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Hospice and Palliative Medicine Fellowship

Saint Louis University offers a one-year Accreditation Council for Graduate Medical Education (ACGME)-accredited postgraduate training program in improving the quality of life for patients living with a serious illness and their loved ones. 

A group of fellows taking a group photo in front of a party background

Our hospice and palliative care fellowship program produces health professionals who excel in palliative medicine and provide compassionate medical care, as well as emotional, spiritual and social support with expertise on communication skills and symptom management. 

Program Purpose and Vision

  • To enhance care for patients and families living with serious illnesses with a focus on providing relief from symptoms and distress.
  • To encourage research, reflection and experiential learning for health care professionals in compassionate palliative care in alignment with the vision of SSM Health Saint Louis University Hospital and the SLUCare Physician Group.


To offer interdisciplinary team-based specialized care for patients and families with serious illnesses, including:

  • Managing complex pain and symptoms.
  • Time devoted to intensive family meetings.
  • Help with advance care planning and coordination of care in partnership with the clinical team.
  • Educating communities, hospital staff, medical students and residents about the importance of palliative care in life-limiting illness.
  • Developing strategies for collaborative work with other specialties of medicine 

Educational Goals

Our curriculum employs a combination of clinical experience and didactic instruction to help you learn to support the best quality of life throughout an illness and to manage factors that contribute to the suffering of patients and their families. You will also develop skills in and experience with research, quality improvement and leadership in our rapidly growing field.

Throughout your year, you will become familiar with:

  • The different aspects of palliative and hospice medicine across all settings for patients with progressive conditions.
  • Exceptional interprofessional care for patients with advanced diseases.
  • Clinical and quality improvement research projects under the guidance of experienced mentors.
  • Strategies to excel in communication skills and establish meaningful connections for patients and their loved ones


The didactic curriculum is innovative and comprehensive, and strongly emphasizes all the following educational domains:

  • The hospice and palliative approach to care
  • Death and dying
  • Psychosocial and spiritual support
  • Pain assessment and management in cancer and non-cancer patients
  • Assessment and management of non-pain symptoms
  • Medical comorbidity and complications with life-threatening diseases
  • Optimizing function as it pertains to quality of life
  • Communication
  • Ethical and legal decision making
  • Quality improvement and research methodology in populations with advanced illnesses
  • Palliative care to diverse populations
  • Prognostication
  • Current care for different pathologies and palliative care interventions
  • Social determinants of healthcare

Clinical Curriculum

The 12-month clinical curriculum includes:

  • Seven months of inpatient adult consultation service (in three separate hospitals for adults and one hospital for pediatric palliative care)
  • One month on home hospice and home palliative care 
  • Two months of inpatient palliative care unit (in two different units)
  • Two weeks in radiation oncology and two weeks in oncology 
  • Longitudinal palliative care in the nursing home and continuity clinic one-half day per week throughout the year
  • Research time half day per week throughout the year
  • Two weeks for elective 

Fellowship Rotations

  • Palliative Care and Research Experience (longitudinal) 
  • Palliative Electives (One month) 
  • SLU-VA Ambulatory Palliative Clinic Experiences (Longitudinal) 
  • Oncology at SSM Saint Louis University Hospital (Two weeks)
  • Home Hospice and Home Palliative Care (One month)
  • Radiation oncology at SSM Saint Louis University Hospital (Two weeks)
  • Addiction medicine inpatient consults (longitudinal) 


  • Weekly palliative care fellow-specific lecture on Wednesday afternoon 
  • Geriatrics and Palliative Care Grand Rounds on Wednesday afternoon
  • Internal Medicine Grand Rounds on Friday morning 
  • Interdisciplinary pain lectures every three months 
  • Rotation-specific lectures

Sample Schedule

July August September October
Inpatient Consults SLU

Oncology / Inpatient consults - VA

Home hospice / Home palliative

Elective / Radiation oncology

November December January February
Inpatient hospice VA Inpatient hospice Inpatient consults VA Inpatient Consults SLU
March April May June

Pediatric PC inpatient consults

Inpatient consults Mercy hospital

Inpatient consults VA

Inpatient Consults SLU

Where We Work

Application Process

Eligibility Criteria

Qualified applicants to the geriatric medicine fellowship program have successfully completed medical school and a residency in internal medicine, family medicine or combined internal medicine-pediatrics from an ACGME-accredited program.

Candidates must be board eligible/board certified by American Board of Internal Medicine (ABIM) and/or American Board of Family Medicine (ABFM). The division currently supports J-1 Visas and may support H-1B Visas on an individual basis.

Foreign medical graduates who have completed a non-ACGME-approved internal medicine or family medicine program and are interested in a geriatric medicine fellowship should contact our division for eligibility determination.


Applications must be submitted through the Electronic Residency Application Service (ERAS). Our program participates in the National Resident Matching Program.

Interview Day

The program director and three to four faculty from the division interview select applicants. You will also have the opportunity to sit informally for lunch in the division, tour the campus, and visit Life Care Center of St. Louis.

Inpatient Palliative Care Consultation Services 

(Seven months)

Site: SSM Health Saint Louis University Hospital, VA Saint Louis Health Care System - Mercy Hospital 
Faculty: Drs Toledo-Franco and Chen at SSM Health Saint Louis University Hospital
Drs Loitman and Cepeda at the VA Saint Louis Health Care System 
Drs. Hinkle-Johnston and Alakkhassery

Goal: Fellows join the inpatient palliative medicine consultation teams to assess palliative care needs, participate and eventually lead family meetings with patients, caregivers and health care team. Fellows see a wide variety of patients through these distinct services, which encompass a tertiary care academic medical center with a Level 1 trauma center and a federally run hospital. In this rotation you have the opportunity to interact with different specialties and develop additional communication skills for patient care but also interdisciplinary work. 

Inpatient Palliative Care Unit / Inpatient Hospice 

Site: VA Saint Louis Health Care System - Jefferson Barracks Division - Private Hospice 
Faculty: Drs. Loitman and Cepeda, Dr Bettlach

Goal: Fellows gain direct management experience with inpatient hospice through their rotation at the inpatient palliative unit. Here you will assume the primary team role in caring for veterans nearing the end of their lives or participate during rounds and support decision-making. Communication skills are reinforced during this rotation. 

Home Palliative Care and Home Hospice 

Site: AccentCare Hospice - Visiting Nurse Association 
Faculty: Dr. Fox 

Goal: Throughout the year, fellows will have exposure to different settings of palliative and hospice practice, including patient homes and long-term care facilities, to gain the knowledge and skills needed to care for a patient with a terminal life-threatening illness. The rotation entails a half day per month for a hospice/palliative interdisciplinary group meeting and a four-week rotation for two months per year of home and nursing home hospice and palliative care.

SSM Health Cardinal Glennon Pediatric Palliative Care 

Site: SSM Health Cardinal Glennon Children's Hospital
Faculty: Drs. Shermini and Vanderford 

Goal: Fellows will understand the pediatric palliative care population, their families, and their multidisciplinary needs concerning medical treatment and quality of life.

Elective (2 weeks)

Site: SSM Health Saint Louis University Hospital and VA Saint Louis Health Care System 
Faculty: Dr. Toledo-Franco

Goal: The fellow will become familiar with the structure of palliative care in a clinically relevant field (e.g., geriatric medicine, interventional pain management, psychiatry, HIV clinic, radiation oncology, etc.) and will assist the team in pertinent procedures.

Palliative Care Clinic Experience 

Site: SSM Health Saint Louis University Hospital and VA Saint Louis Health Care System - Jefferson Barracks Division
Faculty: Dr. Chen at SSM Health Saint Louis University 
Dr. Loitman at the VA Saint Louis Health Care System - Jefferson Barracks Division

Goal: Fellows will be introduced to the principles of palliative and end-of-life care for adults and elderly patients in the ambulatory setting of veterans and cancer patients.

Radiation Oncology - Oncology Rotations

(Two weeks each)

Site: SSM Health Saint Louis University Hospital 
Faculty: Drs. Dombroski and Shahi (radiation oncology) - Dr. Ricciu (oncology)

Goal: Fellows will be introduced to the principles of radiation oncology and oncology caring for patients with cancer and learn treatment options and prognosis.