Specialty training in palliative medicine in Wales provides a comprehensive training experience for those wishing to pursue a career to Consultant level.
In-patient specialist palliative care experience is gained across the rotation. This also includes experience at the Regional Oncology Centre at Velindre Hospital and with the hospital palliative care team at the University Hospital of Wales. Hospital experience is also gained in the Swansea hospitals whilst at Ty Olwen.
Palliative medicine is a relatively new specialty that was first recognised by the Royal College of Physicians as a specialty in 1987. It has continued to grow in size and influence since that time. Originally borne out of the need to improve the quality of life for people with advanced cancer and with its roots in the hospice movement, the specialty is increasingly relevant to any patient with advanced, progressive illness requiring specialist input to improve their quality of remaining life. This has been endorsed in recent years by the publication of several National Service Frameworks, such as Renal Medicine, Long Term Conditions and Cardiology. Its place within cancer management is described in detail in the NICE Guidance “Improving Supportive and Palliative Care for Adults with Cancer, 2004.”
The holistic nature of palliative medicine encompasses the physical, psychosocial and/or spiritual domains of care and as such, good multi-professional working is fundamental to its success. Palliative care is delivered in a variety of settings, including hospice and specialist palliative care units, hospital and community. Many hospice inpatient and community services sit within the charitable sector, supported by the NHS. Doctors are involved in the direct management of hospice inpatients and outpatients and usually act in an advisory capacity in hospital and community teams. The delivery of education and training to a variety of professional groups to improve the standard of general palliative care runs in parallel with the direct delivery of a specialist service.
Due to the nature of their work, palliative medicine physicians enjoy close working relationships with a variety of colleagues including those in general practice, medical and clinical oncology and other medical and surgical specialties.
Palliative medicine can be highly rewarding with a good mix of clinical work and opportunities to rely on highly developed clinical skills and judgement. It is a young specialty with new challenges and opportunities allowing for a varied and changing career.
A sense of achievement is provided by the setting of realistic goals of care with patients and carers to improve quality of life. Time to give holistic care is built into the work and is valued by patients and staff alike. Strong team-working with a broad range of expert colleagues provides a supportive working environment. There are opportunities to work in a variety of settings during training. Consultant posts are varied in their structure with the possibility of developing special interests. Influencing the delivery of palliative care across the broader health community by teaching, training and developing services provides good job satisfaction.