Hospice and Palliative Medicine Fellowship

Children’s Hospital Los Angeles is home to one of the largest and busiest pediatric palliative care services in the country.

Inpatient Palliative Consult Service

Our fellows spend 6 ½ months with CHLA’s busy inpatient pediatric palliative care consultation service. We have a full interdisciplinary team made up of physicians, advance practice nurses, social workers and a psychologist. On average we see 500 new consults annually across all pediatric and young-adult ages and thousands of follow-up visits. Consults range from symptom management to exploring treatment goals in advanced illness and finding value-based, goal-concordant care.

Kaiser Permanente Los Angeles Medical Center also hosts our fellows for three weeks of training on its interdisciplinary inpatient palliative care consultation service, where they mainly care for adults.

Outpatient Palliative Care Clinic

Children’s Hospital Los Angeles has a robust outpatient clinic in which our fellows participate with the interdisciplinary team in a weekly half-day clinic in longitudinal care. We began our telemedicine pilot program in 2018, and now it is a well-established aspect of our care model, allowing us a better peek into the home life of our patients and their families.

Hospice and Home-Based Palliative Care

We have a strong collaboration with Providence Home Care and Trinity Kids Care (TKC). Our fellows spend five weeks with TKC and its pediatric-specific home hospice and home-based palliative care program, seeing on average 20 patients per week. Our fellows work closely with hospice Medical Director Glen Komatsu, MD. Our fellows also complete their hospice experience with five weeks at the adult hospice program to explore how their inpatient hospice unit works. They will also concentrate on how to provide total care for patients with a terminal illness in their homes, along with learning Medicare and Medicaid hospice rules and regulations as part of their rotation.

Long-Term Care and Inpatient Rehab

Fellows spend two weeks at All Saints Sub Acute Facility where they care for both pediatric and adult patients. The rotation is spent with an emphasis on the care of the pediatric patients while supervised by the Pediatric Medical Director, Dr. Sally Ward. Fellows also spend 2 weeks caring for patients in Children’s Hospital Los Angeles inpatient Acute Rehab hospital. The goals of these rotations are to learn about systems and financing of caregiving in the U.S. from infancy through adulthood. Fellows conduct family meetings in these settings to help coordinate care for patients who have functional impairment related to their health conditions.

Electives Rotations

Fellows choose three additional one-week clinical experiences in specialties that collaborate closely with palliative medicine. It is an opportunity to broaden their understanding of the care provided to our unique patients. Some options include: pediatric oncology and radiation oncology clinics, inpatient complex care in hospitalist medicine, radiation oncology, neurocritical care consultation service, and maternal-fetal medicine consultation service. The fellows also complete one week with the acute/chronic pain service during which they spend time with the Complementary and Integrative Medicine outpatient pain clinic.

Quality Improvement and Research

Our department has a strong quality improvement (QI) program that is based on the Institute for HealthCare Innovation (IHI) QI modules. The curriculum is passed throughout the year with a final project that can be used for Maintenance of Certification (MOC) credit. Our fellows are also able to use four weeks of elective time to work on a research or QI plan or other clinical or educational opportunities that support their growth toward future work success.

Leadership and Education Curriculum

Fellows participate in anesthesia/critical care medicine leadership curriculum in a collaborative learning environment with the other first-year fellows in our department. It is an opportunity to consider your personal strengths and how you would like to show up as a leader. Our fellows also participate in the pediatric fellows’ core curriculum, covering important topics from job-application considerations to the best ways of giving and receiving feedback. We also have a weekly Palliative Medicine Lecture Series covering symptom management, communications topics, journal club and more.

Well-Being

Medicine is practiced through a constantly changing environment and one where learning and practicing personal well-being is paramount to your success as a clinician. The Division of Comfort and Palliative Care consistently works to share the culture of well-being at work and integrate our fellows into all activities, such as reflections and recognitions at the start of all meetings. We also hold a monthly compassion-based case conference alternative with wellness check-ins as a full interdisciplinary team. We have integrated narrative medicine into our educational curriculum. We also support fellows attending a monthly wellness session, joined by the Critical Care fellows and supported by our head of Graduate Medical Education Wellness, Helene Morgan, MSW. We welcome well culture-affirming opportunities and support your exploration toward ensuring your work/life is harmonious.

Debra Lotstein, MD, MPH
Medical Director, Division Chief

Ilanit Brook, MD, MSHS
Fellowship Director, Attending Physician

Christopher Adrian, MD
Attending Physician

Gitanjli “Tanya” Arora, MD
Attending Physician

Kelsea Schreiber, MD
Attending Physician

Meredith Winter, MD
Attending Physician

Heather Bemis, PhD
Psychologist

Maura Heckmann, DNP
Nurse Practitioner

Rachel Rusch, LCSW
Social Worker, Support and Bereavement Coordinator

Jennifer Greenman, LCSW
Social Worker, Support and Bereavement Counselor

Ashley Powers, MSW ASW
Social Worker, Support and Bereavement Counselor

Janie Ito, MDiv BCC
Spiritual Care Staff Chaplain

Sally Ward, MD
Division Chief Pulmonary and Sleep Medicine
Pediatric Medical Doctor All Saints Sub-Acute Facility

Glen Komatsu, MD
Chief Medical Officer Palliative Care at Providence St. Joseph Health
Medical Director of Trinity Kids Care

• Children’s Hospital Los Angeles - Division of Palliative Care
• Providence Trinity Kids Care and Trinity Home Hospice
• All Saints Sub-Acute Facility
• Kaiser Permanente Southern California Palliative Medicine Service

• Career Development Mentor
• Well-being Mentor/Coach
• Scholarship/Research Mentor

2020-2021 – Kelsea Schreiber, MD – Attending Physician, Pediatric Palliative Care, Children’s Hospital Los Angeles, Los Angeles, CA

2019-2020 – Ching See Lau, MD – Consultant Pediatrician, Palliative Medicine, Toronto, Canada

2018-2019 – Sarah Dabagh, MD – Pediatric Palliative Care Director, Miller Children’s and Woman’s Hospital, Long Beach, CA

2017-2018 – Ann Wilbanks, MD – Attending Physician, Pediatric Pain, Palliative, and Integrative Medicine, Children’s Minnesota Hospital, Minneapolis, MN

• Funding to attend one academic conference
• Reduced rate for covered parking
• Office space, computer, pager
• Textbooks and other resources available
• Salary minimums:  
  • Postgraduate Year 4: $71,550
  • Postgraduate Year 5: $73,150
  • Postgraduate Year 6: $74,900
  • Postgraduate Year 7+: Compensation will be at the discretion of each division.
• Benefits include: Health and dental insurance; 14 days paid vacation plus six protected sick days; yearly educational stipend; monthly meal stipend; and 401(k) matching up to 3%