The division is part of the Department of Pediatrics, also based at CHEO.

The program will consider candidates who have completed three to four years of core training in pediatrics. At the end of the program, trainees will be qualified to write the Royal College subspecialty fellowship examinations in Pediatric Palliative Medicine and will be qualified to function as an independent pediatric palliative medicine specialist or work in an academic position at university-based pediatric palliative medicine programs.

Related links

• CaRMS
• Royal College of Physicians and Surgeons of Canada

Program goals

The Pediatric Palliative Medicine Subspecialty Residency Program at the University of Ottawa educates physicians to become outstanding leaders as specialists in pediatric palliative medicine.  Our graduates are skilled to practice consultant pediatric palliative care across all settings including in hospital, hospice, and home. They are positioned to be leaders in the field by practicing clinical care of the highest standard, and through advancement in education and research.

Palliative care is enriched through close collaboration between physicians and interprofessional staff from a variety of backgrounds. This training program offers broad exposure to palliative care in pediatric life-threatening or life-limiting illness, as well as scholarship and leadership in palliative care.

Program highlights

The 2-year pediatric palliative medicine program at the University of Ottawa welcomes physicians seeking to become clinical subspecialists in pediatric palliative care in all settings (home, hospice, hospital). The training is enriched through strong collaborative relationships with community partners and the inter-professional palliative care teams at the Children's Hospital of Eastern Ontario (CHEO) and Roger Neilson House, pediatric hospice on the grounds of CHEO.

The training programs includes collaboration with referral centers across Eastern and North-eastern Ontario and Eastern Nunavut, which are included in the CHEO catchment area. A large interdisciplinary team which includes, physicians, nurses, social workers, recreation therapists, and spiritual care providers work collaboratively across CHEO and Roger Neilson House sites to provide comprehensive palliative care for children with life-threatening and life-limiting conditions, across settings of care, from hospital to hospice to home. The team also provides outreach palliative care services for perinatal and neonatal palliative care at The Ottawa Hospital, which is located adjacent to CHEO.

Roger Neilson House has 8 beds and provides inpatient services for respite, pain and symptom management, transitional care and end of life care. Additional services at Roger Neilson House include counselling, recreation therapy, grief and bereavement support, community care (home visits, virtual care) and clinic visits. The Palliative Care Team provides 24-7 telephone service for patients, families and other healthcare providers.

The trainee will have the opportunity to participate in all aspects of the Roger Neilson House program, learning from a diverse group of interdisciplinary clinicians who are passionate about palliative care and teaching.

Program structure

The training program will begin training based on Competency by Design (CBD) in 2023. Subspecialty trainees will have a rotational program as outlined by the Royal College of Physicians and Surgeons of Canada. The program has been configured to fulfill the requirements of the Royal College of Physicians and Surgeons of Canada. The program provides graduated responsibility for patient care with an emphasis on working within an interdisciplinary palliative care team.

Remuneration and benefits applicable for this position will be stipulated by the guidelines and agreements already in place between the Professional Association of Interns and Residents of Ontario (PARO), the University of Ottawa (uOttawa) and the Children's Hospital of Eastern Ontario (CHEO).

Academic funding is available to support research and academic activities for subspecialty residents. This funding may be used to attend relevant conferences or for other educational activities. Previous residents have used funding to attend education courses including: EPEC Pediatrics and the Pediatric Pain Master Class.

The program curriculum is based on the subspecialty training requirements in pediatric palliative medicine as outlined by the Royal College of Physicians and Surgeons of Canada.

The subspecialty Program is designed for delivery over two years. Each year consists of 13 blocks for a total of 26 blocks, each being four weeks in length. The blocks are scheduled as core, selective, or elective rotations, with some rotations spanning more than one block. The schedule is flexible to meet the needs to each resident, within the structure provided by the RCPSC in the "Subspecialty Training Requirements In Pediatric Palliative Medicine" (note that the Royal College requirements are currently under revision and this program will follow that updated version).

The academic teaching program follows a 2-year cycle, which includes monthly National Academic Half-Day sessions conducted with National Faculty from across Canada. In the first year the program includes lectures given by faculty with interactive discussion. The second-year curriculum includes a self-directed learning program with topics assigned for discussion with faculty and challenging case discussions

Teaching and rounds – Common for both years

• National Academic Half Day- 12 per year
• National PPC Journal Club – 4 per year, trainees present once per year
• Project ECHO Palliative Care -12 per year, consisting of teaching, case discussion and mentorship sessions with interdisciplinary palliative care clinicians
  • Trainees present didactic teaching and a clinical case (1 didactic and 1 case each per year)
• Research in Progress – Trainees present 2 x per year
• Department of Pediatrics Grand Rounds- weekly (optional)
• Joint Educational Rounds for Pediatric Palliative Care with SickKids - weekly, Wednesdays
• Regional Academic Rounds (Palliative Medicine Grand Rounds) – 12 per year
• Roger Neilson House Education Days- monthly
• QOLA PPC Rounds-Hosted by McMaster - monthly, Thursday

First year:

• Weekly Academic Half Day- Local, weekly on weeks with no national academic half-day
• National PPC Academic Half Day- monthly virtual learning program with trainees and faculty from across Canada
• Pediatric Serious Illness Conversation Guide Training Workshop and Train the Trainer Program

Second year:

• Trainees complete a self-directed learning program with monthly assigned topics which is complemented by National PPC Academic Half Day, consisting of interactive discussions and case presentations with faculty and other trainees from across Canada
• Trainees develop skill in teaching serious illness communication by participating as facilitators in Pediatric Serious Illness Conversation Guide Training Workshops

CHEO palliative care team

• A multi-disciplinary palliative care team which includes nurses, nurse practitioners, recreation therapies, volunteers, social workers and spiritual care providers
• The palliative care physicians provide a 24-7 telephone service to families who are part of the palliative care program
• The team receives 125-200 new consultations per year, and between 30-50 children we follow die annually.
• There are typically between 5 and 20 hospitalized children who are seen daily and 6-8 children in the hospice.
• In total there are between 15-25 children seen each day, including on weekends.
• There are generally around 200-225 families who are followed by the team at any one time
• These supports are provided to all families who are referred to the palliative care team, including children in Eastern Ontario, Western Quebec and the Eastern part of Nunavut.
• The palliative care team provides coordinates with the clinical services of Roger Neilson House, with team physicians managing patients at both facilities

Consultations:

• Consultations may be focussed on symptom management, respite, care during transitions home from hospital with new medical technology needs (e.g. initiation of non-invasive ventilatory support), holistic support, and/or end of life care.
• Consultations occur for inpatients, when a child is admitted to the hospital or for outpatients, if the child is more stable and not admitted

Ongoing care:

• Each child who is followed by the palliative care team has an annual review meeting with the palliative care team to discuss the child’s clinical trajectory and advance care plans.
• Follow up care is provided both when children are coming to the hospital for outpatient appointments with other teams, including to the Medical Day Unit and while admitted as inpatients.
• Urgent and routine follow up for palliative care issues with the palliative care team often occurs at Roger Neilson House

Perinatal hospice program

• Perinatal hospice services are provided to those who are expecting a baby with a medical condition which is expected to be life-limiting.
• The palliative care team meets with each family referred to this program to provide them with information about the possible outcomes and options for the pregnancy, including stillbirth, live birth with death expected very soon afterwards, and live birth with uncertain duration of life.
• The team works with parents in these situations to develop a birth plan which respects their wishes for the baby’s care and provides guidance about ensuring symptoms are managed and the infant’s quality of life is optimized.

Pain and symptom management

• A separate pain and symptom management team is also provided by the palliative care physician group
• This service provides care for children who require expert symptom management, yet who may not have a life-threatening or life-limiting condition.
  • Children with prolonged exposure to opioids and other analgesics and sedatives, since these children are at high risk of withdrawal and discontinuation syndromes during weaning of these medications
  • Consultations for hospitalized children with severe or difficult to treat symptoms
• This service typically has 50-75 consultations per year, with 2-5 inpatients seen daily

The University of Ottawa’s program in pediatric palliative medicine uses the Children’s Hospital of Eastern Ontario (CHEO) and Roger Neilson House (RNH) as its primary training sites.

There are links with The Ottawa Hospital and Bruyere Continuing Care for adult palliative care training, which is a required component of the residency training program. Selective rotations may be taken at outside institutions upon the approval of the program director.

Children’s Hospital of Eastern Ontario (CHEO)

• CHEO is the academic children’s hospital for Eastern Ontario, Western Quebec and the Eastern Arctic (Nunavut).
• This is a large tertiary paediatrics center with sub-specialties in almost every area of paediatric medicine. 
• Patients with complex paediatric medical needs, cardiac diseases, genetic metabolic, and others conditions are commonly seen. Additionally all children with cancer are referred.
• There is a rehabilitation and therapy centre (children’s treatment centre) within CHEO which addresses the needs of children with disabilities and those needing rehabilitation after illness or trauma

Roger Neilson house (Pediatric hospice)

• Roger Neilson house is a 8-bed residential hospice facility providing medical respite and the full spectrum of inpatient and outpatient pediatric palliative care, including end-of-life care, and/or complex symptom management.
• The hospice provides a grief and bereavement program which is available for  families of all children who have died in the region
• Sibling support and counselling programs and support groups are offered at Roger Neilson House
• Roger Neilson House offers a care setting, when hospital and home are not desired or feasible.
• Hospitals are busy, sterile places, with little space for families to have privacy, and home may be limited in terms of medical support and much needed respite.

Home

• Home is often the preferred location for care, residents will participate in home visits with the PPC team, learning how to effectively navigate home care services and how best to deliver palliative care in this setting in coordination with community agencies

The Ottawa Hospital (TOH) and Bruyere continuing care

• Adult Palliative Care Rotations-consults and Palliative Care Unit

Community palliative care

• This is required for Adult Community Palliative Care rotation
• Patient homes and adult community hospices
• Other living facilities (e.g. group homes)

Trainees are exposed to both multi-centre and centre-specific research. Trainees in our program are expected to participate in a scholarly project as a mandatory part of their training, this can include research, quality improvement or other scholarly work.

The residency program has a dedicated physician, Dr. Dawn Davies, who has a specific focus on supporting trainees in developing and implementing their research and quality improvement projects. In addition, the program has a close link with the CHEO Research Institute, with many program physicians having appointments with the CHEO Research Institute. The Clinical Research Unit of the CHEO Research Institute supports CHEO residents and fellows in their research as well.

We participate in multi-centre trials through the Network for Accessible, Sustainable and Collaborative Research in Pediatric Palliative Care (PedPalASCNET) and the RAPID Pharmacovigilance in Palliative Care Program.

Current areas of study within the pediatric palliative care team include:

• Impacts of specialized Perinatal Palliative Care
• Medical cannabis in symptom management
• Methadone
• Serious Illness Conversation Guide and improving Advance Care Planning Communication
• PPC Education in Low-and Middle-Income Countries
• Palliative care education in humanitarian settings
• Models of implementing children’s palliative care in Global Health contexts

Applications are made through the Pediatric Subspecialty Match of the Canadian Residency Matching Services.

Selection process goals

Ideal applicants to this Program are outstanding physicians with a demonstrated skill and passion to care for seriously ill children and their families.  Compassion, communication, and collaboration will be strengths of their clinical approach. Candidates will have a vision to ensure excellent palliative care for children and families.

It is optimal for applicants to have demonstrated their strengths through clinical experience in pediatric palliative medicine, and through scholarly collaboration with experts in pediatric palliative medicine.  These experiences will allow applicants to describe how their skills and attributes are well suited to pediatric palliative medicine and our Program. 

Applicants describing their experiences will demonstrate how they enhanced the care of patients and families while facilitating their own professional achievements.  This process will also demonstrate that the applicant has a strong fundamental knowledge of the field, has excellent clinical skills, can navigate complex communication scenarios, can work in and lead interprofessional teams, and has strong wellness and resilience strategies.

The ideal candidate:

• Outlines their rationale for applying to pediatric palliative medicine in their personal statement.
• Has reference letters from preceptors which demonstrate their clinical and academic potential, professionalism and ability to work well with an interdisciplinary team
• Has completed rotations/electives/clinical experiences in pediatric palliative medicine
• Demonstrates an interest in working as part of an interdisciplinary team
• Demonstrates their critical thinking and reasoning skills, including application of these skills towards research and other academic activities.

File review process

Review team composition : Review team composition : A selction of faculty members and respresentatives from the Pediatric Palliative Medicine Program, one of which must be the Program Director.

Further details of the File Review Process are described on the CaRMS Program Description Site

Undergraduate training opportunities

Medical students will have the opportunity to rotate with the Pediatric Palliative Care team for a two-week clinical elective in fourth year. Their learning objectives include developing an understanding of palliative care for children, including the importance of an interdisciplinary approach to care across multiple settings (hospital, hospice, home).

Postgraduate training program

Subspecialty trainees have a rotational program as outlined in the course description on the uOttawa Faculty of Medicine website for the two-year Subspecialty Residency. The program has been configured to fulfill the requirements of the Royal College of Physicians and Surgeons of Canada.

Additional postgraduate training

Residents are accepted in pediatric palliative medicine for a four-week elective, selective and mandatory rotations from a variety of disciplines, including adult palliative medicine, pediatrics, neonatology, complex care, oncology and critical care medicine.

Residents are expected to participate in clinical duties at all locations of care including CHEO, Roger Neilson House, and home visits (as available). They are also encouraged to attend Serious Illness Conversation Guide Workshops (required for all pediatric residents during their training), Project ECHO Palliative Care (virtual teaching) and journal clubs. During their rotation, residents will be encouraged to observe the members of the interdisciplinary palliative care team.