Training in Hospice and Palliative Medicine
The Hospice and Palliative Medicine Fellowship at Lahey Hospital & Medical Center (LHMC) is an ACGME-accredited training program housed within the Department of Medicine at LHMC. The mission of our Hospice and Palliative Medicine Fellowship program is to equip you to be experts in delivering comprehensive, patient-centered care to seriously ill patients. Fellows will be able to recommend treatment plans to address a variety of complex symptoms, demonstrate advanced communication skills, and lead serious illness discussions. Fellows will also be able to provide leadership in interdisciplinary teams with social work, pharmacy, chaplains and advanced practice providers to develop comprehensive care plans that meet patients’ physical, emotional, social and spiritual needs.
As a fellow, you will spend one year immersed in the care of medically-complex, seriously-ill patients across multiple settings including inpatient acute care, outpatient clinic, long-term care, inpatient hospice and home hospice. You will receive dedicated teaching on all core aspects of palliative care and will gain the necessary skills to provide competent, compassionate palliative care as attending physicians in the next phase of your careers.
On behalf of our entire multi-disciplinary team, both at our main campus and our affiliates, we are excited to welcome you to the BILH Hospice and Palliative Medicine Fellowship!
Our Program Leadership Team
Jessica Lynch, MD, Program Director
Gary Winzelberg, MD, Associate Program Director
Shih-Ning Liaw, MD, FAAP, Site Director, Boston Children’s Hospital
David Macdonald, MD, FACP, HMDC, Site Director, Care Dimensions
Lionel Lim, MBBS, MPH, Site Director, Bedford-VA Medical Center
- Inpatient Palliative Care Consults (LHMC Burlington, MA): 5.5 months
- Home and Inpatient Hospice (Care Dimensions, Danvers and Lincoln, MA): 2.5 months
- Long-term Care Palliative Care Consults and Hospice (Bedford VA Medical Center, Bedford, MA): 6 weeks
- Pediatric Palliative Care (Boston Children’s Hospital): 2 weeks
- Outpatient Palliative Care Clinic: weekly half-day sessions
- Elective: 4 weeks
- Vacation: 4 weeks
- AAHPM: 1 week
Inpatient Palliative Care Consults at LHMC
Fellows will spend 5.5 months on the LHMC palliative care consult service. Staffed by board-certified Hospice and Palliative Medicine physicians, nurse practitioners, a social worker, a chaplain and a pharmacist, this service provides inpatient consults for symptom management, support and goals of care communication and decision-making to all medical and surgical units throughout the hospital. The service is growing and completed over 1200 new consults in 2022.
Fellows will participate in daily rounds and will work collaboratively with all team members. They will gain increasing responsibilities for patient care starting with direct observation and moving to independent practice with indirect oversight from the attending physician. Teaching will occur during weekly education sessions, daily rounds, direct observation of patient encounters throughout the fellowship year, and after review of documentation. As fellows develop specialty palliative care skills, they will have opportunities to teach medical residents and residents who rotate with the consult service.
Home and Inpatient Hospice with Care Dimensions
Fellows will spend 2.5 months rotating with Care Dimensions and receive hospice training with this non-profit organization that has been serving Massachusetts residents since 1978. With over 4,600 admissions last year, the hospice maintains an average daily census of over 800 patients and also operates two inpatient facilities. Care Dimensions physicians performed almost 4,000 physician visits in the last year and fellows will work closely with these hospice physicians to care for patients at the end of life. An interdisciplinary team consisting of a hospice physician, specialty trained nurse, hospice aide, social worker, chaplain, complementary therapist, volunteer, and bereavement counselor works to take care of patients on home hospice and in long-term care facilities. Fellows will directly observe new and follow-up visits and learn about the unique challenges of caring for patients at the end of life at home. Fellows will progressively receive increased patient care responsibilities including conducting independent home visits and serving as the primary contact during business hours for their panel of patients.
The inpatient hospice experience will take place at one of the two Care Dimension’s hospice houses where teams made up of Palliative Care physicians, nurses, chaplains, social workers and patient care aides work to manage complex symptoms in patients at the end of life requiring general inpatient level (GIP) of hospice care.
Long-term Palliative Care at the VA Bedford Medical Center
Fellows will have a unique opportunity to provide care to veterans at the VA Medical Center in Bedford, MA, which has a longstanding relationship with LHMC. Time will be spent on the Geriatrics/Medicine short term rehab unit where palliative care is integrated into the care of older adults, as well as in the Community Living Centers (CLCs) which provides long-term care to veterans. While at the VA, fellows will benefit from being taught by faculty who have training in both Geriatrics and Hospice and Palliative Medicine, enhancing their ability to take care of older adults with serious illness. There will also be opportunities to follow patients longitudinally as they move to the routine hospice unit at the VA.
Palliative Care Clinic
Fellows will participate in a weekly half-day clinic at LHMC as part of an interdisciplinary team including physicians, nurse practitioners, social workers, psychologists, and a pharmacist. This clinic focuses on early integration of specialty palliative care for patients with cancer and other life-limiting conditions, and serious illness care of individuals with complex symptom management needs including opioid use disorder. Fellows will complete new patient evaluations both in-person and virtually, learning effective “webside manner” approaches. With the support of the clinic team fellows will then provide follow-up care to these patients through return clinic visits, communication through the electronic medical record, and consultations for clinic patients who are hospitalized.
Pediatric Palliative Care
During this two-week rotation with an interdisciplinary pediatric palliative care service at Boston Children’s Hospital, fellows will learn principles and skills relevant to the care of seriously ill children and their families. Fellows will participate in the care of hospitalized children with diverse diagnoses, including cancer, cystic fibrosis, neurodegenerative disorders, congenital heart disease, disorders of prematurity, and genetic and metabolic conditions. Fellows will also receive didactic presentations on core pediatric palliative care topics. Fellows will learn about principles of community-based pediatric hospice and palliative care, including the option for concurrent care when caring for children with life-limiting conditions.
- Dean’s letter or MSPE from medical school
- Medical school transcript
- Three (3) letters of recommendation, one of which must be from your Residency
- USMLE I, II and III board scores
- Personal statement
- Curriculum Vitae as submitted through ERAS
Jessica Lynch, MD
Jessica Lynch, MD is a board-certified internist and hospice & palliative medicine physician at Lahey Hospital & Medical Center (LHMC) in Burlington, MA. She attended the University of Massachusetts Medical School (now the UMass Chan Medical School) graduating in 2012, and went on to train at Beth Israel Deaconess Medical Center in Boston, MA in internal medicine before pursuing fellowship training in the Harvard Palliative Medicine Fellowship program. Following completion of training, she took an attending position at Lahey Hospital & Medical Center and has worked in the department since 2018. She also attends on the inpatient hospice unit for Care Dimensions, a local hospice and palliative care organization.Over the last several years Dr. Lynch has worked to provide medical education to all levels of learners including medical students, residents, fellows and faculty. She served as a preceptor for the Medical Interviewing and the Doctor-Patient Relationship (MIDPR) course for Tufts University medical students. In this course, first-year medical students learn the basics of conducting a patient interview and taking a medical history. Dr. Lynch serves as a clinician educator for medical students and residents who rotate on the inpatient palliative care consult service and provides education on primary palliative care to learners in other departments including internal medicine and surgery. She participates in simulation training focusing on communication with surgical residents and gives continuing medical education lectures to faculty on basic principles of palliative care and pain management.
In addition to her clinical responsibilities, she currently serves as the Program Director for the Hospice and Palliative Medicine Fellowship.
Outside of the hospital, Dr. Lynch enjoys knitting, baking, being outdoors and spending time with family.
Gary Winzelberg, MD, MPH
Gary Winzelberg, MD MPH is Lahey Hospital and Medical Center’s inaugural Chair of the Division of Palliative Care and Geriatric Medicine. His clinical and academic interests include outpatient oncology palliative medicine, physician-patient communication, and medical education. He has served on the Fellowship Training Committee of the AAHPM and on the Hospice and Palliative Medicine Item-Writing Task Force of the American Board of Internal Medicine.
Prior to joining Lahey, Dr. Winzelberg was the founding director of the Hospice and Palliative Medicine Fellowship Program at the University of North Carolina at Chapel Hill, Associate Director of the Palliative Care Program, and Associate Professor in the Division of Geriatric Medicine.
Dr. Winzelberg is board-certified in hospice and palliative medicine, geriatric medicine, and internal medicine. He was a Robert Wood Johnson Clinical Scholar at the University of Washington, completed geriatric medicine fellowship and internal medicine residency training at Beth Israel Deaconess Medical Center and Harvard Medical School. Dr. Winzelberg graduated from the Geisel School of Medicine at Dartmouth and received a BA in political science from Swarthmore College where he was a Eugene Lang Opportunity Grant Scholar.
Dr. Winzelberg’s interests include Red Sox baseball and hiking. To date, he has reached the summit of 33 out of 48 New Hampshire peaks above 4,000 feet.
Lynn Mazur, LICSW
Lynn Mazur, LICSW, is clinical social worker and program manager for the Palliative Care and Geriatric Medicine Division in-patient consult service at Lahey Hospital & Medical Center. Lynn received a Master’s in Social Work (MSW) degree from Smith College, with internships at Hospice of the Good Shepherd (Newton) and Beth Israel Deaconess Medical Center in Boston. She worked with VNA Care Network and Hospice in Worcester prior to joining the palliative care team at Massachusetts General Hospital (MGH) in Boston. Lynn joined Lahey in 2022 after a decade at MGH where she participated in the Palliative Care Education Program (PCEP), created and managed the Palliative Care Volunteer Program, served as faculty/trainer/facilitator to the Harvard Medical School Center for Palliative Care and for the Continuum Project/Serious Illness Conversation training initiative. Lynn was also involved with the MGH Palliative Care Fellowship program, serving on selection and evaluation committees and contributing to on-boarding activities.
Before a career shift to clinical social work, Lynn was involved in marketing and press relations for software development companies on the IPO track in the international trade and transportation logistics sectors in the Washington, DC area.
Lynn is an avid hiker, swimmer, traveler, and snowshoe enthusiast. When not outside, she enjoys reading, writing, and unraveling most attempts at knitting.
Cynthia Ottaviani, PharmD, BCPS
Cynthia Ottaviani is a board-certified pharmacotherapy specialist who started her career at Brigham and Women’s Hospital in Boston after graduating from Massachusetts College of Pharmacy.
Her career at Lahey Hospital & Medical Center began over 21 years ago and during that time she has created the position of Palliative Care Clinical Pharmacist. While working full-time at Lahey, Cynthia earned her Doctor of Pharmacy degree from the University of Florida.
She received training in palliative care by completing a Pain Management and Palliative Care Traineeship from the American Society of Health-System Pharmacists. Cynthia serves as a clinical educator for medical students and residents who rotate on both the inpatient and outpatient palliative care consult services.
Outside of the hospital, Cynthia enjoys spending time with her husband and two sons.
Rae Allain, MD
Rae Allain, MD, is a fellow in an ACGME-approved innovative fellowship designed to train mid-career physicians in hospice and palliative medicine. She received her medical degree from George Washington University, after which she completed residency training in anesthesiology and fellowship training in critical care at Massachusetts General Hospital. She worked in the MGH Department of Anesthesia, Critical Care, and Pain Medicine from 1996-2012 as a vascular anesthesiologist and surgical intensivist. At MGH, Dr. Allain served in various leadership positions, including Anesthesia Critical Care Fellowship Program Director, Interim SICU Medical Director, and Division Chief of Thoracic & Vascular Anesthesia. In 2013, she was recruited to St. Elizabeth’s Medical Center in Brighton, Massachusetts, where she was Medical Director of the 28-bed multidisciplinary ICU. She joined the Department of Anesthesia, Critical Care, and Pain Medicine at BIDMC in 2019. Her ICU work during the COVID-19 pandemic inspired her to pursue fellowship training in palliative care, which she plans to incorporate into her future practice. Currently, Dr. Allain spends half her time as a PC fellow at Beth Israel Lahey Health and the other half as an anesthesiologist and intensivist within BILH.
Outside of work, Dr. Allain enjoys spending time with her husband and checking in with her adult children. She values spending time outdoors running, relaxing at the beach, or on a SUP.
Stephanie Lenzi, DO
Stephanie Lenzi, DO is an attending physician in the department of palliative medicine at Lahey Hospital & Medical Center and Clinical Assistant Professor in the Department of Medicine at Tufts Medical School. Dr. Lenzi graduated from the University of Massachusetts, Amherst and completed medical school at the University of New England School of Osteopathic Medicine. She completed her internal medicine residency at Lahey Hospital & Medical Center where she stayed for an additional year of training as a chief resident. Dr. Lenzi completed a six-month training course in palliative medicine through the Center for Palliative Care at Harvard Medical School and has been board-certified in hospice and palliative medicine since 2012.
Dr. Lenzi is the physician leader for The Schwartz Center Rounds at Lahey and her academic interests include exploring how empathy can improve patient outcomes and examining specific interventions that can enhance the delivery of compassionate care.
Outside of the hospital, Dr. Lenzi enjoys cooking, traveling and spending time with her family.
Megan Rose Carr LaPorte, MD
Megan Rose Carr LaPorte, MD is a palliative care physician at Lahey Hospital & Medical Center. After a year-long Fulbright Scholarship in Thailand, she completed medical school at the Geisel School of Medicine at Dartmouth. She went on to graduate from internal medicine residency at Cambridge Health Alliance, after which she worked as a hospitalist during the COVID pandemic. She completed her hospice and palliative medicine fellowship at Stanford Hospital in California.
Dr. LaPorte’s academic interests include palliative care education and the application of psychoanalytic theory to palliative care practice.
When she isn’t caring for patients, Dr. LaPorte enjoys camping and playing music.
Himanshu Malhotra, DO
Himanshu “Shu” Malhotra, DO is an attending physician at Lahey Hospital & Medical Center. He graduated from University of Western Ontario in psychology and medical biophysics and completed medical school at the University of New England College of Osteopathic Medicine.
Dr. Malhotra’s family medicine residency at York Hospital in Maine was followed by a hospice and palliative medicine fellowship at Temple University Hospital and Fox Chase Cancer Center in Pennsylvania. Dr. Malhotra’s clinical focus includes early integration of palliative care in serious illness and complex symptom management. He has an avid interest in palliative care education and mentorship at the undergraduate and graduate medical education level.
Outside of medicine, Dr. Malhotra enjoys travelling and hiking with his wife, growing potatoes and hot peppers, and hanging out with his cat, Mr. Bingley.
Joanne B. Giugno, ACNP-BC
Joanne Giugno, ACNP-BC, has been a member of the palliative care department at Lahey Hospital & Medical Center since 2013. She graduated from University of Massachusetts, Worcester with a Master of Science in Nursing, and has been credentialed as a nurse practitioner. She has had a long career at Lahey and prior to joining palliative care, Joanne worked on the inpatient neurology consult team.
Joanne has an interest in palliative care medicine in the ICU setting and has extensive critical care experience. She also enjoys educating her colleagues about palliative care medicine and mentors advanced care providers as part of the Nurse Residency Orientation Team. Joanne is a member of the Ethics, Mortality Review and Wellness Committees at Lahey.
Outside of the hospital, Joanne enjoys spending time with her two granddaughters and traveling with her husband.
Leslie Levitan, MSN, FNP-BC, ACHPN
Leslie Levitan, NP, joined the Lahey Hospital & Medical Center palliative care team in 2021 as part of the in-patient consult service. She has been a board-certified family nurse practitioner since 2002, with a Bachelor’s of Science in Nursing (BSN) degree from University of Detroit Mercy’s McAuley School of Nursing, and a Master’s of Science in Nursing (MSN) degree from University of Massachusetts, Boston.
For nearly a decade Leslie managed chronic pain conditions at a large outpatient pain center. Since 2014 she has specialized in both community- and hospital-based hospice and palliative medicine, and holds her advanced practice certification in hospice and palliative nursing (ACHPN).
Outside of work, Leslie enjoys traveling with her family, playing pinball, and of course, good food.
Lahey Hospital & Medical Center (LHMC), now part of Beth Israel Lahey Health (BILH), has a long history of delivering high-quality, patient-centered care since its opening in 1923. When Frank Lahey, MD founded the Lahey Clinic in 1923, his vision was to create a clinic where doctors from different specialties worked together under one roof. The clinic has grown through the years but has maintained its singular focus of multidisciplinary care for patients via a team-based approach. The main campus in Burlington, MA is a 335-bed facility. We are a tertiary medical center, caring for extremely sick and complex patients, while also maintaining a community feel. Located less than 20-miles outside of Boston, MA, training at LHMC offers resources of larger hospitals with a convenient location. We serve patients from Metrowest Boston, the North Shore as well as Southern New Hampshire.
The Palliative Care service at LHMC was established 15 years ago and has grown tremendously in the interim. In the last 4 years alone, we have added two full-time Hospice and Palliative Medicine (HPM) Physicians, two full time HPM Nurse Practitioners, a social worker, pharmacist and additional administrative support. The service continues to expand to meet the needs of our medically complex patient population. Fellows will have the opportunity to work in a close-knit team of providers while learning the fundamental skills necessary to provide high-quality palliative care.
Fellows will have a half-day a week of didactic education to supplement their bedside learning. They will also participate in Thursday morning education sessions with our division designed to provide real-time education on pertinent clinical topics.
The didactic curriculum will also include a focused communication curriculum to teach the essential skills of serious illness conversation, sharing prognostic information, discussing code status, and other key topics.
Examples of educational topics covered include:
- Pain management including opioid rotation and dosing
- Non-pain symptom management
- Interventional pain techniques
- Palliative sedation
Systems-Based Interdisciplinary Practice
- Hospice referral and eligibility criteria
- Psychosocial assessment
- Spiritual assessment
- Prognostication in Palliative Care
- Billing and coding practices
- Career advice/job negotiations
- Serious illness communication training – mapping goals and values
- How to run a family meeting
- Active listening – simple and complex reflections
- Responding to emotion
- Discussing prognosis and prognostic uncertainty
- Discussing code status
- Making a recommendation
- Working in urgent situations: naming the dilemma
- Working in the dual framework – pendulum
- The angry patient and responding to intense emotions