After a weeklong intensive orientation and palliative care bootcamp, the fellows will meet monthly for half-day educational sessions. These sessions will include sessions designed to provide fellows with the information needed to comprehensively assess and manage complex symptoms, such as pain, nausea, dyspnea, anorexia, delirium, and constipation. This is a combination of didactics as well as clinical cases that invite fellows to engage in asking questions and applying knowledge from the didactics. Fellows will learn the evidence base for integrating palliative care into different settings (inpatient, outpatient, home) and for patients with different illnesses (e.g. cancer, dementia, heart failure, chronic kidney disease, end-stage lung or liver disease).  A communication skills curriculum, based on VitalTalk model of teaching will be woven throughout the core curriculum. Observation and feedback of skills, initially practiced in role play, will occur during clinical rotations. Recognizing the intense emotions for patients, families and even practiced clinicians, the curriculum will address the psychological elements of providing palliative care, offering topics that facilitate mature clinical practice as well as reflective self-care to support a sustained clinical practice.  Finally, fellows will be expected to present on topics during the year as a means of developing deeper knowledge and expertise in a particular topic as well as experience in how to present effectively.