The mission of the Advanced Practice Provider (APP) Fellowship in Hospice and Palliative Care is to equip qualified, committed, creative, and caring APPs with the clinical and academic expertise to become future leaders in palliative and supportive care. Nurse practitioners and physician assistants in this program work with members of our Supportive Care Service and train side by side with physician fellows in our Hospice and Palliative Medicine Fellowship program.
It is our privilege, responsibility, and priority to train the next generation of APPs and doctors together, to drive innovation and improvement in palliative and supportive care. The interprofessional approach of our twin fellowship programs, in which nurse practitioners (NPs), physician assistants (PAs), and doctors train side by side in a world-renowned cancer center, ensures that our graduates are uniquely prepared for collaborative care and team science. Upon completion of a fellowship at Memorial Sloan Kettering, palliative care nurse practitioners and physician assistants are ready for independent practice and continued professional advancement.
Program of Training
During the yearlong program, APP fellows form an integral part of the inpatient Supportive Care Service at Memorial Hospital. Evidence-based, patient- and family-centered care is provided with daily involvement by attending doctors, NP and PA staff, and interdisciplinary team members. Outpatient experience is acquired in the Supportive Care outpatient clinic, with fellows supervised by attending doctors and APPs, seeing patients referred from the oncology services. With mentoring, fellows are encouraged to participate in research and quality-improvement projects and to submit reports of this work for presentation at scientific meetings and publication in peer-reviewed journals.
APP fellows will gain a number of skills throughout the fellowship program. These include the following:
- collaborative assessment and management of pain syndromes, nonpain symptoms, and psychosocial distress associated with serious illnesses, including cancer
- basic principles and practical applications of medical and nursing ethics and legal aspects of pain management and palliative care
- spiritual, religious, existential, and cultural aspects of care
- advance care planning
- continuity of care through liaison and coordination with community agencies and healthcare professionals
- care of imminently dying patients and their families
- grief, loss, and bereavement
- team collaboration in palliative care practice, education, and research
Our program dates back to the early 1980s, long before palliative care was known in hospitals and when hospice was early in its development. It was pioneered by Nessa Coyle, a renowned nurse practitioner, who collaborated with Kathleen Foley to educate and mentor the first pain specialists and earliest palliative care nurses, doctors, social workers, and chaplains. Dr. Coyle, co-editor of the Oxford Textbook of Palliative Nursing, established the APP fellowship program, which was subsequently led by her mentee, Kimberly Chow, and now by Kara McGee, a fellowship graduate (class of 2015).
Selected for their past accomplishments and promise of important contributions, APP fellows come from diverse backgrounds, including adult and pediatric oncology, critical care, hospice, and research nursing. We look for dedication to clinical excellence, a love of learning, a collaborative spirit, compassion for patients and families in need, and recognition of the full reach and impact of the palliative APP role. Fellows trained in palliative care at MSK take a variety of career paths to the forefront of the field. Two recent graduates received the Robert Wood Johnson Future of Nursing Scholars Award to pursue PhDs and build an independent program of clinical research. Many fellows later join our team as independent practitioners.
Members of the Supportive Care Service, including fellows, share respect for MSK’s core values, which are reflected in key features of the APP fellowship program. They are as follows:
- fully integrated with the physician fellowship program, which is accredited by the Accreditation Council for Graduate Medical Education (ACGME)
- accelerated development of evidence-based clinical competencies with a high degree of supervised independence
- structured training and mentorship from preeminent palliative care clinicians
- weekly protected academic time and a curriculum that mirrors skill development
- extensive internal and external elective options that allow for individualized learning and exposure to diverse groups of people and care settings institutional and programmatic support for professional development (APP fellows receive a $1000 stipend to attend the AAHPM conference or another national palliative care conference.)
- scholarly involvement, including a grand rounds presentation, the journal club, and mentored research projects designed to lead to national presentations and peer-reviewed publications
- weekly outpatient clinic with physician and APP preceptors
- preparation to sit for the Advanced Practice Registered Nurse Examination (ACHPN)
- world-renowned cancer center where palliative care is an integral part of the patient-centered experience
- robust, rapidly growing interprofessional and interdisciplinary Supportive Care Service, broadly integrated throughout hospital and outpatient settings
- increasing emphasis on the early integration of palliative care by primary teams and specialists
- academic leadership in complex pain management, psychosocial palliative care, and communication skills
- resiliency and wellness promotion through participation in an ongoing resiliency skills curriculum
- close collaboration with Departments of Psychiatry and Social Work; the chaplaincy; the Integrative Medicine, Geriatrics, and Hospital Medicine Services; and the Center for Health Policy and Outcomes
- an authentically collaborative model supported by team members from all professions and disciplines
- supervision, teaching, and mentorship in the context of interprofessional and interdisciplinary respect
- equal responsibilities and independence among APP and physician fellows, after dedicated orientation periods, with APP fellows practicing at the full extent of licensure
- ongoing emphasis on constructive feedback between all members of the service
- a dedicated full-time supportive-care chaplain, social worker, and clinical pharmacist
- patient and family care by the full interdisciplinary and interprofessional team
- close clinical and experiential mentorship by all members of the Supportive Care Service
- orientation and ongoing clinical training throughout year
- foundational principles of empathic communication presented in core didactic sessions
- formalized communications skills training in MSK’s ComSkil program, with sophisticated video resources and actors in clinical scenarios
- real-time, hands-on learning through mentored leadership of family meetings and didactic communication lectures
- emphasis on collaborative communication and consultation etiquette with colleagues, patients, and families
Kara McGee, AGNP-C, ACHPN
APPs and doctors on the Supportive Care Service, both inpatient and outpatient, provide clinical and academic mentorship. Further mentorship is provided by members of the interprofessional team, including chaplains, social workers, nurses, and pharmacists.
Length of Program
Applicants must be master’s-prepared nurse practitioners or physician assistants with current New York State RN and NP or PA licenses, or be eligible to apply for NYS licensure prior to the start of fellowship. APP fellows are required to complete all competencies and training as specified for NPs/PAs working at Memorial Sloan Kettering. An oncology background is preferred but not required.
Number of Positions
Three or five per year, based on program funding
How to Apply
The application is available here. The deadline to apply is January 31. All correspondence should be addressed to:
Kara McGee, AGNP-C, ACHPN
Associate Program Director
Supportive Care Service
Memorial Sloan Kettering Cancer Center
1275 York Avenue, Box 496
New York, NY 10065
Email: [email protected]