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Vocational Training
Palliative Medicine
Notice for Trainees Commencing in 2007
Supervising Committee
SAC in Palliative Medicine.
Definition of Specialty
Palliative medicine is the study and management of patients with active,
progressive, far advanced disease, for which the prognosis is limited and
the focus of care is the quality of life. Palliative medicine includes bereavement
and family support.
General Principles of Training
- Advanced training in palliative medicine is based on a broad experience
in palliative medicine as well as specific experience in cancer medicine
and general medicine.
- The emphasis for the trainee is on clinical aspects of palliative
medicine. This includes diagnosis and appropriate management of major
symptoms (based on relevant pathophysiology) and clinical pharmacology,
and awareness of a range of medical and non medical options available
for the management of palliative care patients.
- Whilst emphasis is on the development of clinical skills, it is essential
that an understanding be developed of the principles of comprehensive
palliative care and the role of the palliative medicine physician in
coordinating other professional staff.
- It is recommended that the period of training should be spent in more
than one palliative medicine service.
Components of Training
Core Training
- A minimum of 2 years is required.
- At least 18 months must be spent in a palliative medicine service
under the supervision of a specialist who holds FRACP. If the supervisor
is not a Fellow, then a co-supervisor who holds Fellowship must be appointed.
- During core training a minimum of 6 months must be spent in a specialist
palliative medicine consultative service or outpatient clinic in a teaching
hospital.
- During core training a minimum of 6 months must be spent in a clinical
oncology position approved for advanced training in medical oncology,
radiation oncology, or in haematological oncology.
- A minimum of 6 months, full time equivalent, should ideally include
adequate experience in the delivery of palliative care services in the
community.
- Trainees are strongly discouraged from undertaking core
palliative medicine training during the year in which they sit for
the FRACP examination.
Non Core Training
- A maximum of one year could be spent in an area with a strong palliative
component such as HIV medicine, respiratory medicine, geriatric medicine,
clinical pharmacology, pain management, intensive care, research, liaison
psychiatry or further experience in palliative medicine.
- Experience in a suitable training post outside Australia or New
Zealand is encouraged. Early discussion with the SAC is recommended
to ensure suitability.
- With respect to training undertaken in other services, the supervisor
should be the director or supervisor of training in that service and
the program should be approved by the SAC.
Content of training
The content of training should include:
- experience in clinical decision making;
- development of a management strategy in light of personal priorities
of the patient and family;
- experience in communication and counselling with patients, their
families and health care professionals;
- assessment, diagnosis and management of various symptom complexes
(including various pain syndromes with due regard to medical and non
medical measures);
- studies of pathology, pathophysiology and clinical pharmacology of
relevance to major symptoms;
- management of confusional states and psychiatric syndromes in liaison
with psychiatric staff;
- experience in addressing the psychosocial, cultural and spiritual
issues of dying patients and their families;
- experience in the ward and outpatient and domiciliary situation of
the problems encountered by the nursing staff in palliative medicine;
- interdisciplinary contact with other health professionals;
- development of skills in team management and leadership.
Procedural Skills
Competence in procedures such as paracentesis and thoracocentesis
is essential.
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