Curriculum

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This unique interprofessional fellowship affords advanced practice clinician fellows the opportunity to train alongside our physician fellows through participation in interprofessional didactics, educational opportunities, and research which includes completion of a joint quality improvement project.

As a graduate of this fellowship, you will possess expertise in complex pain management, non-pain symptom management, pharmacology, and complex communication skills; skills that are imperative when caring for patients with a wide array of complex illness at various stages of disease. You will also receive training in basic research skills, quality improvement, and clinical education. Upon completion of the training, you will be equipped with skills that promote resiliency and self-care in order to foster passion for your work throughout your career.

Clinical training and rotations

The training for Mayo Clinic's Hospice and Palliative Medicine Fellowship consists of 12 months of clinical training, including an outpatient palliative care clinic experience, complemented by didactics and research opportunities.

Rotation schedule

The academic year is divided into 13, four-week block rotations. The final week of each block includes two days of scholarship, two days in the outpatient palliative care clinic, and one day of didactic.

Specific rotation details are below:

Rotation	Length
Palliative Care Consultation Service (PCCS)	3 blocks
Palliative Medicine Clinic	2 days/month
Inpatient Palliative Care Service (IPCS)	3 blocks
Hospice	3 blocks
Pediatrics (COMPASS)	.5 block
IDT	.5 block
Pain Clinic	.25 block
Inpatient Wound Service	.25 block
Electives	1.5 blocks

Rotation descriptions

Palliative Care Consultation Service (PCCS)

You will spend three blocks of time on the Inpatient Palliative Care Consultation Service at Saint Marys and Rochester Methodist campuses. During the inpatient consultative blocks, you are an integral part of the interdisciplinary team providing consultative subspecialty palliative care services to patients in the acute setting. Consultation Service team members include board-certified consultants, advanced practice clinicians, nurses, social workers, pharmacists, chaplains, and music therapists.

Inpatient Palliative Care Service (IPCS)

The inpatient palliative care service is located at Mayo Clinic Hospital, Methodist Campus, and is a primary service addressing complex symptoms in those with serious or life-limiting illnesses.

On this service, you will work closely with members of the interdisciplinary team to meet the complex needs of the patients and provide total person care. In addition, you will liaison with members of other subspecialty teams to ensure that patients receive goal concordant care within the limitations of their illness.

Your first two blocks on IPCS are comprised of 8 and 12-hour day shifts with a weekend assigned each block. The final block hours will include 12-hour night shifts. During night shifts, fellows assume primary responsibility for the service pager and are the initial point of contact for patient care issues that arise. During this block, you will have a supervising IPCS advanced practice clinician on site who is in a "mentor" role, available for complex issues that arise and other collaboration as needed.

Outpatient Continuity Clinic

You will see patients two full days per month in the Palliative Medicine Clinic. In this clinic, we provide patients longitudinal subspecialty palliative care in addition to acute or urgent symptom management needs.

The outpatient practice serves patients within the entire spectrum of serious illnesses including, but not limited to:

Cancer
Heart failure
COPD and pulmonary fibrosis
Dementia
Stroke
Renal failure
Multimorbidity

The Palliative Care Clinic experience provides the opportunity to follow patients during transitions of care from outpatient to inpatient and hospice as the clinician of record.

In addition to our free-standing palliative medicine clinic, we also have an embedded clinic within neurology as well. You will spend some of your clinic days in this clinic, allowing you to experience the benefits and drawbacks of both types of outpatient palliative care environments as well as foster professional relationships with referring clinicians.

Hospice

You’ll spend time with the Mayo Clinic hospice team developing symptom management plans, participating in the recertification process, and assisting with the complex medical decisions patients and their families encounter as they near the end of life. Additionally, fellows will spend time with all interdisciplinary specialties, gaining additional insight into the expertise of each discipline as pertains to patients receiving hospice care.

While on the integrated hospice rotation, you will be paired with a physician medical director providing acute hospice care needs. In addition, you will gain deeper understanding of the nuances of hospice certification, recertification, and other critical elements as the medical director provides that impact the hospice care referral process.

While on the community hospice rotation, you will be paired with a hospice trained advanced practice clinician providing hospice care in rural community settings outside of Rochester. During this rotation, you will gain insight into the care needs and complexity of home-based hospice care, which is largely provided by the close friends and families of enrolled patients. Through this experience, you will gain invaluable knowledge that will help guide hospice discussions throughout your career when caring for individuals encountering their final stages of life.

Scholarship

You are provided two days per month to complete scholarly activities. These include honing academic skills through a combination of online classwork, self-guided education, and participation in live didactics with fellows across all three Mayo sites.

Additionally, you will be completing a mentored group quality improvement project from conception to dissemination in collaboration with physician co-fellows.

Pain Service

The outpatient pain rotation encompasses a wide array of cancer and noncancer-related pain management, including somatic and neuropathic pain management using opioids, adjuvants, and interventional procedures.

During this rotation, you will spend time with advanced practice clinicians learning the approach and techniques for the management of complex, chronic pain. In addition, you will spend time with experts learning the nuances of intrathecal pumps for complex pain.

There is also the opportunity to observe interventional pain procedures on an individual basis.

Pediatrics

You will spend a half block with our pediatric palliative consult service, also known as Comprehensive Pediatric and Adolescent Support Services (ComPASS). During this rotation, you will participate in both inpatient and outpatient pediatric visits at Mayo Eugenio Litta Children’s Hospital.

In addition, you will spend time with the pediatric bereavement coordinator and child life specialists to learn about childhood development and how it relates to illness and grief responses.

IDT

Wound

Electives

Didactic training

Didactic training is an integral part of the Hospice and Palliative Medicine Fellowship. During your training, you participate in these conferences:

Hospice and palliative care noon conference. Mandatory, interactive didactics that incorporate complex case discussions, expanded bereavement and wellness content, as well as knowledge-based didactic sessions from faculty within and outside palliative care at Mayo Clinic in Rochester.
Hospice and Palliative Medicine Grand Rounds. Quarterly lectures given by national and international experts in palliative care.
Palliative care core didactics. One full day each month is dedicated to core didactic training. These didactic sessions incorporate a variety of lecture, small group, and experiential learning styles (including training in the SIM Center) to convey necessary core skills in a fun and collegial manner.
Journal club. Monthly interdisciplinary meetings reviewing research with geriatric and palliative care co-fellows applicable to the hospice and palliative care and geriatric populations. During this session, fellows are expected to critically appraise a contemporary evidence-based article relevant to the fellows’ practice.
PalliTALK. This three-day intensive communication training is held in Madison, Wisconsin, for all of the Upper Midwest hospice and palliative care fellowships. This outstanding opportunity affords intensive training in expert-level communication in a fun and relaxed setting that also fosters your networking among fellow trainees. All participation costs, including registration, hotel, meals, and transportation costs are covered by the fellowship.

Other trainee experiences

External conferences

Mayo Clinic has outstanding trip support for fellows. Fellows are strongly encouraged to participate in the American Academy of Hospice and Palliative Medicine (AAHPM) Annual Assembly. All participation costs including registration, hotel, transportation, and meals are covered by the fellowship. Trip days to attend AAHPM are accounted for within the curriculum and do not require use of vacation days.

Research training

Research opportunities abound at our world-class academic medical center. You are expected to participate in scholarly activities, including completion of a mentored quality improvement project in coordination with your co-fellows.

Teaching opportunities

Opportunities are available for you to teach rotating residents, medical students, and advanced practice provider trainees. In addition, advanced practice fellows are charged with provision of a didactic session to the pallaitive care faculty that is of interest to the fellow and applicable to the palliative care and hospice populations.

Schedule and hours

Your schedule will depend on your rotation block, most of which require an average of 50 training hours per week. Shifts are 8- to 12- hours, three to five days per week depending on outpatient or inpatient schedule. While on the inpatient palliative care service, your schedule will include overnight shift assignments as well as one weekend per block.

Weekend schedule will vary, dependent on current block rotation assignments during the fellowship year.

Call frequency

Advanced practice clinician fellows will not take call during fellowship.

Program faculty

Emily Black, APRN, C.N.P.

About: Emily received her BSN from Creighton University and completed her FNP master’s program at Concordia University. She has been at Mayo for 16 years: Five years as a staff nurse and 11 as a CNP. The last four years of practice have been spent with the Mayo Hospice Program.

Clinical interests: Advanced end-of-life symptom management and supporting patients/families through the end of life journey. Also, supporting education and mentoring for nursing staff.

You should know: Emily enjoys traveling, trying new foods, live music, and hiking. Additional hobbies including caring for her 50 houseplants and spending time her husband and daughter.

Michelle Blankenship, APRN, C.N.P., M.S.N.

About: Michelle received her BSN from the University of Arizona, as well as her MSN and post-graduate certification in health care education from the University of Phoenix. She has been at Mayo Clinic for six years, with two years in hospice. She also has a background in emergency medicine, urgent care, and family medicine.

Clinical interests: Hospice and supporting patients and their families with care through end-of-life.

You should know: In her free time, Michelle enjoys golfing, boating, fishing, hiking, and pretty much anything outdoors!

Mashele Huschka, APRN, C.N.P., D.N.P.

About: Mashele has worked at Mayo Clinic for more than 20 years in a variety of roles, including statistical programmer analyst, staff nurse, and nurse practitioner. She graduated with a Doctorate of Nursing from Winona State University in 2018 and has since worked in the Palliative Care Clinic.

Clinical interests: Communication for serious illness and psychosocial support.

Research interests: Quality of life and symptom palliation in the oncology population.

You should know: When she's not at work, you can find Mashele and her husband fostering the interests of their four children!

Ashley Loken, APRN, C.N.P., D.N.P.

About: Ashley completed her BSN and DNP at Metropolitan State University in St. Paul, Minnesota. She worked in La Crosse, Wisconsin, for three years in palliative care prior to starting at Mayo on the IPCS team in May of 2020.

Clinical interests: Symptom management of hospitalization patients and collaboration with medical teams to help with ongoing goals of care discussions.

You should know: Ashley enjoys anything active, trying new recipes, and spending time with family outside of work.

Emily Readle, R.N., C.M.S.R.N., CHPN

About: Emily received her BSN from Anderson University in University in Anderson, Indiana, and is currently pursuing her DNP for acute care and geriatrics through Winona State University. She spent the first four years of her career as a bedside nurse in solid organ transplant and has worked in palliative care for the last four years.

Clinical interests: End-of-life symptom management and collaboration with bedside nursing for staff and patient education.

You should know: Outside of work, Emily spends her time reading, gardening, crafting, hiking, biking, kayaking, baking, and traveling.

Caila Rinker, MDiv, BCC

About: Caila Rinker received her Bachelor of Arts in Biblical and Theological Studies from Wheaton College, IL, Master of Divinity from Fuller Theological Seminary in Pasadena, CA, and completed her Clinical Pastoral Education in the Providence St. Joseph Health System in Los Angeles. She began her chaplaincy career at Providence Holy Cross Medical Center in Los Angeles, started at Mayo Clinic in 2018, and began working on the Palliative Care team in 2020. She has worked in a variety of clinical settings, including ED/Trauma, ICU, NICU, Cardiology, Palliative Care, and long-term post-acute care.

Clinical interests: Grief, spiritual distress, and spiritual/existential needs of diverse patient populations.

You should know: Outside of work, Caila enjoys spending time with her husband and two sons (ages 9 and 4), especially running and playing outside.

Melissa Smith, APRN, C.N.P., M.S.N.

About: Melissa (Missy) received her BSN from the University of Iowa and completed her PNP master’s program at St. Catherine University in St. Paul, Minnesota. She has been at Mayo Clinic for over 20 years, with four years in pediatric palliative care. She also has a background in pediatric primary care, emergency medicine, and pediatric intensive care.

Clinical interests: Symptom management and interdisciplinary collaboration with local and regional hospices to support end-of-life care.

Research interests: Advanced symptom management, integrative medicine, and pediatric to adult transition of patients with medical complexities.

You should know: Outside of work, Missy enjoys traveling, gardening, spending time her husband, children, and two dogs, and listening to true crime podcasts.

Rachel Wiste, APRN, C.N.P., M.S.N.

About: Rachel received her BSN from Viterbo University, where she also completed her FNP master's program as well. She has been at Mayo Clinic for 17 years: seven years as a staff nurse caring for patients on the brain and spinal cord rehabilitation unit, and 10 years as a nurse practitioner on the inpatient palliative consult service.

Clinical interests: She enjoys caring for the geriatric cardiology patient population and complex goals of care discussions, while closely collaborating with medical teams and bedside nursing to help in caring for those with complex medical illness.

You should know: Outside of work, Rachel enjoys time with her husband, two boys, as well as additional family and friends, going to sporting events, out to eat, and spending time outside.

Department

The Section of Palliative Medicine at Mayo Clinic delivers interprofessional team-based care for patients and families dealing with serious illness. The goal of the palliative care practice is to bring palliative services to the right patient at the right time within their disease trajectory.

Care is led by certified, subspecialty palliative medicine clinicians who use a collaborative approach across medical disciplines, relying on input from physicians, advance practice clinicians, pharmacists, nurses, chaplains, social workers, music therapists, psychologists, and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient's life.

Palliative medicine is intimately aligned with the primary values, mission, and vision of Mayo Clinic.

Facilities

You will provide care at both campuses of Mayo Clinic Hospital- Rochester, gaining experience in expert symptom management and complex communication.

Mayo Clinic Hospital — Rochester, Saint Marys Campus

There are two palliative care consultation services at this campus that care for patients with advanced cardiac and lung diseases, trauma, oncologic, surgical, geriatric, and neurological conditions both on the general care floors, as well as intensive care units.

Mayo Clinic Hospital — Rochester, Methodist Campus

There is one palliative care consultation service at the Rochester Methodist Campus. This team cares for patients with hematologic/oncologic diagnoses, including both solid tumor and hematologic malignancies, blood and marrow and solid organ transplant recipients, as well as patients within a limited number of medical and surgical subspecialties.

Evaluation

To ensure that you acquire adequate knowledge and develop the appropriate technical skills to meet program expectations, your performance is monitored carefully during the Hospice and Palliative Medicine Fellowship ensuring alignment with the Palliative Nursing: Scope and Standards of Practice (2021) and Core Competencies for the Palliative and Hospice APRN (2021).

You are formally evaluated by supervising faculty members after each clinical rotation and meet with the program director on a quarterly basis to review these evaluations. In addition, you regularly evaluate the faculty to confirm that your educational needs are being met.