Pediatric Advanced Care Team (PACT) | Harvard Interprofessional Pediatric Palliative Care Fellowship: Physician Fellowship

The Harvard Interprofessional Pediatric Palliative Care Fellowship is an innovative, clinically intensive one-year training program that immerses postgraduate clinicians in pediatric medicine, social work, and advanced practice nursing in a truly interprofessional educational environment. The Physician (MD/MO) Fellowship is an ACME-accredited program in hospice and palliative medicine. The Social Work (SW) and Nurse Practitioner (NP) Fellowships are unique in their respective disciplines in providing subspecialty training in pediatric palliative care (PPC).

The mission of the Pediatric Hospice and Palliative Medicine Fellowship at Boston Children’s Hospital is to train future leaders in pediatric palliative care by embracing interprofessional education and diverse perspectives to promote excellence in communication, teamwork, symptom management, and professional growth and resilience in caring for seriously ill children and their families.

1. Train fellows to be experts in symptom (pain and non-pain) assessment and management in patients with serious illness, using non-pharmacologic and pharmacologic interventions
2. Equip fellows with skills to care for the actively dying patient and support the family in bereavement
3. Teach fellows to communicate effectively with seriously ill patients and their families
4. Develop fellows’ expertise in delineating goals of care to support medical decision-making and goal-concordant care
5. Foster fellows’ skills in resilience and sustainability
6. Guide fellows to understand the ethical and legal considerations in pediatric palliative care
7. Instill interprofessional teamwork and competency in fellows, enabling them to provide effective psychosocial and spiritual support for patients with serious illness and their families
8. Prepare fellows for leadership in clinical care, education, and program development

• 2002: Launch of PACT MD Fellowship with one MD fellow
• 2005: Launch of PACT SW Fellowship with one SW fellow
• 2008: Launch of PACT NP Fellowship with one NP fellow
• 2008: Combined with adult palliative care fellowships at Massachusetts General Hospital (MGH) and Dana-Farber Cancer Institute (DFCI) to form the Harvard Interprofessional Palliative Care fellowship, with PACT fellowship serving as the “pediatric track” for the combined fellowship
• 2012: Second MD fellow added to PACT Fellowship cohort
• 2019: ACGME accreditation of Hospice and Palliative Medicine Fellowship at Boston Children’s Hospital
• 2021-22: Inaugural class of MD fellows under independent ACGME accreditation

Sponsoring institution: Children’s Hospital-Boston-MA
Number of MD fellows: 2 per year

How to apply

Applications are accepted through the Electronic Residency Application Services (ERAS®). The Fellowship Program participates in the National Resident Matching Program (NRMP®) Medicine and Pediatric Specialties Match. Our program can be found under Hospice and Palliative Medicine (Multidisciplinary Specialties), our program name is Children’s Hospital-Boston-MA: NRMP Program Code: 1259540F0

For more information on the ERAS system, please visit the Association of American Medical Colleges website.

Requirements

• Be board-eligible or board certified in pediatrics or one of its sub-specialties
• Have a commitment to a career in pediatric palliative medicine
• Completed application by Aug. 16, 2024

Application materials

• Curriculum vitae
• A personal statement describing the applicant’s interest in and commitment to an academic career in palliative care
• Three letters of recommendation, one of which should be from the applicant’s department head, program director, or division chief
• USMLE transcript

Timeline

• July and August: Applications accepted via ERAS® 
• September and October: Interviews conducted (interviews are virtual as per institutional and AAMC recommendations)
• Early December: match results released

Responsibilities

• The trainee will become familiar with comprehensive, interdisciplinary evaluation and management of children with diverse advanced illnesses and their families, and will be responsible for the care of inpatients and outpatients in varied settings, including an academic teaching hospital, hospice/home care, and chronic care.
• The trainee will be trained as a clinician-educator through supervised experiences in the teaching of pediatric palliative care.
• The fellow can seek mentorship and additional opportunities in research projects, and may pursue intensive research experience following the clinical fellowship.

Program leadership

Hadley Bloomhardt, Program Director
Shih-Ning Liaw, Associate Program Director

Inquiries should be addressed to:

Hadley Bloomhardt, Program Director
Physician, Pediatric Advanced Care Team (PACT)
Dana-Farber Cancer Institute/Boston Children’s Hospital
Fellowship Director, Pediatric Hospice and Palliative Medicine Fellowship
Instructor, Harvard Medical School
450 Brookline Ave.
Boston, MA 02215
Office: 617-632-5504
Email: hadleym_bloomhardt@dfci.harvard.edu

Clinical rotations

• 28 weeks on service (Boston Children’s/DFCI)
  • 13 weeks on each inpatient team
  • 2 dedicated weeks on outpatient service
• 10 weeks hospice (Care Dimensions)
  • 4 weeks inpatient hospice
  • 6 weeks home visits (adult hospice, pediatric hospice, home-based PPC)
• 1 week Inpatient Palliative Care Unit (BWH)
• 1 week Long-Term Care (Seven Hills)
• 2 weeks Subacute Care (FCH)
• 2 weeks Pain Team elective
• 3 weeks elective of choice
• 4 weeks vacation

Participating sites

• Dana-Farber Cancer Institute
• Care Dimensions Hospice
• Franciscan Children’s Hospital (FCH)
• Seven Hills Pediatric Center
• Brigham and Women’s Hospital (BWH)

Call requirements

• Home-based call coverage, no required in-house call

Ambulatory experience

• Biweekly clinic afternoons September to May
• Home visits through Care Dimensions

Didactic structure

• PACT Summer Curriculum
  • 6 to 8 hours/week in July
• Palliative Care Summer Curriculum (in conjunction with MGH Adult CP Fellowship)
  • 4 hours/week from July to August
• PACT Longitudinal Curriculum
  • 2 hours/week from August to May
  • Includes Resilience Curriculum and Spiritual Care Curriculum
• Palliative Care Longitudinal Curriculum (in conjunction with MGH Adult PC Fellowship)
  • Includes Communication Curriculum and Health Equity Curriculum

Conferences

• PACT Rounds: PPC grand rounds at Boston Children’s
• Harvard Medical School Center for Palliative Care Clinical Case Seminar
• Selected conferences from various other sources, including Boston Children’s Pediatrics Grand Rounds, MGH Palliative Care and Geriatric Grand Rounds, DFCI Psychosocial Oncology Grand Rounds, webinars, etc.

Small-group teaching opportunities

• PACT Journal Club: Fellows present and facilitate discussion about journal articles
• AAHPM Pediatrics Council Virtual Journal Club
• Franciscan Children’s Hospital: Fellows teach staff at FCH about PPC topics

Quality improvement curriculum

• Six didactic sessions
• Mentored Quality Improvement project (August to February)
• PACT IDT: Fellows present cases for discussion around palliative care quality/safety

Retreats

• Teaching retreat in fall (in conjunction with MGH Adult PC Fellowship)
  • One-day retreat with focus on developing fellows’ skills as educators
• Resilience retreat in winter
  • One-day retreat with focus on experiential application of strategies for resilience and sustainability
• Leadership retreat in spring (in conjunction with MGH Adult PC Fellowship)
  • One-day retreat with focus on leadership development

Mentorship structure

• Primary PACT mentor in same discipline as fellow
• Secondary non-PACT mentor in same discipline as fellow

Resilience curriculum

In addition to informal debriefings after consults, difficult encounters, and patient deaths that are integrated into the fabric of our daily work, the following structured activities are built into the fellowship schedule:

• “Tending toolbox”
• Reflections
• Resilience retreat
• Spiritual care curriculum

• Active DEl initiatives are taking place at multiple institutional levels, including Harvard Medical School, Boston Children’s, and DFCI, to establish the priority of DEl
• Faculty requirement for education on DEl, implicit bias, and bystander-to-upstander training
• Annually, Boston Children’s GME and the Office of Health Equity and Inclusion host a “Virtual Second Look for Diverse Fellowship Candidates”
• PACT fellows participate in MGH Fellowship’s Health Equity Curriculum
• Pediatric-specific health equity curriculum is under development