Fellows join the inpatient palliative medicine consultation teams at UCSF Medical Center, Kaiser Oakland, Zuckerberg San Francisco General Hospital & Trauma Center (ZSFG), and the San Francisco Veterans Affairs hospital (VA). Fellows see a wide-variety of patients through these distinct services, which encompass a quaternary care academic medical center, an HMO, a county hospital & level 1 trauma center, and a federally-run hospital. During their inpatient rotations at UCSF Medical center and ZSFG, fellows also manage Comfort Care patients in several specially appointed comfort care suites.

Fellows gain direct management experience with inpatient hospice through their rotation at the inpatient hospice unit in the San Francisco VA. Here they assume the primary team role in caring for veterans nearing the end of their lives.

Fellows master the clinical and regulatory intricacies of delivering home hospice care during their time with By the Bay Health, a Medicare certified hospice program directed by Dr. Kai Romero. Working under the supervision of Drs. Kai Romero and Sarah Sedki, fellows participate in weekly interdisciplinary case conferences and conduct home visits with all members of the hospice interdisciplinary team. Fellows also receive additional didactic instruction focused on managing transitions of care as well as the medical and regulatory knowledge essential to hospice. Because a career in hospice frequently includes caring for children, two weeks of this rotation focus on minors receiving either hospice care or participating in the California hospice waiver – a program that allows children with life-limiting or life-threatening medical conditions to receive community or home-based supportive services. 

At the Benioff Children’s Hospital at Mission Bay (a new facility opened in 2015), fellows join interdisciplinary members of the Pediatric Pain, Palliative & Integrative Medicine Center team including anesthesiologists, pediatric palliative care physicians, psychologists, nurse practitioners, child life specialists, social workers, and others in caring for children with serious illness in both the inpatient and outpatient settings. Prior pediatric training is not required for these rotations.

Each fellow has a weekly palliative care continuity clinic with the UCSF Symptom Management Service (SMS), a dedicated palliative care service based at UCSF's Helen Diller Comprehensive Cancer Center, or with the Outpatient Palliative Care Service (OPCS). The SMS provides a broad range of palliative interventions to patients with life threatening disease and works closely with UCSF's Psycho-oncology clinic, whereas the OPCS sees patients with non-cancer diagnoses. Fellows take on ongoing primary responsibility for a panel of palliative care patients. During fellow clinic, faculty supervisors are dedicated to fellow precepting and are not scheduled for any other clinical activity. Clinic time is protected, with fellows required to sign out their service pager.

To explore their particular interests in palliative medicine, fellows may choose from or modify several existing electives - such as Pain Medicine, Oncology, Home-Based Care, and Narrative Medicine - or build their own elective. Multiple training sites ensure access to a wide variety of elective opportunities. Supervised by the program director, fellows use elective building as an opportunity to practice curricular development. Time can also be set aside during these months to pursue work on the ACGME-required scholarly and quality improvement projects.