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) postfellowship 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.
