowship to Dr. Kelly Arnett. Here are some thoughts form Dr. Nowels along with a few from some dear colleagues.
I am so very grateful for the support in DFM in sponsoring our Hospice and Palliative Medicine (HPM) Fellowship since 2005. The department has consistently and steadfastly supported the fellowship program and clinical palliative medicine as part of its mission. To me this is a natural connection in that each are person centered, relationally based forms of health care delivery who see people with a variety of problems and strive to understand and help them in multiple dimensions of their lives. Additionally each discipline arose in the 1970’s as a grass roots, counter-culture response to the developing “medical industrial complex”. Our graduates care for seriously ill people who have diminished quality of life, and their families, across settings and throughout their illness experience. I know of only 2 segments of health care system that meet the triple aim – primary care and HPM.The mission of the fellowship is: To develop physicians who address the nation’s palliative care needs by providing expert-level palliative care and innovatively advancing the field of palliative medicine.
We also strive to facilitate the systematic delivery of primary level palliative care in all settings.
We are fortunate to have the fellowship at University of Colorado where our HPM faculty is large, diverse, engaged in scholarly pursuit furthering effective palliative care, and where there is strong leadership and hospital commitment to clinical and educational palliative care endeavors. Our fellows consistently cite the engaged faculty and the diverse training settings and patient populations (University Hospital, Denver Health, VA, Children’s Hospital, and The Denver Hospice) as the main strengths of the program. Recently we have created a community and population-based component to our curriculum with the goal of providing tools for our fellows to identify and begin to address the specialty palliative needs for the many, many people who cannot access such services currently. Kelly Arnett (pictured here), our new Program Director, developed this and we believe it is the first in the nation.
There are projected large deficits in the HPM physician workforce, especially as physicians my age retire. Our fellowship has been able to respond by increasing the size of our class of traditional fellows – we train 5 annually. Additionally we sponsor the Community-Based Palliative Medicine (CBPM) Fellowship as a site within our training program. The CBPM is approved by the ACGME as part of its Advancing Innovation in Residency Education (AIRE) agenda. It was designed to facilitate training mid-career physicians who have developed a interest in HPM, yet are unable to return to traditional fellowship settings, to become board-eligible in HPM. The CBPM combines on-line education leading to a Masters in Palliative Medicine through the Univ. Colorado Graduate School with additional virtual clinical training. Developed by Amos Bailey, MD, the CBPM, has graduated 3 fellows who all passed their board exam with 7 more graduating later this summer and an additional 14 trainees. Between the traditional pathway and the CBPM I believe that we are now the largest HPM fellowship in the US. The success of the CBPM has stimulated similar efforts in geriatric training.
The time is right for a transition in leadership for the HPM Fellowship. The program is strong, well supported, and with an energized faculty. Kelly has developed her leadership chops and is really well positioned to continue the program growth and innovation. She has a real passion for helping meet the palliative needs of underserved and her DEI and community/population-based focus are needed in a world where mostly middle-class white people access these life-enhancing services. She has super organizational skills which will be a great asset in moving the program forward. And I get to continue to be involved and provide support for a little while as the program continues its good work and explores possible growth at Children’s and Highlands Ranch.
I want to express my deep gratitude to the DFM and its leadership for allowing and supporting me and the HPM fellowship over time.
And now, some additional information and sentiments from some special colleagues:
Dr. Kelly Arnett -
"Dave has built such an incredible hospice palliative medicine fellowship program from its inception, and it is an honor to now be stepping into the role of Program Director. Dave has been a mentor to me since I was a resident, and it is exciting to now attempt to fill his shoes as program director of the fellowship. As we have been planning this transition, he has provided me with so many insights and so much wisdom. I am so grateful I will continue to have him as a mentor as I learn the ropes of this new role. It is a very exciting time for our fellowship, having recently grown to five fellows per year. I am excited for the future of our program as we continue to evolve and innovate palliative medicine education."
Dr. Colleen Conry -
"Dave started the HPM program back before it was a recognized specialty and ACGME program. He has led the program, ensured accreditation, and created partnerships with Internal Medicine, Pediatrics, and Emergency Medicine (and probably others I am not recalling). He rose to the challenge of funding for each of these slots, some from hospitals, some one-time funding from unique places like the military, some from the VA. He’s worked closely with hospices across the state. While Dave doesn’t take credit for the Hospice AIRE program, it is known across the country as one of the most innovative residency programs ever created and Dave had a major role in its creation."