Breathing New Life into Palliative Care
This new subspecialty training, led by the Department of Medicine, builds on the success and momentum of the Department of Family and Community Medicine’s one-year certificate in palliative care.
“Palliative care is not only about end of life care for cancer patients, but about ensuring an appropriate balance of attention to ‘cure’ versus ‘care,’” says Professor Gillian Hawker, Sir John and Lady Eaton Professor and Chair of Medicine. “All too often, comfort measures are introduced too late in the patient’s disease course. So this residency training program couldn’t have come at a better time.”
Leading the development of the new subspecialty have been medical educators and palliative care physicians, including Professors James Downar and Camilla Zimmermann from the Department of Medicine and Professor Jeff Myers from the Department of Family and Community Medicine. Trainees wishing to enter the Department of Medicine’s subspecialty palliative medicine training program will first complete postgraduate training in internal medicine, neurology, anesthesia or paediatrics, before pursuing an additional two years of training in palliative medicine.
“We are aiming to train physicians who will join the academic community, building our evidence base, and developing new models of disease management that will enable more Canadians to benefit from a palliative approach to care,” says Downar, the palliative medicine program director.
U of T is playing a major role in the expanding and increasingly relevant field of palliative medicine, with the 2014 establishment of The Global Institute for Psychosocial, Palliative and End-of-Life Care, the longstanding work of the Temmy Latner Centre for Palliative Care at Sinai Health System, and the 2008 creation of the Family and Community Medicine Division of Palliative Care, currently led by Professor Myers.
Ultimately, U of T’s palliative care community is laying the groundwork for what they hope will become an Inter-Departmental Division of Palliative Medicine, poised to serve as a national and international leader in clinical care, training and academic advancement of palliative medicine.
The first year of the program will be focused primarily on core competencies taught through consultation and specialized palliative care unit rotations, generally featuring a large proportion of patients with cancer. The second year involves intensive training in end-stage, non-cancer illnesses, such as heart failure and end-stage lung disease. Trainees will learn how to manage end-stage illnesses from the subspecialists who work with them every day, including cardiologists specialized in heart failure management and neurologists focused on ALS and Parkinson’s. They will also receive protected time to complete a scholarly project.
As interim director of palliative medicine in the Department of Medicine, and Rose Family Chair in Supportive Care, Zimmermann is excited about the creation of a more formalized path to this field. Currently, many physicians working in palliative care have received little formal training in the field. Instead, like Zimmermann, they have had to learn on the job.
Zimmermann was inspired to pursue palliative medicine after attending a lecture by the “father” of palliative care, Dr. Balfour Mount, while in her second year of medical school in the 1980s. However, there was no clear path at the time. She ended up taking what she calls a circuitous route by building expertise through various research and clinical opportunities.
“I’m glad that aspiring academic clinicians will now have access to Royal College subspecialty training in palliative medicine. And I am excited to welcome our first residents.”
