In the rewarding world of Palliative Medicine, compassion meets multidisciplinary care for patients of all ages.
What is Palliative Medicine?
Palliative Medicine is a medical speciality recognised by the respective nation’s Royal College of Physicians. It provides clinical leadership, care and support to prevent and relieve suffering for people with life-limiting and life-threatening illnesses. Its diagnostic and therapeutic priorities focus on meeting each patient’s individual goals through shared decision-making with them and those closest to them.
Palliative Medicine is practiced both as part of multidisciplinary palliative care teams and in partnership with other relevant specialities. This allows for individualised, holistic care to be consistently delivered.
Palliative Medicine’s Specific Expertise
There are several specific expertise that Palliative Medicine involves. These include:
- Assessing and managing physical, psychological and spiritual symptoms and mitigating distress.
- Clinical analysis of and decision-making in complex scenarios, such as when a patient’s clinical needs, preferences and interests are finely balanced and may require the skilled application of ethical and legal guidance.
- Skilled communication about and coordination of care, especially at disease transitions and boundaries between care settings.
- Working with partners, colleagues and organisations across sectors to provide excellent multidisciplinary care for patients and those important to them.
- Care and support to those critical to the patient, including facilitating their bereavement care.
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What is Palliative Care?
The different types of palliative care work in conjunction with Palliative Medicine. It represents active, total care of patients whose disease is not responsive to curative treatment. The control of pain and other symptoms, including psychological, social and spiritual concerns, is paramount.
The goal is to achieve the best possible quality of life for patients and their families. Priorities must focus on meeting every individual’s plans to deliver person-centred, holistic care.
Aims of Palliative Care
There are five fundamental aims of palliative care:
- To affirm life and regard dying as a normal process.
- To relieve pain and other distressing symptoms.
- To integrate psychological and spiritual aspects of patient care.
- To help patients live as actively as possible until death.
- To provide a support system to help families cope during both illness and bereavement.
What Does Palliative Care Mean to Patients and Carers?
If you’re a patient or carer for someone receiving palliative care, it’s important to understand what palliative care aims to do for you. As mentioned above, palliative care is about providing holistic care to look after every aspect of you or your loved one. Sometimes, palliative care is also referred to as ‘supportive care’ and can be offered alongside potentially curative treatments such as anti-cancer treatment.
What Are Palliative Care Services?
Palliative care teams are available in hospitals to see inpatients, as well as outside hospitals, providing support and assistance to people in their own homes or hospices. To be referred to a palliative care service, speak to your GP or district nurse if you’re at home or your hospital doctor if you’re an inpatient.
You can find out more information on when you should be offered palliative care and the different types of palliative care available in your area of the UK and Ireland here:
Careers in Palliative Medicine
Palliative Medicine is a rewarding career, allowing you to support patients and families at vulnerable times. There are opportunities for complex problem-solving, challenging communication and fascinating ethical dilemmas. Excellent palliative care requires multi-professional teams and interactions with a wide variety of hospital and community colleagues. Palliative Medicine specialist training takes place in hospitals, hospices and in the wider community.
If training full-time in a numbered post, it takes four years to gain a Certificate of Completion (CCT) in Palliative Medicine. Since 2022, Palliative Medicine has been dual accredited with General Internal Medicine. This means that, of the four years of specialist training, one must be spent in acute medicine.
The RCP census shows that Palliative Medicine is the 11th largest medical speciality, with around 700 consultants across the U.K. Further to this, trainee numbers in palliative medicine are on the rise. Approximately 48% of consultants work less than full-time, with a comparable proportion of trainees choosing to train flexibly.
Around a third of consultant roles are joint NHS and third-sector positions. This reflects the options available to work across settings and organisations. Speciality trainees rate their training highly in the GMC trainees’ annual survey.
The transformation of the NHS following the COVID-19 pandemic will require increased speciality training numbers. Larger cohorts of medical student replacements have already been announced, allowing the expansion of the Palliative Medicine workforce with necessary roles in all settings.
The Palliative Medicine workforce in years to come will include physician associates, paramedics, Allied Healthcare Professionals, and nurses of different grades. This will consist of more nurse consultants, advanced nurse practitioners and a growing number of pharmacists with specialist palliative care knowledge.
The APM is encouraging the diversification of its membership to reflect this trend.
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Consultants
Why Do We Need Consultants in Palliative Medicine?
With population growth and a more significant percentage of elderly people, the number of patients nearing end-of-life is increasing. Patients with advanced diseases are also living longer and needing more specialist palliative care.
There is an increasing referral of patients with diseases other than cancer to specialist palliative care. The complexity of medical treatments and co-morbidities in advanced disease is rising, and there is a national focus on improving the quality of end-of-life care services.
What Do Consultants in Palliative Medicine Offer?
Consultants in Palliative Medicine provide medical leadership to multi-professional specialist palliative care teams. They work in hospitals, hospices and in the community. This enables continuity of care by carrying out their services in multiple settings. Their core roles cover five areas:
- Clinical expertise
- Leadership of palliative care services
- Clinical governance
- Education
- Research
Consultants provide their clinical expertise in several ways. These include:
- Assessing complex symptoms with an understanding of the pathology
- Evaluating and supporting end-of-life patients and their families
- Formulating evidence-based and individualised management plans
- Advising other clinicians on ethical decision-making and symptom control
In addition, Consultants are expected to demonstrate leadership in a variety of contexts. For example:
- Clinical and operational oversight of palliative care teams
- Strategic leadership for service development
- Supportive leadership and appraisal of speciality, staff grade and associate specialist (SSAS) doctors.
What Appeals About Palliative Medicine?
If delivering high-quality, multidisciplinary, patient-centred care interests you, then Palliative Medicine could be the speciality for you. As a trainee, you’ll learn to care for patients with a wide range of illnesses of all ages and across numerous settings such as their homes, as well as hospitals and hospices. You’ll learn to think on your feet, apply theoretical and scientific knowledge and blend this with empathy and pragmatism.
As a small and dynamic speciality, there is a wonderful opportunity to help shape the future by involving yourself in collaborative research, quality improvement and education during your training.
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Getting into Palliative Medicine
If you’ve decided that Palliative medicine might be the professional avenue you want to move down, the next step is understanding how best to approach this. As a varied and fast-developing discipline, getting into Palliative medicine might seem overwhelming, but with advice and support from the APM, the process can be made much more straightforward.
How Do I Improve My Chances of Getting into Palliative Medicine?
It’s crucial to check the Person’s Specification paperwork available. This is accessible through the HEE speciality Website, while the ST4 Person-Specification paperwork is available through the RCP application website.
Once you’ve taken a look at this, try measuring your CV against the ‘Essential’ and ‘Desirable’ criteria. Market yourself and your interest in the speciality. While accessing a standalone position in a hospice is more challenging than previously, it’s vital to look for opportunities where you can link up with specialists in palliative medicine. This may be as a post-foundation doctor, through ‘taster-sessions’ during hospice training or similar roles. Also, consider competing for one of our prizes to help you stand out from the crowd.
How Do I Apply?
Applications (Round One) usually open in November for a predicted start date between August and December. Completing the application form is an in-depth process, so make sure it’s not left to the last minute. Once reviewed, candidates’ applications are shortlisted for interviews. Each interview has four sections, each lasting 5-8 minutes.
Candidates will then be marked on each of these four question areas, with a fifth mark being given for your communication and reflection skills in the ethical scenario, with the entire interview lasting around 30 minutes.
The four question sections are:
- Suitability and Commitment: This will give an opportunity to expand on the application form.
- Medical Registrar Suitability: This will explore the non-clinical parts of being a medical registrar, including managing an unselected take and an MDT.
- Professionalism and Governance: This will be a discussion underpinned by Good Medical Practice, allowing you to explain your strengths in this area.
- Ethical and Communication Scenario: This will be scored on the skills in handling an ethical scenario and will receive extra marks for communication and reflection skills.
For more information on this, head to the PHST3 Website.