Dr Kirsten Donnelly, ST4 trainee in palliative medicine at The Christies NHS Foundation Trust, shares her experience of training and working in palliative medicine, and what influenced her in choosing the specialty.
What influenced you in choosing palliative care?
I have always been interested in palliative care; I believe it is an area where you can make a huge difference for patients and their families. If we get it right for patients in the later stages of their illness then this can have a lasting positive impact for other family members.
I completed a special study module whilst in my fourth year at medical school, which allowed me to spend a week with a community palliative care team. I found it to be a humbling experience, being invited in to patients’ homes and being part of their experience at such a poignant time in their lives.
I always had an interest but it was only during foundation training after I learnt more about the training programme that I made the definite decision that this was what I wanted to do.
What rotations did you do in your training? What did you find helpful?
I completed core medical training (CMT), choosing rotations relevant to palliative medicine. I completed a palliative medicine rotation based in a hospice, which was very useful for consolidating my career decision. It would also have been useful to complete an oncology rotation, but general medical specialties such as elderly care all constitute good experience.
Other routes to specialist palliative medicine training include via core surgical training, general practice and anaesthetics, which is quite different to other medical specialties but does need to provide equivalence to competencies gained in core medical training to enter higher medical training in palliative medicine.
Do you work closely with other specialties?
We often work closely with GPs if based in the community and all medical and surgical specialties if based in a hospital setting. It is useful to develop good working relationships with local oncologists as a significant amount of our workload involves patients with cancer.
What are the best things about working in palliative care?
It is very satisfying to achieve good symptom control for a patient who has been previously struggling with symptoms such as pain or nausea. It is also satisfying to see what a positive effect open and honest communication can have for a patient and their family.
The best things about working in palliative care are making a difference for patients and their families at a significant time in their lives, the teamwork within a multi-disciplinary team and the largely sociable hours.
And what are the main challenges?
It can be emotionally draining and difficult at times and it is important to know where you can find support. It can sometimes be challenging working alongside professionals in other specialties who may misunderstand what we do.
What are your typical working hours? Are they sociable/family-friendly hours?
I work full time Monday to Friday, 9am to 5pm with non-resident on-call (one in five) at the local hospice. Palliative medicine is generally a family-friendly specialty and many registrars and consultants do work less than full-time.
Are there opportunities for teaching or lecturing?
Yes there is generally opportunity to be involved in local undergraduate and postgraduate teaching programmes. There are opportunities to lecture at conferences and educational meetings.
Are there opportunities for research?
Palliative medicine is a growing field for research and there are many opportunities for involvement. My training programme in the North West Deanery includes a 6 month research block.
Do you work closely with other healthcare colleagues or groups?
Yes, we work very closely with palliative care specialist nurses who often make up core members of the teams in which we function. We also work closely with other allied healthcare professionals such as physiotherapists, occupational therapists, social workers and psychologists to provide holistic care for our patients.
I am a member of the Association for Palliative Medicine and have recently taken on the role of trainee representative on the Palliative Medicine Specialty Advisory Committee.
Are there typical patient groups? What are they like?
We look after patients who have life-limiting conditions. These can be cancers or chronic cardiac, renal, chest or neurological conditions such as heart failure, COPD and MND. All our patients are different and we may be involved for many different reasons such as symptom control, emotional and psychological support or terminal care.
What is the required mix of skills for this specialty?
Excellent communication skills are necessary, along with keen clinical skills and an affinity for teamwork.
What advice would you give to someone considering a career in your specialty?
Try and gain some experience within the field, perhaps completing a special study module whilst at university or undertaking a taster week during foundation training. Make contact with a consultant in your local area.