Death & Dying Fellows Put Learnings into Practice

Despite the need for better conversations around end-of-life care that the COVID-19 pandemic brought, many practitioners still find themselves unprepared to talk about serious illness and death with patients and families. The Jewish Healthcare Foundation's 2023 Feinstein Death and Dying Fellowship aimed to address this gap. The fellowship, now in its eighth year, featured presentations and activities on a variety of topics around the end of life, culminating in a virtual session on March 27 which afforded fellows the opportunity to apply the learnings from prior sessions through role-play of serious illness conversations. Twenty-four fellows from a wide range of backgrounds engaged with a multidisciplinary faculty of experts from the field throughout the nine-week experience.

This year marked the welcome return of in-person sessions and site visits into the fellowship curriculum. Fellows visited UPMC Children's Hospital, where they learned the key aspects of pediatric care at the end of life and engaged in small-group discussions with members of the Pediatric Palliative Care and Family Dynamics Team. At UPMC Canterbury Place, the second site visit of the fellowship, students toured the long-term care facility and had the opportunity to listen to a facilitated discussion focused on conversations around end-of-life care. This enabled fellows to understand the crucial role that long-term care facilities have in end-of-life discussions.

The finale kicked off with a presentation by Robert Arnold, MD, director of the Section of Palliative Care and Medical Ethics at the University of Pittsburgh School of Medicine and chief medical officer at the Palliative and Supportive Institute of UPMC Health Systems. Dr. Arnold discussed techniques for gaining comfort around having conversations with seriously ill patients, including understanding the role of emotions—for patients, families, and providers—in these discussions. He offered strategies for structuring meaningful end-of-life conversations and stressed that this skill requires continuous practice to master.

Following Dr. Arnold's presentation, fellows practiced end-of-life conversations in small groups using case scenarios. Breakout groups were facilitated by Michael Barkowski, DO, MA, internist, Division of Supportive Care/Palliative Care, Allegheny General Hospital and Wexford Hospital, Allegheny Health Network; Amie Hull, DNP, CRNP, Supervisor CRNP, UPMC Senior Communities; Emily Jaffe, MD, MBA, VP and Executive Medical Director and JHF Board member, Enterprise Palliative Care Strategy and Implementation, Highmark Health; Libby Moore, LSW, DHCE, director, Federated Guardians; Ethan Silverman, MD, Program Director, Hospice and Palliative Medicine Fellowship, Assistant Professor of Medicine, University of Pittsburgh School of Medicine; and Lyn Weinberg, MD, geriatrician, Allegheny Health Network.

As the session concluded, fellows reflected on their experience with the fellowship and how the learnings will impact their future work. Fellow Jessica Jack, BS, a master student at the University of Pittsburgh School of Social Work, noted, "As a social work student looking to pursue a career in hospice, this fellowship has taught me about death in dying in multiple contexts, not just hospice care with older adults. The discussions I was able to have with professionals in the field and other disciplines through the fellowship are irreplaceable."

Annie Sun, a rehab sciences student at the University of Pittsburgh, expressed a shift in perspective as a result of participating in the fellowship: "Truthfully, death and dying was not something I had considered to be a focus for me as an EMT since my goal had always been to keep patients alive and transport them to the hospital. After learning so much of the importance of the discussion of topics like these, I feel more confident in my role as a provider to give the best care I can."

Thank you to all of the additional speakers who contributed their expertise to this Fellowship: Judy Black, MD, MHA, medical advisor, Jewish Healthcare Foundation; Theresa Brown, PhD, BSN, RN, writer, nurse, patient; Nina Butler, EdD, education consultant; Ariel Clatty, PhD, medical ethics manager, UPMC Shadyside Hospital; Rev. Richard Freeman, Sr., MSPC, physician consultant, manager of pastoral care, Children's Hospital of Pittsburgh; Niharika Ganta, MD, medical director, Palliative Care Programs, Hospital of the University of Pennsylvania & Penn Presbyterian Medical Center; Lucy Gilliam, director of nursing, UPMC Canterbury Place; Ruth Ann Guillinger, MD, physician, LIFE Pittsburgh; Betsy Hawley, executive director, Pediatric Palliative Care Coalition; Eric Horwith, MSW, LSW, regional manager, Family Hospice and UPMC Home Healthcare, adjunct professor, University of Pittsburgh School of Social Work; Alicia Kolling, PA-C, senior advanced practice provider, Supportive Care Program, Children's Hospital of Pittsburgh; Douglas F. Kupas, MD, FAEMS, EMS medical director, Geisinger EMS; Andrea Lurier, PhD, CT, manager, Highmark Caring Place; Carol May, RN, MSN, MBA, CHPPN, director of supportive care, Children's Hospital of Pittsburgh; Jennifer Gonzalez McComb, MD, MPH, FACP, clinical associate professor, Department of Medicine, Section Chief Pulmonary and Critical Care Medicine, UPMC Shadyside Hospital; Heather Mikes, DO, FAAHPM, director of geriatrics and palliative care, UPMC Latterman Family Health Center; Scott Miller, MD, MA, FAAHPM, chief medical officer, Family Hospice of UPMC, clinical associate professor of medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh; Alison O'Donnell, DO, MPH, geriatrician, Allegheny Health Network; Alyssa Osselborn, RN, unit nurse on TRU Unit, UPMC Canterbury Place; Charles (Chuck) Rhoads, MD, MBA, NHA, administrator, UPMC Canterbury Place; Tamara Sacks, MD, primary care physician, Community LIFE; Elizabeth Schandelmeier, LCSW, APHSW-C, bereavement coordinator/counselor, Family Hospice of UPMC; Jonathan Weinkle, MD, internist and pediatrician, Squirrel Hill Health Center; and Justin Yu, MD, MS, faculty, supportive care program, Children's Hospital of Pittsburgh, assistant professor, Department of Pediatrics, University of Pittsburgh.

While the Fellowship targets graduate students, a related Death & Dying Series will be scheduled for later this fall and will be open to practitioners in the field.