July 1, 2014 Dear Prospective Fellow: The Palliative Medicine Fellowship Training Program at the University of South Florida is designed for candidates who wish to pursue a clinical or an academic career in hospice or palliative medicine. The program offers a one-year fellowship that leads to board eligibility in hospice and palliative medicine. Up to two fellows will be selected this year. The first major teaching site for the program is LifePath Hospice & Palliative Care, Inc., the largest non-profit independent hospice in the country. With an average daily census of over 2,500 hospice patients and active palliative care consultation services, the fellow will have an opportunity for contact with diverse patients having varied clinical conditions in a wide array of settings. Lifepath Hospice has had a long-standing affiliation with the University of South Florida, serving as a teaching site for medical students, residents and fellows. The James A. Haley Veterans Hospital is the second major teaching site for the program offering an active inpatient palliative care consult service, an inpatient hospice unit, an active home care program as well as a large skilled nursing facility. Fellows in palliative medicine will receive broad, practical experience in hospice and palliative medicine through rotations at the 24-bed Melech House or Sun City Center House Inpatient Care Centers, LifePath’s Home Hospice Program, and community hospital consultation services affiliated with Axis Palliative Healthcare, LLC, an affiliate of LifePath Hospice and Palliative Care, Inc. In addition, fellows may choose electives at the Tampa General Hospital, H. Lee Moffitt Cancer Center, both having active palliative care services, as well as the James A. Haley Veterans Hospital. Fellows are expected to identify a specific scholarly activity/research project during their first year and participate in this activity throughout the year. LifePath Hospice and Palliative Care, Inc., is one of the only hospices in the country with an active research department. Fellows can also interact with multidisciplinary colleagues at the Center for Hospice, Palliative Care, and End of Life Studies at USF which focuses on education and research in end of life and palliative care. Fellows will be encouraged to submit one or more papers for publication in the medical literature. During the training period, in addition to clinical rotations, fellows will participate in educational activities for and teach medical students, residents and other disciplines. Fellows will be evaluated monthly by interdisciplinary faculty in the six competency domains required by the Accreditation Council for Graduate Medical Education: Patient Care, Medical Knowledge, Practice-based Learning and Skills, Interpersonal and Communication Skills, Professionalism and Team-based Practice. During the year, each palliative medicine fellow will spend six months in hospice inpatient units/palliative care consultation services, four months with home hospice teams, one month on a pain service, and one month on an elective. The fellow will also have a continuity experience with a hospice home care team for 12 months. These settings give fellows opportunities to care for patients with a broad range of palliative care needs. Electives will be offered in geriatric home care, geriatric long term care, oncology, radiation oncology, cardiology, pulmonary medicine, and ethics and humanities. A completed application including three letters of recommendation should be sent to the Fellowship Program Director as soon as serious interest is determined. Candidates who have completed post-graduate training in Internal Medicine or Family Medicine will be eligible for this fellowship training program. Candidates will be judged on the strength of prior training, demonstrated clinical competence and potential for excellence in a career in hospice and palliative medicine. Interdisciplinary faculty members will interview selected candidates before final decisions are made. All enrolled fellows will receive a stipend based on the salary guidelines of the University of South Florida. It is the policy of the LifePath Hospice and Palliative Care and the University of South Florida not to discriminate against any individual on the basis of race, color, religious creed, national origin, sex, sexual orientation, marital status, age, political affiliation, handicap or veteran status in matters of admissions, employment, or services in the educational programs or activities that it operates, in accordance with civil rights legislation and agency commitment. The field of hospice and palliative medicine, both academic and clinical areas, remains wide open for well-trained graduates. One can literally pick the geographic area and practice preference. I have personally found it an enjoyable and rewarding profession. I am pleased to hear of your interest in the field. Please let me know how I can be of further assistance to you. Sincerely, Robert Walker, M.D. Associate Professor and Director Hospice and Palliative Medicine Fellowship Program Enclosures: application & checklist University of South Florida Department of Internal Medicine Hospice and Palliative Medicine Fellowship Program The following documents are required along with your application to our program. Until we have received all required documents, your application will NOT be reviewed. Checklist Application form Curriculum Vitae (CV) Letters of recommendation (3 current) One page personal statement re: goals and aspirations and why you are choosing a hospice and palliative care fellowship Transcript from medical school Copy of medical school diploma USMLE (Steps 1, 2 & 3) ECFMG certificate (if graduated from foreign medical school) All such applications and recommendations should be mailed to: Robert Walker, MD, Program Director c /o Lourdes Rodriguez 12901 Bruce B Downs Blvd. MDC19 Tampa, FL 33612 You may also e mail your application packet to LRODRIG1@HEALTH.USF.EDU POST GRADUATE TRAINING PROGRAM APPLICATION University of South Florida College of Medicine Tampa, FL Department of Internal Medicine POSITION APPLYING FOR: Hospice & Palliative Medicine Fellowship TO BEGIN: July 1, 2015 PERSONAL DATA Name: ______________________________________ Social Security No.:___________________ Present Address: __________________________________________________________________ Number Telephone Number: ( Street City State )_____________________ Pager Number: ( Zip ) _______________ Email: __________________________________________________________________________ Birthdate: _____________________ Birthplace: _________________________________________ City / State / Country Citizen of __________________ VISA Status _____________ ECFMG No.:__________________ (if applicable) Emergency Contact Name: __________________________ Telephone No.: ( ) ____________ EDUCATION Medical School Name: _____________________________________________________________ Address: ________________________________________________________________________ INTERNSHIP / RESIDENCY School (list below in chronological order every program you have attended) Location Dates Attended __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________________________ Board Eligible __________________ Board Certified ______________ Specialty ______________ RESEARCH EXPERIENCE, PUBLICATIONS, SPECIAL SKILLS __________________________________________________________________________________ __________________________________________________________________________________ ____________________________________________________________________________ LICENSE: Do you hold a valid state medical license? _______ State(s) __________ Number: _____________ AREA OF INTEREST: Describe your possible future professional goals or interests? (i.e. academic career, private practice, group practice, nursing home physicians, etc.) __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ____________________________________________________________________ DATE: _______________ SIGNATURE: ____________________________________________ COPIES OF THE FOLLOWING ARE REQUIRED FROM EACH APPLICANT APPLYING FOR A POSITION Application form ECFMG (if applicable) Medical School Diploma USMLE (1,2 & 3) Curriculum Vitae Letters of Recommendation Medical School Transcript One-page personal statement. (Re: goals and aspirations and why you are choosing a hospice and palliative medicine fellowship) A small (2x3) photo is appreciated to help in identifying you if you should come for an interview. 2x3 photograph All applications and documentation should be sent to: Robert Walker, MD, Program Director c/ Lourdes Rodriguez o 12901 Bruce B Downs Blvd. MDC 19 Tampa, FL 33612