Table 4:

Themes from Open-Ended Questions

Theme	Exemplary Quotes
The importance of palliative care education in CV fellowship	• “Not really considered”; “Never brought up as an issue.” • “[Trainees] are already exposed [to palliative care] during residency.” • “We should definitely incorporate more formal training on this topic.” • “Palliative care…should be covered in the fellowship curriculum, however it should not be exhaustive since we…depend on palliative care specialists to help navigate complex goals of care discussions.”
How palliative care skills are taught in CV fellowship	• “Palliative care is primarily a learned clinical skill - not really something we focus on in lectures. The fellows do get learning in this way; just not formally.” • “Many of these [skills] are covered during practice, instead of in a didactic setting.” • “Basic info is provided for all. The option for elective is available for those interested to gain more experience and focus.”
Time is a barrier	• “It’s getting overwhelming when everything is important to cover (gen cards, DEI, QI, PS, Wellness).” • “Time is the major barrier - given all educational demands.” • “Have not seen the space and time to implement since they have received such training, most of them, during IM residency.”
Connection to heart failure care	• “We don’t yet even have a HF-specific rotation yet, so the more formal exposure suggested here doesn’t happen.” • “We do not have alignment with the director of HF and transplant in terms of the need for palliative consultation on all patients being considered for advanced therapies, and this represents a barrier in terms of education.”
Lack of a mandated focus on palliative care education	• “Palliative care is NOT a COCATS area of focus/rotation, so while an honorable idea, just isn’t something we’ve dedicated much time to.” • “Required online content that is systematized would be great.”
Some programs have developed innovative approaches	• “We have started a robust palliative care curriculum that has started this year-clinical case conferences, didactic sessions, interactive shared decision-making sessions, hired actors as patients, and in fellows’ clinic, precepted serious illness conversations. This is the first year, but well received. Hope to expand it to our procedural specialties, where it is very needed. This new general cardiology curriculum is [in] collaboration with our palliative care division, cardiologists trained in [PC], and [PC] APP. Has been an important addition to the curriculum.” • “Every year, all of our first-year fellows participate in a 2-day workshop called CardioTalk,42 run by cardiology and palliative care specialists focusing on communication skills specific to goals of care and shared decision making, using standardized patients.”