Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training

Chelsea Salyer; Susan McCammon; Emma Bassette; Lindy H Landzaat; Lori Spoozak; Joanna Veazey Brooks

doi:10.1016/j.jpainsymman.2023.01.005

Facilitators and Barriers to Recruiting Surgeons into Hospice and Palliative Medicine Training

J Pain Symptom Manage. 2023 May;65(5):409-417. doi: 10.1016/j.jpainsymman.2023.01.005. Epub 2023 Jan 19.

Authors

Chelsea Salyer¹, Susan McCammon², Emma Bassette², Lindy H Landzaat², Lori Spoozak², Joanna Veazey Brooks²

Affiliations

¹ Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA. Electronic address: Csalyer2@kumc.edu.
² Division of Gynecologic Oncology (C.S., L.S.), Department of OBGYN, University of Kansas, Kansas City, Kansas, USA; Department of Otolaryngology (S.M.), University of Alabama Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care (S.M.), University of Alabama Department of Medicine, Birmingham, Alabama, USA; Department of OBGYN (E.B.), Creighton University, Omaha, Nebraska, USA; Division of Palliative Medicine (L.H.L., L.S., J.V.B.), University of Kansas Department of Internal Medicine, Kansas City, Kansas, USA; Department of Population Health (J.V.B.), University of Kansas School of Medicine Kansas City, Kansas, USA.

PMID: 36682672
DOI: 10.1016/j.jpainsymman.2023.01.005

Abstract

Context: Few individuals have fellowship training in both hospice and palliative medicine (HPM) and a surgical specialty including general surgery, general obstetrics and gynecology, or affiliated subspecialties. There is a paucity of data to explain why some surgeons choose to pursue HPM fellowship training.

Objective: Identify facilitators and barriers to palliative medicine fellowship training among physicians from a surgical specialty.

Methods: We conducted individual semistructured interviews with 17 surgeons who were also fellowship-trained in HPM. Interviews were recorded, transcribed, and thematic analysis was conducted to identify themes.

Results: Participants reported pivotal experiences-either positive exposure to palliative care or suboptimal surgical care experiences-as a key motivator for pursuing specialty palliative care training. Additionally, participants chose HPM training because they felt that practicing from a HPM perspective aligned with their personal care philosophy, and in some cases, offered professional opportunities to help achieve career goals. Participants reported encountering bias from both HPM and surgical faculty, and also found that some HPM fellowship programs did not accept surgical trainees. Surgeons also reported logistical concerns related to coordinating a one-year fellowship as a barrier to formal HPM training.

Conclusions: Understanding the motivations of surgeons who pursue HPM training and identifying challenges to completing fellowship may inform solutions to expand surgeon representation in palliative care. Both HPM and surgical faculty should be educated on the benefits of specialty HPM training for surgical trainees and practicing surgeons. Further research should explore HPM fellowship best practices for welcoming and training surgeons and other underrepresented specialties.

Keywords: Hospice and Palliative Medicine Fellowship; Palliative care education; surgical palliative care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Education, Medical, Graduate
Fellowships and Scholarships
Hospice Care*
Hospices*
Humans
Palliative Medicine* / education
Surgeons*