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Introduction to the UIC Hematology/Oncology Fellowship
Welcome New Fellows! We have compiled this nuts & bolts guide for you that will hopefully ease your transition. It is by no means exhaustive, so if you have any additional questions, feel free to contact us.
Home Base
Most of us consider our section office a home base (Office of the Section of Hematology & Oncology, 8th floor Clinical Sciences Building, 840 S Wood). Here you will find your mailboxes, a fellow’s office with computers and a phone, our main conference room, and some of the Attendings’ offices. Rowena Peralta and Cindy Bernabe, our Departmental Administrative Assistants, Onesima Martinez, the section's Administrative Director, and Elizabeth Hammerschmidt, our Fellowship Coordinator, are also located here. They can help you with everything, including pagers, scheduling issues, mail, and even advice.
Elizabeth Hammerschmidt ‐ (312) 996‐9424, [email protected] Rowena Peralta ‐ (312) 996‐1581, [email protected] Cindy Bernabe ‐ (312) 413‐4260, [email protected] Onesima Martinez ‐ (312) 413‐9287, [email protected]
Helpful Links
Hospital Employee Portal https://employee.hospital.uic.edu/ Once you log into this site, you can access the hospital paging directory in the menu on the right‐hand side of the page. You will also need to access hospital applications like powerchart and cerner through this page.
Center for Clinical and Translational Science http://www.uic.edu/depts/mcam/CCTS/ The university has many resources that fellows are able to complete free of charge while they are training at the university. The university’s Center for Clinical and Translational Science provides fellows with the opportunity to pursue an intensive summer program, certificate program, or Masters of Science in Clinical and Translational Science through its REACH (Research Education And Careers in Health) Program.
Masters of Public Health Program http://www.uic.edu/sph/admissions/how‐to‐apply‐degrees Fellows are also able to pursue a Masters of Public Health while they are in training at UIC. The university offers both an online program as well as a traditional classroom program with classes in the afternoons and evenings. Fellows will need to apply through the SOPHAS website. UI Clinical Trials Listing http://chicago.medicine.uic.edu/cms/One.aspx?portalId=506244&pageId=9729019
UI Cancer Center Website http://www.chicago.medicine.uic.edu/cancercenter
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IRB training website
http://tigger.uic.edu/depts/ovcr/research/protocolreview/irb/education/index.shtml
Schedule
(You will receive the Fellows Annual Rotation schedule from Elizabeth Hammerschmidt)
‐‐The fellowship starts July 1st (this is the exception; we usually switch on the 2nd of each month)
‐‐Each fellow covers his/her own service on holidays, unless privately arranged with another fellow.
‐‐Weekend coverages:
UIC Onc and VA Onc cover each other
UIC Stem Cell and UIC Heme Consults cover each other, as well as cover VA Hematology
VA Hematology/Hemepath has no weekend call (covered by Stem Cell and UIC Heme as above)
Mt. Sinai covers it own weekends (worked out between you and the Attending)
‐‐Each fellow usually has at least 2 weekends off per month (or at least 4 days per month, depending on the circumstances).
Paging System:
To page from on campus: Dial 136, then listen to instructions
To page from off campus: Dial 312‐996‐2242, then listen to instructions
If you get paged to
3‐xxxx, dial these 5 digits if in house. If outside: dial (312) 413‐xxxx
6‐xxxx, dial these 5 digits if in house. If outside: dial (312) 996‐xxxx
5‐xxxx, dial these 5 digits if in house. If outside: dial (312) 355‐xxxx
NOTE: VA pages are also 5‐xxxx, so it is sometimes confusing which hospital is paging you. If in house at the VA: dial these 5 digits as is. If outside, e.g. from UIC: dial (312) 569‐xxxx
ROTATING PAGERS
Services may page you via the Rotating Pagers (not actual pagers, but numbers assigned to us)
ALL UIC ONCOLOGY Admissions, Consults, and Sickle Cell Admissions: 7557
ALL UIC HEMATOLOGY Admissions and Stem Cell questions: 7985
ALL UIC HEMATOLOGY Consults: 7447
VA (Rotating 24 Hour Pager) for Consults – 312‐921‐9804
Mt Sinai: 1551
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When you are on a particular UIC service, make sure to forward all pages from that service’s pager number to your own pager.
This can be done 2 ways:
1. call UIC operator 6‐7000 and ask them to do it 2. dial 136 (from in house, or 312.996.2242 from off campus), enter *xxxx (an asterisk followed by
the service’s pager #), then listen to instructions
for example:
say you are covering UIC Oncology/Sickle Cell
dial 136
dial *7557
listen to instructions (it will be 3 for covering or referral, 1 for covering, then enter YOUR pager #).
henceforth, any pages to 7557 will go directly to your personal pager. ***We need to make sure that these virtual numbers are always forwarded to someone’s pager (hopefully the right person). Services get irritated when they page a number and no one is on the receiving end. We fought hard to get these rotating numbers and we should try to maintain their efficacy. With the former system of call schedules and personal pagers assigned to services that change monthly, we were all getting erroneous pages too frequently (and too late at night).
Mt. Sinai has its own paging system with its own idiosyncrasies (see below)
Continuity Clinics (Starting Monday, July 2, 2008)
(You will receive a clinic assignment schedule from Elizabeth Hammerschmidt)
‐ University Clinics are located in the Outpatient Oncology Center, 1801 W. Taylor, Suite 1E
‐ VA Clinics are located in the Jessie Brown VA – 6 West taking the Damen Elevators
Each fellow carries at least 2 half‐day clinics per week.
For the incoming 1st years, at least one of these will be a VA clinic.
The current fellows have arranged it so that there will be two senior fellows in each VA General Hem/Onc clinic for the first 6 months to help ease transitions.
This means each 1st year fellow will start with one VA General Hem/Onc clinic and at least one UIC Subspecialty clinic per week for the first 6 months.
Bear in mind, you may have clinic conflicts while rotating at Mt. Sinai; your continuity clinic assignments (maximum of 2 clinics) take precedence over any clinics conducted at Mt. Sinai.
Conferences:
At the beginning of each month, Elizabeth will send out a monthly calendar that includes all monthly meetings and conferences in the section. She will also send out weekly emails prior to each meeting with the topic and location. Didactics, Journal Clubs, and Heme Path Lectures are regularly scheduled, which you should attend at least 80% of the time (RRC requirement).
Monday:
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12:00 PM: Tumor Board; 3rd floor COMRB
Tuesday:
7:15 AM: Breast Tumor Board (every other Tuesday) Hospital Room 3117
7:30 AM: Didactic Session; 9th Floor Conference Room, 937 CSB
8:00 AM: Internal Medicine Grand Rounds; 1st floor Auditorium COMRB
12:00 PM: Research Conferences; 5th or 6th floor COMRB Wednesday:
11:00 AM: VA HCC Tumor Board, VA Radiology Conference Room
3:00 PM: Ear Nose and Throat Conference, 3rd Floor ENT Clinic Conference Room
Thursday:
7:30 AM: Head/Neck Tumor Board, OCC Rad Onc Conference Room
2:30 PM: BMT Conference, BMT Unit in Hospital
5:00 PM: Chest Tumor Board, 9th Floor CSB
Friday:
7:00 AM HCC Tumor Board, Hospital 2513
7:30‐8:30 AM Didactic series, 9th Floor Conference Room, 937 CSB
8:30‐9:30 AM Didactic series, 9th Floor Conference Room, 937 CSB (Every other Friday ‐ alternates with Hematopathology Conference)
8:30‐9:30AM Heme Path conference in pathology conference room, 258 CSB
ASCO and ASH
‐‐2 professional societies to consider joining. Most of the fellows have joined either or both.
‐‐ASCO members receive the Journal of Clinical Oncology; membership is quarterly; annual meeting is usually late May/early June; more info at www.asco.org
‐‐ASH members receive Blood; membership on a rolling basis; annual meeting is usually early December; more info at www.hematology.org
‐‐Clinical rotations continue to be covered by fellows during these conference periods, while the lecture schedule is adjusted for them
Suggested Reading
‐‐DeVita is the standard Oncology text, and either Hoffman or Williams are excellent Hematology texts
‐‐Some books are donated by drug reps; ask Judy for details
‐‐For daily stuff, The Washington Manual of Oncology or the Bethesda handbook of clinical oncology are highly recommended, and the Manual of clinical hematology is decent as well. A good chemotherapy
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guide is worth having nearby (the need for this varies from rotation to rotation; sometimes the books are readily available in the specific hospital).
‐‐Websites that may be useful are www. nccn.org and www.oncologyse.com.
‐‐Ask Onesima Martinez, in the HemOnc office, what the procedure is for accessing your book fund
Admission procedure
In order to admit a patient to the UIH, a PIN (Patient intake notification) needs to be filled out.
‐ A PIN is ordered through Gemini (Order menu, patient intake notification)
When doing a direct admission from the patient’s home (i.e. not through the ED) or from clinic, you are responsible for calling Bed‐Control (6‐0335), the admitting fellow, and notifying either 8 West for Oncology Admissions or 8 West Stem Cell Unit for Onc and Heme admissions, respectively.
An alternative way is to fill out a form although this is now discouraged. This form is sent via fax or computer to the admission and bed control offices and a bed is assigned.
If a patient comes through the ER, the ER will enter a PIN. If a patient comes as a direct admission from the clinic, your or the clinic RNs enter it. If a patient needs to be transferred from an outside hospital, you need to do it (or the resident on call if you are not in house). The ER is a different story: some admissions are questionable, and the work up is often incomplete. Be very thorough in your questions and request Xrays and other studies prior to accepting the patient.
Transfers from outside hospitals are frequent and work as follows: the attending from the OSH calls you out of the blue via your pager and presents the case to you. You can ultimately decide if you want to accept the patient. However, if you feel uncomfortable with the transfer, you should talk to your attending first before accepting/rejecting. Usually, the transfers are legitimate and we should live up to the standard of a referral hospital.
Some guidelines:
- We usually do not accept cancer patients who do not have a tissue diagnosis (eg “has a chest mass”). These patients get admitted to medicine for initial work up and then we are consulted once a diagnosis is made. - We usually do accept patients with a definitive diagnosis and active oncologic issues from outside institutions even if they have not been seen by one of our attendings before. - We generally do not accept patients without any insurance coverage – clear this with the on‐service attending.
On call:
You are on call 2 out of the usual 4 monthly weekends. In addition to rounding on your service, you take
the call from home and help the in‐house residents over the phone with any issues that may arise. You
also direct admissions from the ER, which works as follows: an ER resident, who presents a case to you,
pages you. You ask questions and then decide to admit or need further studies prior to deciding.
Always ask whom they see in clinic (attending).
‐ The oncology fellow covers patients with an established oncological diagnosis or patients with sickle
cell anemia.
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‐ Please be aware of the terminated and suspended patient relationships who should not be
allowed admission to the sickle cell service. However, these patients can be admitted to the general
medicine service.
‐ The BMT/heme fellow covers patients with leukemias, lymphomas, multiple myelomas, TTP/ITP, or
patients who have had bone marrow transplants.
You may get calls from the ER for a patient who is appropriate for another service, and the referral
should be made to the appropriate fellow on call. If a patient is to be admitted, ask the ER resident to
call the SPECIALTY M.O.D. – this is the senior resident on call who is responsible for all the heme, onc,
liver and GI admissions overnight/weekends. You should make an effort to call the MOD as well, to
convey your impression and initial plan. Then, a few hours later, the resident will call you and discuss
the case and plan with you in more detail.
The ICU is a closed unit, and only the ICU fellows/attendings have admission rights. If you like to admit a
patient to the unit, you need to talk to the ICU fellow
Checking Consults:
At UIC, you will be proxied the consults for oncology and hematology.
Check the proxy list on the left hand side of the main menu.
There you will see patient name, medical record number, reason for consult, consulting
physician, and a contact pager #.
At VA, you have to log onto the GUI website (this is different from the CPRS medical chart we usually
use.
Log on and type “ph”
Then “ser” for services menu
Then heme‐onc consults (you can type hem and it is selection #1) and select the date range
(typically from “t‐1” to “t”)
Research:
Prior to beginning your research, as a first year fellow you will be required to complete IRB training
modules Investigator Training 101 and HIPPA training. As a second year fellow you will be required to
complete an addition module, Continuing Education in Human Subject Protections to complete the IRB
training. If you are planning to continue in academic research IRB training must be renewed every 2
years.
IRB training website:
http://tigger.uic.edu/depts/ovcr/research/protocolreview/irb/education/index.shtml
LMS Training:
As part of being a State of Illinois Employee, you will periodically receive emails for online courses to
take to keep up‐to‐date with State Requirements. Such topics include fire safety, professionalism, etc.
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You will be given an link to sign on to your personal LMS access and can perform these modules at your
convenience but before the deadline. These modules are enforced by the State of Illinois and they can
withhold your paycheck until you are uptodate.
Chemotherapy Orders:
At the VA, orders are entered through the GUI/CPRS system in the pharmacy orders menu.
At UIC, on the inpatient services, a chemotherapy note is required along with ordering the medications
through the Gemini Order system.
It is important that you follow the strict template guidelines as below:
CHEMOTHERAPY NOTE (EXAMPLE)
Regimen: Cisplatin 80 mg/m2 IV day 1
5FU at 1000 mg/m2 day 1 through day 4
Patient: 52 y/o male with stage III (T1N2) lymphoepitelioma of the nasopharynx, s/p induction therapy
with single agent cisplatin (day 1,22,43) and concurrent radiation (completed 5/8/03). Now admitted
for chemotherapy with cisplatin/continuous 5FU.
Measurements: Ht 5'6" Wt 125 lbs BSA 1.6 m2
Chemotherapy Orders:
Hydration: NSS at 500 cc/h x 2 hours, then NSS at 125 cc/h prior to chemotherapy
Premedication:
1. Ondansetron 24 mg PO one hour prior to cisplatin
2. Dexamethasone 20 mg PO one hour prior to cisplatin
Chemo:
1. Cisplatin 130 mg (80 mg/m2) IVPB; mix in 250 cc NSS and run over 2 hours starting 6/9/03 at 1800
2. 5FU 1600 mg (1000 mg/m2) IVPB; mix in 1000 cc NSS and over 24 hours as continuous infusion for 4
days, starting 6/9/03 at 2000.
References:
Al‐Sarraf, M et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal
cancer: Phase III randomized intergroup study 0099. J Clin Oncol 1998; 16:1310
Side effect profile:
1. 5FU:
‐myelosuppression
‐mucositis, diarrhea, N/V, anorexia
‐dermatitis, nail changes, dry skin,
erythema, photosensitivity,
hyperpigmentation, rash, hand‐foot
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syndrome (paresthesia, erythema, and
swelling of palms and soles), alopecia
‐cerebellar syndrome
‐myocardial ischemia
‐tear duct stenosis, blurred vision,
phtophobia
‐anaphylaxis, vein pigmentation, fever,
thrombophlebitis, epistaxis
2. Cisplatin: ‐myelosuppression
‐nephrotoxicity with hypokalemia,
hypomagnesemia, hypophosphatemia
‐nausea and vomiting
‐ototxicity
‐neurotoxicity
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UIC Consult Note Requirements:
One of the documentation requirements for consults is that the name of the physician who requested
the consult must be documented in your consult note (both for inpatient and outpatient consults).
University Audit recently looked at outpatient consults to determine if the proper documentation
existed in the patient's medical record. A large number of consults did not document the name of the
physician who requested the consult. Documenting the requesting department is not acceptable (eg.
referred from Transplant).
Documentation Tips
This is a request for consultation from Dr. ____ regarding evaluation of _______
Dr _______ requested a consult for evaluation of ________
For outpatient consult visit, also include who the primary care physician is and address/fax number.
Once you have written the note, forward it to review by Claudette Battle asking her to fax it to the
referring and primary care physician.
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Important Numbers:
HOSPITAL ROTATIONS
UICH ONC ROTATION
8 West: 413‐8416, 8418, 8420
7 East: 996‐6161
Lab Results: 996‐4440
ER: 996‐8177
Specialty MOD on call Pager: 2724
Specialty intern on call Pager: 2725
Bed Control: 996‐0335
Onc Clinical UIC: 355‐1625
PharmD on call pager: 4958
Specialty clinic at VA: 569‐7288
Surgical Pathology: 413‐0096 or 996‐3886
XRT: 996‐3630
UICH SICKLE CELL ROTATION
Bone Marrow Biopsies: 3‐9482
8 West: 413‐8416, 8418, 8420
7 East: 996‐6161
ICU: 996‐4008
Lab Results: 996‐4440
ER: 996‐8177
Specialty MOD on call Pager: 2724
Specialty intern on call Pager: 2725
PharmD on call pager: 4958
Specialty clinic at VA: 569‐7288
Surgical Pathology: 413‐0096 or 996‐3886
XRT: 996‐3630
UICH HEM CONSULT ROTATION
MICU: 996‐4008
8 West: 413‐8416, 8418, 8420
7 East: 996‐6161
Lab Results: 996‐4440
ER: 996‐8177
Specialty MOD on call Pager: 2724
Specialty intern on call Pager: 2725
Bed Control: 996‐0335
Onc Clinical UIC: 355‐1625
PharmD on call pager: 4958
Specialty clinic at VA: 569‐7288
Surgical Pathology: 413‐0096 or 996‐3886
XRT: 996‐3630
HOSPITAL FACILITIES AT UIC
Blood Bank 6‐3980
Bone Marrow 3‐9482
HemePathology 3‐0285
Hematology/Oncology Clinic 5‐1626
Lab Results (Outpatient) 6‐4440
Outpatient Oncology Pharmacy 6‐6985
Radiology 6‐0275
CT Scan 6‐0238
MRI 6‐9200
Nuclear Medicine 6‐3965
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Pathology (Hematology)
Dr. Fredrick Behm 6‐3150
Dr. Sally Campbell‐Lee 6‐1350
Pathology (Surgical) 6‐3874
Radiation Therapy 6‐3700
Radiation Oncology 6‐3630
VA ROTATION
VA extensions are 5xxxx, which means 312‐569‐xxxx if you’re calling from outside the hospital
(NOTE: “5” is also used in UIC extensions, which means 312‐355‐xxxx)
VA operator: 569‐8387
Admitting: 56177
Blood flow lab: 56776
CT: 57597
ER: 56241
Hoptel: 58003
IP radiology: 56655
Lab: 57277
MRI: 56650
Nuc med: 56431
Onc office: 56442
Path: 56692
IP pharmacy: 56886
OP pharmacy: 57244
Clinic scheduling: 57291
U/S: 56491
Liz: 389‐6590 (pager)
Dr. Reddy: 708‐216‐8777 #14439
Hines VA: 23456
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Program Policies and Procedures for Residents’ Duty Hours and Work Environment
Absences – Rotation and Clinic Coverage: If you are unable to be present for your rotation or clinic for
any reason you are responsible for covering your own absence. Contacting the department
Administrative Assistant or Fellowship Coordinator is not an acceptable alternative for finding coverage,
except in the case of a serious, last‐minute emergency. you should have a copy of the contact list and
schedule available on your PDA/email etc so you know who else you can call in case of illness, etc. You
are expected to contact each person and report a failure to cover to the Chief Fellow and Attending only
after all other possibilities have been exhausted.
Mt. Sinai Rotation: Our rotation at Mt. Sinai hospital is off‐site and by contract you are only allowed to
cover two half‐day clinics at the UIC/VA. This is so you can be at Mt. Sinai participating in their services
and conferences. To reduce stresses on fellows, you are excused from UIC conferences during your Mt.
Sinai rotation (except Friday morning didactics), but you should make an effort to attend when possible.
Mercy Hospital Rotation: same applies as for Sinai (see above)
Working from Home: Fellows on Research (or any other rotation) are NOT allowed to work from home.
If a fellow has an extenuating circumstance, the Program Director may approve on a case‐by‐case basis.
However, in absence of special permission, fellows are expected to be on‐campus during regular
business hours, M‐F and during non‐clinical and light clinical elective rotations.
Arriving Late/Leaving Early: Any report from attendings or research mentors of unexcused lateness to
rounds, clinic or the lab, or leaving early without your supervisor’s approval will result in a meeting with
the Program Director. Pending the outcome of this meeting, the fellow may have a note regarding
professionalism placed in his or her permanent file, or other disciplinary actions may be taken
depending on the circumstance and history of the fellow.
Pager/Call : We have created call and rotation schedules in adherence with the ACGME duty hours
requirements. Fellows on call in clinical rotations are expected respond in a timely manner at all times.
Fellows who do not answer call without a sufficient explanation will be subject to disciplinary actions.
Duty Hour and Fatigue Monitoring: The duty hours will comply with the ACGME guidelines. Duty Hours
are strictly enforced to provide time away from patient care duties. At any time a fellow feels that their
work hours exceed the duty hours, or are feeling stressed or fatigued he/she must notify the Program
Director or Fellowship Coordinator immediately.
A fellow shall:
Not exceed total 80 duty hours, including on‐call time from home
Not work for more than 12 hours during a calendar day
Receive a full 24 hour period free of clinical responsibility, including pager call (Sunday 8 AM to Monday 8 AM)
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Fellow performance and fatigue will be monitored using the same policy developed for house‐staff fatigue monitoring.
Duty Hour and Fatigue Monitoring: Fellows are required during each clinical rotation to log duty hours
in New Innovations. Duty hours are monitored by the Program Coordinator.
Service Coverage Responsibilities: You are responsible for covering your service at all times. If for any
reason you need to switch a rotation, you are responsible for finding a fellow who is willing to switch
with you. All changes to the schedule need to be approved by the Program Coordinator and Chief
Fellow, and potentially by Dr. Peace.
Holiday Coverage:
Each fellow covers his/her own service on holidays, unless previously arranged with another fellow. In this instance, you must let the program coordinator know who is covering your shift so schedule modifications can be made.
Weekend Coverage:
UIC Onc and VA Onc cover each other (UIC onc fellow covers their own service every 1st and 3rd weekend of the block; that weekend the NU fellow should be covering the VA. VA onc fellow covers UIC onc inpatient AND the VA every 2nd and 4th weekend of the month)
UIC Stem Cell and UIC Consults cover each other (inpatient heme/transplant service and urgent heme consults on weekends)
VA Hematology/Hemepath/Blood Bank/Mercy have no weekend call
Mt. Sinai covers its own weekends: fellow rounds one day of the weekend, attending rounds the other. Check with the attending each week which day you need to round.
Each fellow usually has at least 2 weekends off per month or at least 4 days off per month depending on the circumstances.
Conference Coverage:
Clinical rotations continue to be covered by fellows during conferences and lectures. If for any reason you are unable to attend your assigned clinic you are responsible for finding coverage and relying that information to the program coordinator and attending
Clinic coverage for vacation/Sinai/Mercy:
In the past fellows were responsible for finding their own clinic coverage for vacation, Sinai, and Mercy.
Most fellows agreed they would prefer to have assigned coverage for these rotations. Everyone is
expected to help out and cover the clinics they are assigned to.
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Moonlighting: (Refer to GME Policy XXXVI)
a. No resident may be engaged in moonlighting unless he/she is licensed for unsupervised medical
practice in the state where the moonlighting occurs.
b. No resident may engage in moonlighting without obtaining his own liability insurance for the
moonlighting activities.
c. Residents on J‐1 visas may never moonlight.
d. A resident wishing to moonlight must obtain prior written permission from his/her program director.
The program director’s statement must be retained in the resident’s file.
e. It is the responsibility of the institution hiring the resident to moonlight to determine whether
appropriate licensure is in place, whether adequate liability coverage is provided, and whether the
resident has the appropriate training and skills to carry out assigned duties.
f. Violation of the moonlighting policy is subject to disciplinary action. If a program director allows a
resident to moonlight, he/she must provide written permission prior to any moonlighting activity. The
program director's statement must be retained in the resident's file.
If moonlighting occurs within the home institution or in sites that are used by the educational program
(“in‐house” moonlighting), the time must be counted toward the 80‐hour per week duty hours limit.
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Overall Educational Goals for the Program
Goals
The overall goals of the program are for fellows to master the basic principles of hematology and
medical oncology to be clinically competent in the care of patients with benign and malignant
hematological disorders and neoplastic disorders. In addition, we strive to train competent physicians
to acquire the necessary skills for the evaluation and interpretation of basic or clinical research in the
field of hematology and medical oncology.
Objectives
The Section of Hematology/ Oncology adheres to the ACGME Core Curriculum which encompass
scholarship and Life Long Learning; Physicians as Teacher and Communicator; Personal and Professional
Development and Medical Practices Issues. The following sections outline the outcomes of the core
curriculum of the section of hematology/oncology.
The UIC Hematology/Oncology Fellowship Program provides the opportunity to gain competence or
expertise in the performance and (where applicable) interpretation of the following:
1. Bone marrow aspiration and biopsy, including preparation, staining, examination, and interpretation of blood smears, bone marrow aspirates, and touch preparations and interpretation of bone marrow biopsies.
2. Measurement of the complete blood count, including platelets and white cell differential, using automated or manual techniques with appropriate quality control.
3. Administration of chemotherapeutic agents and biological response modifiers through all therapeutic routes.
4. Management and care of indwelling venous access catheters. 5. Therapeutic phlebotomy 6. Therapeutic thoracentesis and paracentesis 7. Serial measurement of palpable tumor masses Correlation of clinical information with cytology, histology, and imaging techniques
1. Application and understanding of Genetic and molecular testing 2. The program provides experience in or observation of the following: 3. Apheresis procedures 4. Performance and interpretation of partial thromboplastin time, prothrombin time, platelet
aggregation, and bleeding time 5. Bone marrow and peripheral stem cell harvest for transplantation 6. Fine needle aspiration and biopsy
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Specific Program Content
The Fellows receive formal instruction, clinical experience, and opportunities to acquire knowledge in
the following:
1. Morphology, physiology, and biochemistry of blood, marrow, lymphatic tissue, and the spleen 2. Basic molecular and pathophysiologic mechanisms, diagnosis, and therapy of diseases of the
blood, including anemias, diseases of white cells, and disorders of hemostasis and thrombosis 3. Etiology, epidemiology, natural history, diagnosis, pathology, staging, and management of
neoplastic disorders 4. Immune markers, immunophenotyping, cytochemical studies, and cytogenetic and DNA analysis
of neoplastic disorders 5. Molecular mechanisms of neoplasia, including the nature of oncogenes and their products 6. Chemotherapeutic drugs, biologic products, and growth factors and their mechanisms of action,
pharmacokinetics, clinical indications, and limitations, including their effects, toxicity, and interactions
7. Multiagent chemotherapy protocols and combined modality therapy in the treatment of neoplastic disorders
8. Principles and application of surgery and radiation therapy in the treatment of neoplastic disorders
9. Management of the neutropenic and/or immunocompromised patient 10. Effects of systemic disorders, infections, solid tumors, and drugs on the blood, blood‐forming
organs, and lymphatic tissues 11. Allogeneic and autologous bone marrow transplantation and the nature and management of
post‐transplant complications 12. Indications and application of imaging techniques in patients with blood and neoplastic
disorders 13. Pathophysiology and patterns of solid tumor metastases 14. Principles of gynecologic oncology 15. Pain management in the cancer patient 16. Rehabilitation and psychosocial management of patients with hematologic and neoplastic
disorders 17. Hospice and home care for the cancer patient 18. Recognition and management of paraneoplastic disorders 19. The etiology of cancer, including predisposing causal factors leading to neoplasia 20. Cancer prevention and screening 21. Leading an active multidisciplinary tumor board 22. Tests of hemostasis and thrombosis for both congenital and acquired disorders and regulation
of antithrombotic therapy 23. Treatment of patients with disorders of hemostasis and the biochemistry and pharmacology of
coagulation factor replacement 24. Transfusion medicine, including the evaluation of antibodies, blood compatibility, and the use of
blood component therapy and apheresis procedures 25. Personal development, attitudes, and coping skills of physicians and other health‐care
professionals who care for critically ill patients 26. Human immunodeficiency virus‐related and other immunodeficient states associated
malignancies
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27. Management of chemotherapy related toxicities including nausea and vomiting, neuropathy, and fatigue
Ambulatory Care Setting
Fellows will assess and manage patients with hematologic and oncologic disorders in the ambulatory
care setting and in‐ hospital setting
1. Fellows will learn interpersonal skills with patients and health providers by establishing personal relationship, ascertain patient goals, and patient compliance, in addition to effectively communicating the plan of treatment for patients.
2. Gather pertinent information by enhancing their medical interviewing skills, time management skills, and the use of patient records and other clinical information sources.
3. Document patient encounters through patient history, physical data, Laboratory/ radiologic data, and treatment plans.
4. Gather proper documentation of medications, including chemotherapy, antibiotics, and blood products prescribed or administered.
5. Plan and coordinate follow‐up care, gain knowledge of the referral mechanisms, and knowledge of the extended care system.
6. Demonstrate the ability to act as a patient advocate.
Consultative Medicine
1. Provide an effective consultation and communicate effectively with the person requesting consultation, review patient charts, provide prompt responses and recommendations, and be able to identify the responsibility for executing a plan or follow‐up.
2. Fellow will learn to also request an effective consultation, by identifying clear and specific questions for the consultant, provide necessary clinical information to the consultant, and communicate results to the patient.
SPECIFIC GOALS AND OBJECTIVES
A. Patient‐ Centered Medical Care
Fellows will demonstrate proficiency in the clinical skills and knowledge necessary to provide patient
care that is compassionate, appropriate, and effective for the treatment of patient health problems.
UIC Hematology and Oncology fellows will:
1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
2. Gather essential and accurate information about their patients. 3. Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up‐to‐date scientific evidence and clinical judgment. 4. Develop and carry out patient management plans. 5. Counsel and educate patients and families. 6. Use information technology to support patient care decisions and patient education. 7. Perform competently all medical and invasive procedures considered essential for the area of
practice. 8. Provide healthcare serviced aimed at preventing health problems or maintaining health.
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9. Work with health care professionals, including those from other disciplines, to provide patient focused care.
B. Medical Knowledge and Scholarship
Fellows will demonstrate knowledge about established and evolving biomedical, clinical, and cognate
(e.g. epidemiological and social behavioral) sciences and the application of this knowledge through
research and teaching.
UIC Hematology and Oncology fellows will:
1. Demonstrate an investigatory and analytic thinking approach to clinical situations. 2. Know and apply the basic and clinically supportive sciences which are appropriate to their
disciplines. 3. Demonstrate knowledge of how illness and injury effect function and quality‐of‐life and utilize
that information to improve patient care. 4. Demonstrate scholarship through a faculty‐mentored research or education project, and
disseminate the findings through appropriate channels. 5. Contribute to teaching of colleagues at University of Illinois at Chicago, and participate in
activities to improve their own teaching skills. 6. Demonstrate integrity, clarity, and insight in written and oral presentations. 7. Develop skills for disciplined and ongoing learning to stay up‐to‐date with medical knowledge. 8. Articulate the ethical, legal and social responsibilities of medical knowledge.
C. Practice Base Learning and Improvement
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate
scientific evidence and improve their patient practices.
UIC Hematology and Oncology fellows will:
1. Analyze practice experience and perform practice‐based improvement activities using a systematic methodology.
2. Locate, appraise and assimilate evidence from scientific studies related to their patient’s health problems.
3. Obtain and use information about their own population of patients and the larger population from which their patients are drawn from.
4. Use information technology to manage information, access on‐line medical information; and support their own education.
5. Facilitate the learning of students and other healthcare professionals.
D. Interpersonal and Communication Skills
Fellows must be able to demonstrate interpersonal and communications skills that result in effective
information exchange and teaming with patients, their patients families, and professional associates.
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UIC Hematology and Oncology fellows will:
1. Create and sustain a therapeutic and ethically sound relationship with patients. 2. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning and writing skills. 3. Work effectively with others as a member or leader of a health care team or other professional
group.
E. Professionalism
Fellows must be able to demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to diverse patient population.
UIC Hematology and Oncology fellows will:
1. Demonstrate Respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self‐interest; accountability to patients, society and the profession; and a commitment to excellence and on‐going professional development.
2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices.
3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.
F. System Based Practice
Fellows must demonstrate an awareness of and responsiveness to the larger context of system of health
care and the ability to effectively call on system resources to provide care that is of optimal value.
UIC Hematology/Oncology fellows will:
1. Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.
2. Know how the types of medical practices and delivery systems differ from one another, including methods of controlling health care cost and allocating resources.
3. Practice cost‐effective health care and resource allocation that does not comprise quality care. 4. Advocate for quality patient care and assist patients in dealing with system complexities. 5. Know how to partner with health care managers and health care providers to assess,
coordinate, and improve health care and know how these activities can affect system performance.
G. Quality Assessment
1. Understand the principles and objectives of quality assessment of procedures and clinical care.
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Demonstrate the knowledge of the process of quality assessment and use of outcome data to improve
quality assessment and use of outcome date to improve quality of care.
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Hematology/Oncology Consult Rotation
University of Illinois Hospital and Health Sciences System
I. Educational Goals (knowledge, skills, attitudes)
The educational goals of the hematology/oncology consult (H/O consults) rotation at UIH is to prepare fellows to act as qualified consultants in the sub‐specialty, specifically in the setting of a hematology and oncology consultation service at a tertiary hospital.
Fellow Year 1:
First year fellows rotate on the H/O consults service usually for 1 to 2 months over the entire first year.
Therefore, it is expected that they will develop greater and greater knowledge and skills in the field of
hematology and oncology. Fellows need also adopt the right attitudes to make this rotation successful.
Knowledge
Hematology and oncology consultants are mostly called upon for their expert knowledge in the broad
and complex fields of solid tumors as well as malignant and benign hematologic disease. H/O consults
include a broad spectrum of diseases and differential diagnoses that are seen in a tertiary referral
center.
Fellows in the first year of their fellowship must acquire a lot of new knowledge in hematology and
oncology, mostly during this and other consult rotation. Because there is much to learn, this process
takes time, and the depth of knowledge must increase progressively. At every stage of their training,
fellows need to challenge themselves by reading further about patients they evaluate on the service.
They should actively look for relevant articles about any unfamiliar situation. Progressively, they must
develop expertise at recognizing the major clinical syndromes, use anti‐neoplastic therapy effectively,
and learn about the major tumors in some details.
More specifically, first year fellows need to learn about all the areas of knowledge listed below. Within
each area of knowledge, they should first learn the information most relevant to the care of their
patients. They should read regularly about their patients either from the established hematology and
oncology texts (all available on line through the University library) or from review articles published
frequently in either hematology or oncology journals (such as Blood and the Journal of Clinical
Oncology) or core internal medicine journals (New England Journal of Medicine).
During the first year of their fellowship, fellows need build their differential diagnosis trees (including
the benign diseases that mimic malignant ones) and learn the most important diagnostic and
therapeutic approaches to common malignancies and hematologic conditions.
As fellows become increasingly knowledgeable, they improve the quality of their teaching and
consultations. They also become more independent over time, although attending back‐up is available
24/7 and must be sought for any unfamiliar situation.
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Skills
Fellows in the first year of their fellowship must acquire new skills in the fields of hematology and
oncology. They are already familiar with these skills in the context of general internal medicine.
1. How to obtain a comprehensive history, perform a good physical exam, and focus the history and physical examination for major hematologic and oncologic conditions
2. How to gather important data from the electronic medical records, looking for information on vital signs, prior antineoplastic therapy, other medications, laboratory data (including blood counts and pathology reports), imaging studies, and surgical findings.
3. How to seek more information from other persons, including family members, outside hospitals who transferred the patient (primary or hematology/ oncology physicians, pathology laboratories), patient’s primary care physician, hospital physicians at UIC (primary team, surgeons about OR findings not documented fully in the record, other consultants about their opinions)
4. How to select appropriate tests to help with medical decisions 5. How to use the relevant information to develop an assessment and diagnostic and therapeutic
plan 6. How to interpret special laboratory tests such as serological tests, PCR tests, cytogenetic tests,
coagulation tests or biopsy results, paying attention to the positive and negative predictive values of these tests.
7. The indications for performing bone marrow aspiration and biopsy as a diagnostic test in the assessment of abnormal blood counts.
8. How to obtain and transport clinical specimens in an appropriate manner 9. How to offer phone advice that is relevant and to the point, while knowing when a curbside
consultation is not appropriate and a full consultation is required 10. How to lead the team of fellow, resident(s) and student(s) in order to be effective in order to
complete the clinical tasks within a reasonable time 11. How to review the medical literature to gather evidence supporting patient care decisions 12. How to teach the medical students and residents on the consultation team 13. When it is appropriate to transfer patients to the inpatient hematology or oncology services and
to be a liaison between general medicine and specialist services in these instances.
Fellow Year 2 and 3:
Second and third year fellows rotate on the H/O consult service usually for 1‐2 months. Typically, they
are already familiar with many of the areas of knowledge and skills required for this rotation. Still, they
will emphasize further their supervision of the team (Team Leaders), and their involvement with
teaching residents and students (Clinical Teachers). Senior fellows should be seen as role models by the
more junior members of the team and consulting services.
Knowledge
At this level of training, fellows need develop a deeper knowledge of the areas of listed below. They
should already be familiar with most diagnoses being evaluated. They will explore the recent literature
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to deepen their level of understanding of interesting cares. Within the areas of knowledge, they will
select the areas they do not know as well for improvement.
Skills
Fellows in the second and third year of their fellowship must perfect their skills. The most important
may be for the senior fellow to function as a junior attending in many ways. They manage the
consultation team in a more independent manner, although still under the supervision of the attending
on service. They should be capable of providing reasonable diagnostic and therapeutic plans in most
consultations except in the most complex cases.
Areas of Knowledge
Fellows will learn about many of these areas of knowledge during the three‐year fellowship, but will
need to supplement their knowledge by reading about areas of knowledge not addressed during the
training. Fellows review this list to identify any gap in their knowledge.
I. Basic Principles
1. Basic Laboratory Concepts and Techniques a. Role of DNA, RNA and proteins in normal cellular processes b. Concepts of translation and transcription in normal cellular processes
2. Pharmacology a. Pharmacokinetics, mechanism of action, metabolism, route of administration, indications,
dosages, and toxicities of pharmacologic and biologic agents. b. Current experimental therapeutics, such as monoclonal antibodies, radioimmunotherapy, etc. c. Working knowledge of the mechanism of new drug development and approval process.
3. Clinical Laboratory Techniques a. Automated complete blood count with white blood cell differential b. Hemoglobin electrophoresis c. Reticulocyte count d. Osmotic fragility e. Red blood cell (RBC) enzyme assays f. Specific techniques for microscopic identification of RBC parasites g. High pressure liquid chromatography (HPLC) h. Flow cytometry of peripheral blood, bone marrow, body fluids, lymph nodes and other tissues i. Cytogenetics, including fluorescence in‐situ hybridization (FISH) j. Prothrombin time and activated partial thromboplastin time k. Coagulation factor and inhibitor assays l. Bleeding time m. Platelet function studies n. Heparin induced thrombocytopenia (HIT) assays o. Tissue (e.g. HLA) typing p. Southern blot q. Polymerase chain reaction (PCR) r. Reverse transcriptase – PCR (RT‐PCR)
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s. Serum and urine protein electrophoreses and immunoelectrophoreses and/or immunofixation t. Hematopathology tissue assessment techniques, including standard morphologic evaluation
and the use of immunostaining u. Blood banking techniques of cross‐matching, antibody identification, direct antiglobulin test
and indirect Coomb's test v. Apheresis, plasmapheresis, plateletpheresis, leukopheresis w. Therapeutic phlebotomy x. Exchange transfusion y. Immunocytochemistry z. Cytochemistry
4. Transfusion Medicine a. Knowledge of the procedures used to collect, evaluate and prepare blood products b. Components of blood products typically administered to patients, including red blood cell
(RBC) preparations, platelet preparations, granulocyte preparations, fresh frozen plasma and cryoprecipitate.
c. Various methods by which these blood products can be handled and prepared d. Clinical indications for use of specific blood products e. Potential risks associated with the administration of various blood products.
a. allergic (anaphylactic) reactions b. graft versus host disease c. introduction of infectious organisms d. alloimmunization e. delayed transfusion reactions f. hemolytic reactions g. febrile reactions
f. alternatives to blood product therapies. g. mechanism by which apheresis can be used to isolate and collect specific blood components h. use of emergent plasmapheresis (as used in TTP) and leukapheresis (as used in AML) i. methods used for peripheral blood stem cell collections.
5. Radiation Therapy a. Basic principles of radiation biology. b. Basic approaches of administering radiation therapy, including the different radiation source
types c. Short‐term toxicities and the potential long‐term consequences of radiation therapy (e.g.
secondary malignancies, coronary artery disease). d. Interactions of radiation therapy with medications, including antineoplastic pharmacologic
agents
6. Normal Hematopoiesis a. Working understanding of hematopoiesis including:
a. Stem cell plasticity, embryology and differentiation b. Erythropoiesis c. Leukocyte differentiation, maturation and trafficking d. Basics of lymphocyte biology e. Thrombopoiesis
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b. Understanding of cell surface receptor and cell surface protein changes in normal
development and differentiation of hematopoietic cells.
c. Understanding of the role of growth factors and cytokines. d. Knowledge of hemoglobin synthesis e. Knowledge of normal platelet development and the role of thrombopoietin and other platelet
growth factors.
II. Red Blood Cell Disorders
1. Anemias
a. Production Disorders
Nutritional Deficiencies
Anemia of Chronic Disease
Red Cell Aplasia and Hypoplasia
Sideroblastic Anemias
b. RBC Destruction Disorders (Hemolytic Anemias)
Hemoglobinopathies
Thalassemias
Sickle Cell Anemia
Other Congenital Hemoglobinopathies
c. Hemolytic Anemias Autoimmune Hemolytic Anemias
Metabolic Enzyme Deficiency Hemolytic Anemias
Paroxysmal Nocturnal Hemoglobinuria
RBC Membrane Disorders
Microangiopathic Hemolytic Anemias
Non‐autoimmune, Acquired Hemolytic Anemias
d. Erythrocytosis e. Porphyrias f. Hemochromatosis
2. White Blood Cell Disorders
a. Granulocyte Dysfunction Disorders
b. Granulocytopenia
c. Lymphopenia and Lymphocyte Dysfunction Syndromes
d. Leukocytosis
3. Platelet and Megakaryocyte Disorders
a. Hereditary Platelet Disorders
b. Acquired Platelet Function Disorders
c. Thrombocytopenia
Decreased Platelet Production
Increased Destruction or Consumption of Platelets
d. Thrombocytosis
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e. Anti‐Platelet Function Drugs
4. Bone Marrow Failure States
a. Aplastic Anemia
III. Hemostasis 1. Normal Mechanisms of Hemostasis
2. Bleeding Disorders
3. Thrombotic Disorders
a. Heparin‐induced Thrombocytopenia
b. Antiphospholipid Syndrome
4. Pharmacologic Manipulation of Bleeding and Thrombosis
IV. Complications of Malignancies 1. Febrile Neutropenia 2. Tumor Lysis Syndrome 3. Disseminated Intravascular Coagulation 4. Superior Vena Cava Syndrome 5. Spinal Cord Compression 6. Mucositis 7. Paraneoplastic Disorders
V. Management and treatment of hematologic neoplastic disorders
4. Chronic Myeloproliferative Diseases a. Chronic Myelogenous Leukemia b. Polycythemia Rubra Vera c. Chronic Idiopathic Myelofibrosis d. Essential Thrombocythemia
2. Acute Myeloid Leukemias
3. Myelodysplastic Syndrome Disorders
4. B‐cell Neoplasms
a. B‐Lymphoblastic Leukemia/Lymphoma b. Lymphoplasmacytic Lymphoma (Waldenström’s Macroglobulinemia) c. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma d. Hairy Cell Leukemia e. Plasma Cell Disorders
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f. Plasma Cell Myeloma (Multiple Myeloma), Plasmacytomas and g. Other Plasma Cell Disorders h. Amyloidosis i. B‐cell Lymphomas j. B‐cell Proliferations of Uncertain Malignant Potential k. Post‐transplantation Lymphoproliferative Disorders
5. T‐cell and NK‐cell Neoplasms
a. Adult T‐cell Leukemia/Lymphoma b. Mycosis Fungoides, Sezary Syndrome and Cutaneous T‐cell Lymphoma c. T‐cell Lymphomas
6. Hodgkin’s Disease
7. Histiocytic and Dendritic Cell Neoplasms
8. Mastocytosis
VI. Management and treatment of individual cancers
1. Head and neck cancers
2. Lung cancer and mesothelioma a. Small‐cell lung cancer b. Non–small‐cell lung cancer c. Mesothelioma
3. Gastrointestinal cancers
a. Esophageal cancer b. Gastric cancer c. Colon cancer d. Anal cancer e. Hepatobiliary cancers f. Pancreatic cancer
4. Genitourinary cancers
a. Renal cell cancer b. Urothelial cancers c. Penile cancer d. Prostate cancer e. Germ cell tumors
5. Gynecologic malignancies a. Ovarian cancer b. Uterine cancer c. Cervical cancer d. Vulvar and vaginal cancers
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6. Breast cancer
7. Sarcomas
a. Bone sarcomas b. Soft tissue sarcomas
8. Skin cancers
a. Melanoma b. Basal cell and squamous cell cancers
9. Endocrine cancer
10. Central nervous system malignancies
11. Carcinoma of unknown primary site
Overview of the Rotation:
During this rotation, fellows work with an attending, one or more resident(s) and medical student(s) to
offer consultations in hematology and oncology. The consult team takes care of very sick and very
complex patients. Over the course of the rotation, fellows see quite a significant number of new
consultations and follow‐ups.
II. Core Competencies and Curriculum
Teaching Methods / Clinical Encounters
During this rotation, fellows evaluate inpatients referred to the H/O consultation service. This
consultation service deals with all patients except those with sickle cell disease. Patients are first
evaluated by one medical student, resident, or fellow, then discussed when possible with the fellow, and
finally presented formally to the attending and the rest of the team. Prior to the presentation, whenever
a case is difficult, unusual, or challenging, fellows and residents will locate and print an article that
addresses the problem being evaluated.
This rotation values and emphasizes teaching. Frequently, every person on the team participates in
teaching: attendings, fellows, residents, and medical students. Students who review the literature about
one of their patients may present a short summary to the group. Students interested in hematology/
oncology may chose to review an antibiotic or antibiotic group and present a short summary to the
group. Fellows teach during short lectures to the team usually when the attending is not present.
Attendings teach both during sitting rounds (presentation of new consultations and follow‐up problems)
and during walking rounds (at the bedside). They also present “mini‐lectures”, and more formal lectures
on the topic of their choice. Frequently, the fellow or one member of the team will request a specific
topic.
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Patient Characteristics / Disease Mix
The patient mix is very broad on this service. The degree of illness severity is variable. Many patients are
evaluated in one of the intensive care units: medical ICU, surgical ICU, and neurosurgical ICU. Others are
evaluated on the wards within the medical, surgical, OBGYN, psychiatry. Benign hematology problems
make up a significant number of the consults from these services. These consults are generally for
common problems abnormalities in the complete blood count or screening coagulation tests. Less often
diagnoses such as TTP and hemophilia will be encountered. Patients with known malignant diagnoses
will be seen by the consult service if they are in hospital and not in the inpatient oncology or stem cell
services. Patients may also be newly diagnosed with malignant disease on general medicine or surgical
services.
Procedures and Skills
The only invasive procedure performed by this service is bone marrow aspiration and biopsy. Some
procedures are performed during this rotation, while others may only be performed during other
rotations. The diagnostic and therapeutic procedures required on this service are:
1. Performance and interpretation of peripheral blood smears. This will be evaluated by the supervising attending during consult rounds.
2. Performance and interpretation of bone marrow aspiration and biopsy. 3. Evaluation of solid tumors at diagnosis and after treatment by the use of diagnostic imaging
Hematology and oncology consultants frequently recommend the performance of invasive procedures
such as biopsies. Therefore, attending physicians will advise that the trainees properly explain any
invasive procedures performed to the patient, discuss the possible risks and discomforts of the
procedure, and obtain informed consent.
Faculty Supervision
Fellow ability to clinically approach problems in hematology and oncology will be judged by the
supervising attending physician during the H/O consult rotation. The attending physicians will outline
the goals of the rotation to the fellows early during the rotation and provide feedback mid‐rotation and
at the end of the rotation. Importantly, they will report to the Program Director any significant problem
that is identified so that early corrective action can be implemented. They will complete a formal
evaluation through the “New Innovations” software in a timely manner once they receive a request via
e‐mail.
Methods of evaluation
At the end of the rotation, the attending physician will receive a “New Innovation” formal evaluation form by e‐mail and will complete this evaluation within a reasonable time. The New innovation evaluation form allows documentation of the fellow competency (competencies: patient care, medical knowledge, professionalism, and interpersonal and communication skills). The evaluation should be discussed with the fellow at the end of the rotation.
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Fellows document milestones of their training: interesting cases, presentations, unusual or new situation faced on the service, etc. in their portfolios. They will also complete an attending evaluation trough New Innovations.
Attitudes / Behaviors
Patient Care: fellows must provide patient care that is compassionate, appropriate, and effective for the treatment of hematologic and oncologic disease. They must communicate effectively and demonstrate caring and respectful behaviors when interacting with patients; gather accurate information about their patient; advise diagnostic and therapeutic plans based on patient information, up‐to‐date scientific evidence, and clinical judgment; use information technology to support patient care decisions; work with health care professionals, including those from other disciplines, to provide patient‐focused care
Medical Knowledge: fellows must demonstrate knowledge about basic and clinical sciences in the area of hematology/ oncology, and apply this knowledge to patient care.
Practice‐Based Learning and Improvement: fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. They must locate, appraise, and assimilate evidence from scientific studies related to their patients’ disease; apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; use information technology to manage information, access on‐line medical information; and support their own education; facilitate the learning of students and other health care professionals
Interpersonal and Communication Skills: fellows must demonstrate interpersonal and communication skills that result in effective information exchange especially within the team and when acting as consultants to other physicians. They need work effectively with others as a member and leader of the hematology/ oncology consultation team.
Professionalism: fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. They must demonstrate respect, compassion, and integrity; a commitment to excellence and on‐going professional development; a commitment to ethical principles; sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
System‐Based Learning: fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. They are expected to practice cost‐effective health; advocate for quality patient care, and assist patients in dealing with system complexities
Resources
1. UIC medical library. http://library.uic.edu/ 2. The Medical library holds numerous journals and older volumes of journals that are relevant to
hematology and oncology, and are not accessible on line 3. Key Oncology Websites 4. American Society of Clinical Oncology
www.asco.org
Professional society website with extensive educational resources
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5. National Comprehensive Cancer Network www.NCCN.org
Extensive step by step guidelines on each malignancy as well as supportive care
6. Chemoregimen.com www.Chemoregimen.com
Online resource to help search for appropriate antineoplastic regimen by disease type
7. Chemoorders.com www.Chemoorders.com
Online resource to help search for appropriate treatment regimens and aid in correct
prescribing of antineoplastic agents
8. Oncology Stat www.Oncologystat.com Educational website with links to articles and presentations, including journal watch section
9. Key Hematology Websites 10. American Society of Hematology (ASH)
www.hematology.org
Professional society website with educational and teaching resources for fellows as well as links
to publications as information on upcoming meetings
11. ASH image bank http://ashimagebank.hematologylibrary.org/
Extensive collection of images of normal and abnormal hematopoietic cells
12. ASH self assessment program http://www.ash‐sap.org/
Free text for hematology trainees on benign and malignant hematology with self assessment
questions for each chapter
13. Bloodline.net http://www.bloodline.net/
Reference site with links to online hematology resources including journal watch section
Conferences:
Fellows are expected to attend the conferences of the fellowship teaching curriculum throughout their
training. All fellows are expected to participate in the discussions during these sessions. This includes:
Didactic conference (7.30‐8.30am Friday mornings and 7.30‐8.30am every other Tuesday)
Journal club (8.30‐9.30am on Friday morning alternating with hematopathology conference)
Hematopathology conference (8.30‐9.30am on 2nd and 4th Friday of every month)
In addition attendance is required at monthly research meetings of the section and monthly clinical
trials meetings.
Fellows should also attempt to attend Tumor Board (Monday 12‐1pm) and Thoracic multidisciplinary
conference (Thursday 5‐6pm).
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Inpatient Hematology/ Stem Cell Transplant Services
University of Illinois Hospital and Health Sciences System
I. Educational Goals (knowledge, skills, attitudes)
The educational goals of the joint service of inpatient hematology and stem cell transplant (SCT) rotation
at UIH are:
1. To allow fellows to acquire insights into the care of patients undergoing high dose chemotherapy and allogeneic or autologous transplantation
2. To obtain a high degree of exposure to management of patients with lymphoma, leukemia and myeloma.
Fellow Year 1:
First year fellows rotate on the SCT service for approximately 1‐2 months. This is an intensive rotation
and it is expected that fellows will quickly gain knowledge and skills in malignant hematology and stem
cell transplant.
Knowledge
In this rotation fellows will be expected to increase their knowledge in the complex fields of malignant
hematology and stem cell transplant. This includes several uncommon disorders which are treated with
modalities which may not be familiar to the first year fellow. Fellows in the first year of their fellowship
must acquire a lot of new knowledge in this area. Because there is much to learn, this process takes
time, and the depth of knowledge must increase progressively. At every stage of their training, fellows
need to challenge themselves by reading further about patients they evaluate on the service. They
should actively look for relevant articles about any unfamiliar situation. Progressively, they must develop
expertise at recognizing the major clinical syndromes and their treatment.
More specifically, first year fellows need to learn about all the areas of knowledge listed below. Within
each area of knowledge, they should first learn the information most relevant to the care of their
patients. They should read regularly about their patients either from established texts (available on line
through the university library) or from review articles published frequently in either hematology journals
or core internal medicine journals.
As fellows become increasingly knowledgeable, they improve the quality of their teaching and
consultations. They also become more independent over time, although attending back‐up is available
24/7 and must be sought for any unfamiliar situation.
33
Skills
Fellows in the first year of their fellowship must acquire new skills in the fields of hematology and
oncology. They may already be familiar with these skills in the context of general internal medicine.
14. How to obtain a comprehensive history, perform a good physical exam, and focus the history and physical examination for major hematologic and oncologic considitions
15. How to gather important data from the electronic medical records, looking for information on vital signs, prior antineoplastic therapy, other medications, laboratory data (including blood counts and pathology reports), imaging studies, and surgical findings.
16. How to seek more information from other persons, including family members, outside hospitals who transferred the patient (primary or hematology/ oncology physicians, pathology laboratories), patient’s primary care physician, hospital physicians at UIC (surgeons about OR findings not documented fully in the record, other consultants about their opinions)
17. How to select appropriate tests to help with medical decisions 18. How to use the relevant information to develop an assessment and diagnostic and therapeutic
plan 19. How to interpret special laboratory tests such as serological tests, PCR tests, cytogenetic tests,
coagulation tests or biopsy results, paying attention to the positive and negative predictive values of these tests.
20. The indications for performing bone marrow aspiration and biopsy as a diagnostic test. 21. How to obtain and transport clinical specimens in an appropriate manner. 22. How to lead the team of fellow, resident(s) and student(s) in order to be effective in order to
complete the clinical tasks within a reasonable time 23. How to review the medical literature to gather evidence supporting patient care decisions 24. How to teach residents on the service
Fellow Year 2 and 3:
Second and third year fellows rotate on the SCT service for approximately 1‐2 months. Typically, they
are already familiar with many of the areas of knowledge and skills required for this rotation. Still, they
will emphasize further their supervision of the team (Team Leaders), and their involvement with
teaching residents (Clinical Teachers). Senior fellows should be seen as role models by the more junior
members of the team.
Knowledge
At this level of training, fellows need develop a deeper knowledge of the areas of listed below. They
should already be familiar with most diagnoses being evaluated. They will explore the recent literature
to deepen their level of understanding of interesting cares. Within the areas of knowledge, they will
select the areas they do not know as well for improvement.
34
Skills
Fellows in the second and third year of their fellowship must perfect their skills. The most important
may be for the senior fellow to function as a junior attending in many ways. They manage the
consultation team in a more independent manner, although still under the supervision of the attending
on service. They should be capable of providing reasonable diagnostic and therapeutic plans in most
consultations except in the most complex cases.
Areas of Knowledge
Fellows will learn about many of these areas of knowledge in hematology during the three‐year
fellowship, but will need to supplement their knowledge by reading about areas of knowledge not
addressed during the training. Fellows review this list to identify any gap in their knowledge. Although
the focus of this rotation is upon malignant hematology and stem cell transplant many areas relevant to
benign hematology and solid tumor oncology may also be emphasized.
II. Basic Principles
7. Basic Laboratory Concepts and Techniques g. Role of DNA, RNA and proteins in normal cellular processes h. Concepts of translation and transcription in normal cellular processes
8. Pharmacology d. Pharmacokinetics, mechanism of action, metabolism, route of administration, indications,
dosages, and toxicities of pharmacologic and biologic agents. e. Current experimental therapeutics, such as monoclonal antibodies, radioimmunotherapy, etc. f. Working knowledge of the mechanism of new drug development and approval process.
9. Clinical Laboratory Techniques aa. Automated complete blood count with white blood cell differential bb. Hemoglobin electrophoresis cc. Reticulocyte count dd. Osmotic fragility ee. Red blood cell (RBC) enzyme assays ff. Specific techniques for microscopic identification of RBC parasites gg. High pressure liquid chromatography (HPLC) hh. Flow cytometry of peripheral blood, bone marrow, body fluids, lymph nodes and other tissues ii. Cytogenetics, including fluorescence in‐situ hybridization (FISH) jj. Prothrombin time and activated partial thromboplastin time kk. Coagulation factor and inhibitor assays ll. Bleeding time mm. Platelet function studies nn. Heparin induced thrombocytopenia (HIT) assays oo. Tissue (e.g. HLA) typing pp. Southern blot qq. Polymerase chain reaction (PCR) rr. Reverse transcriptase – PCR (RT‐PCR) ss. Serum and urine protein electrophoreses and immunoelectrophoreses and/or immunofixation
35
tt. Hematopathology tissue assessment techniques, including standard morphologic evaluation and the use of immunostaining
uu. Blood banking techniques of cross‐matching, antibody identification, direct antiglobulin test and indirect Coomb's test
vv. Apheresis, plasmapheresis, plateletpheresis, leukopheresis ww. Therapeutic phlebotomy xx. Exchange transfusion yy. Immunocytochemistry zz. Cytochemistry
10. Transfusion Medicine j. Knowledge of the procedures used to collect, evaluate and prepare blood products k. Components of blood products typically administered to patients, including red blood cell
(RBC) preparations, platelet preparations, granulocyte preparations, fresh frozen plasma and cryoprecipitate.
l. Various methods by which these blood products can be handled and prepared m. Clinical indications for use of specific blood products n. Potential risks associated with the administration of various blood products.
a. allergic (anaphylactic) reactions b. graft versus host disease c. introduction of infectious organisms d. alloimmunization e. delayed transfusion reactions f. hemolytic reactions g. febrile reactions
o. alternatives to blood product therapies. p. mechanism by which apheresis can be used to isolate and collect specific blood components q. use of emergent plasmapheresis (as used in TTP) and leukapheresis (as used in AML) r. methods used for peripheral blood stem cell collections.
11. Radiation Therapy a. Basic principles of radiation biology. b. Basic approaches of administering radiation therapy, including the different radiation source
types c. Short‐term toxicities and the potential long‐term consequences of radiation therapy (e.g.
secondary malignancies, coronary artery disease). d. Interactions of radiation therapy with medications, including antineoplastic pharmacologic
agents.
12. Normal Hematopoiesis a. Working understanding of hematopoiesis including:
f. Stem cell plasticity, embryology and differentiation g. Erythropoiesis h. Leukocyte differentiation, maturation and trafficking i. Basics of lymphocyte biology j. Thrombopoiesis
b. Understanding of cell surface receptor and cell surface protein changes in normal
development and differentiation of hematopoietic cells.
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i. Understanding of the role of growth factors and cytokines. j. Knowledge of hemoglobin synthesis k. Knowledge of normal platelet development and the role of thrombopoietin and other platelet
growth factors.
II. Bone Marrow Failure States and Aplastic anemia
1. Bone marrow failure states a. Clinical characteristics of the inherited and congenital forms of bone marrow b. Demonstrate the ability to provide a differential diagnosis and the acquisition of practical
knowledge of the role of medications, other drugs and environmental pathogens (including chemicals and infectious diseases) in the development of bone marrow failure states.
2. Aplastic Anemia
a. Diagnosis of aplastic anemia.
b. Understanding of the indications and risks of various treatment approaches (including stem
cell transplantation, anti‐thymocyte globulin, cyclosporine, other immune mediators)
III. Hematologic Neoplastic Disorders
Have understanding and knowledge of the diagnosis and treatment of the following diseases 1. Chronic Myeloproliferative Diseases
e. Chronic Myelogenous Leukemia f. Polycythemia Rubra Vera g. Chronic Idiopathic Myelofibrosis h. Essential Thrombocythemia
2. Acute Myeloid Leukemias
3. Myelodysplastic Syndrome Disorders
4. B‐cell Neoplasms
l. B‐Lymphoblastic Leukemia/Lymphoma m. Lymphoplasmacytic Lymphoma (Waldenström’s Macroglobulinemia) n. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma o. Hairy Cell Leukemia p. Plasma Cell Disorders q. Plasma Cell Myeloma (Multiple Myeloma), Plasmacytomas and r. Other Plasma Cell Disorders s. Amyloidosis t. B‐cell Lymphomas u. B‐cell Proliferations of Uncertain Malignant Potential v. Post‐transplantation Lymphoproliferative Disorders
5. T‐cell and NK‐cell Neoplasms
d. Adult T‐cell Leukemia/Lymphoma e. Mycosis Fungoides, Sezary Syndrome and Cutaneous T‐cell Lymphoma f. T‐cell Lymphomas
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6. Hodgkin’s Disease
7. Histiocytic and Dendritic Cell Neoplasms
8. Mastocytosis
9. Complications of Hematologic Malignancies
a. Febrile Neutropenia b. Tumor Lysis Syndrome c. Disseminated Intravascular Coagulation d. Superior Vena Cava Syndrome e. Spinal Cord Compression f. Paraneoplastic Disorders
VI. Palliative Care
1. Pain Management a. Practical competency in managing pain in patients with hematologic disorders. b. Understanding of the pharmacology, indications, dosage, administration potential toxicities
and potential interactions of narcotics c. Practical competency in the indications and use of nonpharmacologic methods for treating
pain.
2. Nutrition a. Practical competency for the role of nutrition in the care of patients with hematologic
disorders. The trainee should understand the physical and psychological significance, and limitations, of nutrition in hematologic disease.
3. Hospice/End‐of‐Life Care a. Practical competency in discussing and delivering end‐of‐life care and counseling to those
patients whose hematologic diseases are leading to the patient's death. b. Understanding of the types of end‐of‐life care that can be delivered by different health care
models, including in‐home hospice, residential hospice and other nursing services and settings.
VII. Bone Marrow Transplantation/Stem Cell Transplantation
1. Working knowledge of the basic, cellular and molecular biology of hematopoiesis and BMT/SCT.
2. Understanding of tumor immunology and the biologic and immunologic relationships between a donor's hematopoietic cells and host.
3. Knowledge and practical competency of the indication and role of autologous, full intensity allogeneic, low intensity allogeneic and tandem BMT/SCT in the management of hematologic diseases.
4. Be familiar with the role of the National Marrow Donor Program (NMDP) in identifying unrelated stem cell donors.
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5. Knowledge of the preparative regimens used in anticipation of autologous and allogeneic BMT/SCT.
6. Understand the method of collecting and handling bone marrow and peripheral stem cells for transplantation.
7. Understand the approaches used to mobilize hematopoietic stem cells to the peripheral blood
8. Practical competency of the process of performing autologous and allogeneic BMT/SCT. 9. Understand the need for prophylactic and supportive care measures in patients undergoing
BMT/SCT. 10. Understand approaches to preventing infectious diseases 11. Understand the use of immunosuppressive therapies to prevent or decrease graft‐versus‐
host disease 12. Understand the complications that can occur post‐transplant, including marrow
engraftment failure, acute and chronic graft‐versus‐host disease, opportunistic infections, veno‐occlusive disease, and others.
Overview of the Rotation:
During this rotation, fellows work with an attending, one resident and 2 interns to cover patients on the
inpatient hematology service. The fellow and attending with the assistance of a mid‐level practioner are
also be responsible for the care of inpatients undergoing autologous and allogeneic stem cell transplant.
Patients on this joint service are often very sick and of a high level of acuity.
II. Core Competencies and Curriculum
Teaching Methods / Clinical Encounters
During this rotation, fellows evaluate inpatients on the service on a daily basis. This service deals with all
hematology inpatients except those with sickle cell disease. Patients admitted to the service are first
evaluated by the resident, intern or fellow, then discussed when possible with the fellow, and finally
presented formally to the attending and the rest of the team. Prior to the presentation, whenever a case
is difficult, unusual, or challenging, fellows and residents will locate and print an article that addresses
the problem being evaluated.
This rotation values and emphasizes teaching. Frequently, every person on the team participates in
teaching: attendings, fellows and residents. Fellows teach during short lectures to the team usually
when the attending is not present. Attendings teach both during sitting rounds (presentation of new
consultations and follow‐up problems) and during walking rounds (at the bedside). They also present
“mini‐lectures”, and more formal lectures on the topic of their choice. Frequently, the fellow or one
member of the team will request a specific topic.
Patient Characteristics / Disease Mix
The patient mix is predominantly patients with malignant hematologic disorders who are in hospital for
treatment of the underlying disease or for complications of their disease/ treatment. The degree of
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illness severity is variable. Patients may be evaluated in the intensive care units. Otherwise patients are
evaluated on the wards or within the bone marrow transplant unit. Less often diagnoses such as TTP and
hemophilia will be encountered. Patients will often have known diagnoses however occasionally
patients with newly diagnosed hematologic malignancies are admitted to the service or transferred from
outside institutions,
Procedures and Skills
Several invasive procedures are performed on this service. The diagnostic and therapeutic procedures
required on this service are:
4. Performance and interpretation of peripheral blood smears. 5. Performance and interpretation of bone marrow aspiration and biopsy for diagnosis and
staging. 6. Performance of lumbar puncture and instillation of intrathecal chemotherapy 7. Access of ommaya reservoir and instillation of intraommaya chemotherapy
Frequently the performance of invasive procedures such as biopsies and insertion of central lines will be
recommended to patients. Therefore, attending physicians will advise that the trainees properly explain
any invasive procedures performed to the patient, discuss the possible risks and discomforts of the
procedure, and obtain informed consent.
Faculty Supervision
Fellow ability to clinically approach problems in hematology will be judged by the supervising attending
physician during the hematology/ SCT rotation. The attending physicians will outline the goals of the
rotation to the fellows early during the rotation and provide feedback mid‐rotation and at the end of the
rotation. Importantly, they will report to the Program Director any significant problem that is identified
so that early corrective action can be implemented. They will complete a formal evaluation through the
“New Innovations” software in a timely manner once they receive a request via e‐mail.
Methods of evaluation
At the end of the rotation, the attending physician will receive a “New Innovation” formal evaluation form by e‐mail and will complete this evaluation within a reasonable time. The New innovation evaluation form allows documentation of the fellow competency (competencies: patient care, medical knowledge, professionalism, and interpersonal and communication skills). The evaluation should be discussed with the fellow at the end of the rotation.
Fellows document milestones of their training: interesting cases, presentations, unusual or new situation faced on the service, etc. in their portfolios. They will also complete an attending evaluation trough New Innovations.
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Attitudes / Behaviors
Patient Care: fellows must provide patient care that is compassionate, appropriate, and effective for the treatment and the prevention of hematologic and oncologic disease. They must communicate effectively and demonstrate caring and respectful behaviors when interacting with patients; gather accurate information about their patient; advise diagnostic and therapeutic plans based on patient information, up‐to‐date scientific evidence, and clinical judgment; use information technology to support patient care decisions; work with health care professionals, including those from other disciplines, to provide patient‐focused care
Medical Knowledge: fellows must demonstrate knowledge about basic and clinical sciences in the area of hematology/ oncology, and apply this knowledge to patient care.
Practice‐Based Learning and Improvement: fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. They must locate, appraise, and assimilate evidence from scientific studies related to their patients’ disease; apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; use information technology to manage information, access on‐line medical information; and support their own education; facilitate the learning of students and other health care professionals
Interpersonal and Communication Skills: fellows must demonstrate interpersonal and communication skills that result in effective information exchange especially within the team and when acting as consultants to other physicians. They need work effectively with others as a member and leader of the hematology/ oncology consultation team.
Professionalism: fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. They must demonstrate respect, compassion, and integrity; a commitment to excellence and on‐going professional development; a commitment to ethical principles; sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
System‐Based Learning: fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. They are expected to practice cost‐effective health; advocate for quality patient care, and assist patients in dealing with system complexities
Resources
14. UIC medical library. http://library.uic.edu/
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1. The Medical library holds numerous journals and older volumes of journals that are relevant to hematology and oncology, and are not accessible on line
2. Key Oncology Websites
1. American Society of Clinical Oncology
www.asco.org
Professional society website with extensive educational resources
2. National Comprehensive Cancer Network www.NCCN.org
Extensive step by step guidelines on each malignancy as well as supportive care
3. Chemoregimen.com
www.Chemoregimen.com
Online resource to help search for appropriate antineoplastic regimen by disease type
4. Chemoorders.com
www.Chemoorders.com
Online resource to help search for appropriate treatment regimens and aid in correct
prescribing of antineoplastic agents
5. Oncology Stat
www.Oncologystat.com Educational website with links to articles and presentations, including journal watch section
3. Key Hematology Websites
1. American Society of Hematology (ASH) www.hematology.org
Professional society website with educational and teaching resources for fellows as well as links
to publications as information on upcoming meetings
2. ASH image bank http://ashimagebank.hematologylibrary.org/
Extensive collection of images of normal and abnormal hematopoietic cells
3. ASH self assessment program http://www.ash‐sap.org/
Free text for hematology trainees on benign and malignant hematology with self assessment
questions for each chapter
4. Bloodline.net http://www.bloodline.net/
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Reference site with links to online hematology resources including journal watch section
Conferences:
Fellows are expected to attend the conferences of the fellowship teaching curriculum during this
rotation. All fellows are expected to participate in the discussions during these sessions. This includes:
Didactic conference (7.30‐8.30am Friday mornings and 7.30‐8.30am every other Tuesday)
Journal club (8.30‐9.30am on Friday morning alternating with hematopathology conference)
Hematopathology conference (8.30‐9.30am on 2nd and 4th Friday of every month)
In addition attendance is required at monthly research meetings of the section and monthly clinical
trials meetings.
Specific to this rotation, fellows are required to attend and help direct multidisciplinary rounds on
Thursday at 2.30pm. Fellows will present the patients currently on the service and give updates on their
clinical condition
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UIC Inpatient Oncology Service
University of Illinois Hospital and Health Sciences System
I. Educational Goals (knowledge, skills, attitudes)
The educational goals of the Inpatient Oncology Service at UIH are to prepare fellows to act as
qualified sub‐specialty physicians in the setting of primary solid tumor diseases. Fellows should
display competency in the treatment and management of the complications that may arise as a
result of their disease and the treatments themselves.
Fellow Year 1:
First year fellows will typically have 2‐3 months of Inpatient Oncology Service at UIH. During their
time on service it is important for them to become more familiar with the general practices of
oncology and patient management.
Knowledge
Oncologist should have an in‐depth knowledge base of the various disease states with the field.
During the first year of training it is important for the fellow to familiarize themselves with the basic
pathophysiology of each disease state. During their time on service fellows will learn the staging for
each disease sub‐type and general aspects in treatment and monitoring of disease status. The
fellow will also be the first in‐line to field questions from other services as to how to workup and
make diagnosis in patients who present with likely malignancy.
Skills
Fellows in the first year of fellowship must acquire new skills in the field of oncology. They are
already familiar with these skills in the setting of general internal medicine.
1. How to obtain a comprehensive history, perform a good physical exam, and focus the history and physical examination for each major oncologic disease
2. How to gather important data from the electronic medical records, looking for information on symptoms at presentation, clinical course, labs/imaging and prior treatment the patient has received up to this point
3. How to seek more information from other persons, including family members, outside hospitals who transferred the patient (primary or oncologists, labs, imaging and pathology)
4. How to select appropriate tests to help with medical decisions 5. How to use the relevant information to develop an assessment and diagnostic and
therapeutic plan 6. How to lead the team of fellow, resident(s) and student(s) in order to be effective in order
to complete the clinical tasks within a reasonable time 7. How to review the medical literature to gather evidence supporting patient care decisions 8. How to teach the medical students and residents on the consultation team 9. How to present cases seen on the Inpatient Oncology service at case conferences
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Fellow Year 2+3:
Second and third year fellows rotate on Inpatient Oncology service 1‐2 months during the year. They
should be familiar with basic disease pathology and physiology. During their second and third years
fellows should now be focusing appropriate treatment strategies and management of acute toxicities
either from the disease or the therapies themselves.
Knowledge
At this level of training, fellows need to develop a deeper knowledge of the areas of listed below. They
should already be familiar with most diagnoses being evaluated. They will explore the recent literature
to deepen their level of understanding of interesting cases. Within the areas of knowledge fellows
should identify and actively pursue areas they do not know as well for improvement.
Skills
Fellows in the second and third years of fellowship must perfect their skills. The most important may be
for the senior fellow to function as a junior attending in many ways and be able to run service in an
independent manner, although still under the supervision of the attending on service. They should be
able to provide reasonable diagnostic and therapeutic plans in most consultations except in the most
complex cases.
Areas of Knowledge
Will be learned throughout the three years of fellowship.
Basic Principles of Oncology Diagnosis and Management
1. Basic science and pathogenesis of specific tumor type a. Risk factors
2. Epidemiology of specific tumor types a. Geographic variations b. Gender differences
3. Pathophysiology a. Understanding the molecular and evolving physiologic traits of specific tumor types
4. Introduction to chemotherapy a. Indications b. Pharmacokinetics c. Side effect profiles d. Drug interactions e. Contraindications f. Dose adjustments
5. Introduction to targeted/immunotherapy a. Indications b. Pharmacokinetics c. Side effect profiles d. Drug interactions
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e. Contraindications f. Dose adjustments
Major Clinical Syndromes
- Anal Carcinoma - Bladder Cancer
o Bladder Cancer o Upper Tract Tumors o Urothelial Carcinoma of the Prostate
- Bone Cancer o Chondrosarcoma o Ewing’s Sarcoma o Osteosarcoma
- Breast Cancer o Noninvasive o Invasive o Phyllodes Tumor o Paget’s Disease o Breast Cancer During Pregnancy o Inflammatory Breast Cancer
- Cancer of Unknown Primary - Central Nervous System Cancers
o Adult Low‐Grade Infiltrative Supratentorial Astrocytoma/Oligodendroglioma o Adult Intracranial Ependymoma o Anaplastic Gliomas/Glioblastoma o Limited (1‐3) Metastatic Lesions o Multiple (>3) Metastatic Lesions o Leptomeningeal Metastases o Primary CNS Lymphoma o Metastatic Spine Tumors o Meningiomas
- Cervical Cancer - Colorectal Carcinoma
o Colon Cancer o Rectal Cancer
- Esophageal Cancer - Gastric Cancer - Head and Neck Cancers
o Cancer of the Lip o Cancer of the Oral Cavity o Cancer of the Oropharynx o Cancer of the Hypopharynx o Cancer of the Nasopharynx o Cancer of the Glottic Larynx o Cancer of the Supraglottic Larynx o Ethmoid Sinus Tumors o Maxillary Sinus Tumors
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o Unresectable/Recurrent/Persistent Head and Neck Cancer o Occult Primary o Salivary Gland Tumors o Mucosal Melenoma
- Hepatobilliary Cancer o Hepatocellular Carcinoma o Gallbladder Cancer o Intrahepatic Cholangiocarcinoma o Extrahepatic Cholangiocarcinoma
- Kidney Cancer - Malignant Pleural Mesothelioma - Melanoma - Neuroendocrine Tumors
o Carcinoid Tumors o Islet Cell Tumors (Pancreatic Endocrine Tumors) o Neuroendocrine Unknown Primary o Adrenal Gland Tumors o Pheochromocytoma o Poorly Differentiated (High Grade or Anaplastic)/Small Cell o Multiple Endocrine Neoplasia, Type 1 o Multiple Endocrine Neoplasia, Type 2
- Non‐Melanoma Skin Cancers o Basal and Squamous Cell Skin Cancer o Dermatofibrosarcoma Protuberans o Merkel Cell Carcinoma
- Non‐Small Cell Lung Cancer - Ovarian Cancer
o Epithelial Ovarian Cancer o Borderline Epithelial Ovarian Cancer o Less Common Ovarian Histologies
- Pancreatic Adenocarcinoma - Prostate Cancer - Small Cell Lung Cancer
o Small Cell Lung Cancer o Lung Neuroendocrine Tumors
- Soft Tissue Sarcoma o Extremity o Retroperitoneal/Intra‐Abdominal o Gastrointestinal Stromal Tumors (GIST) o Desmoid Tumors
- Testicular Cancer - Thymic Malignancies - Thyroid Carcinoma
o Nodular Evaluation o Papillary Carcinoma o Follicular Carcinoma o Hurthle Cell Neoplasm o Medullary Carcinoma
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o Anaplastic Carcinoma - Uterine Neoplasms
o Endometrial Cancer o Uterine Sarcoma
Overview of the Rotation:
The Inpatient Oncology Service is a high pace clinical rotation. During the rotation, fellows work with an
attending, one resident, one intern and medical student(s). It is the responsibility of the fellow to
ensure that the team is appropriately managing the acute needs of the patients on service.
II. Core Competencies and Curriculum
Teaching Methods / Clinical Encounters
During this rotation, patients will be evaluated by medical students, residents and the fellow. It is the
responsibility of the fellow to engage the team with specific aspects of each patient as teaching topic.
Fellows will also direct the team in formulating an organized and appropriate plan of care for each
patient prior to final presentation to the attending. Each teaching topic will be supported by current
literature and clinical guidelines. Each member of the team (medical students, residents and fellow) will
also be responsible for 1 powerpoint presentation on an oncologic topic during the rotation. Each
presentation should be 20 minutes.
Patient Characteristics / Disease Mix
The patient mix is very broad on this service. Patients have newly diagnosed malignancies, currently
undergoing treatment, complications of therapy or have chronic issues related to their
cancer/treatment. Patients come from all ethnic and socioeconomic backgrounds.
Faculty Supervision
Fellow ability to clinically approach patient’s disease status will be judged by the supervising attending
physician during the rotation. The attending physicians will outline the goals of the rotation to the
fellows early during the rotation and provide feedback mid‐rotation and at the end of the rotation.
Importantly, they will report to the Program Director any significant problem that is identified so that
early corrective action can be implemented. They will complete a formal evaluation through the “New
Innovations” software in a timely manner once they receive a request via e‐mail.
Methods of evaluation
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At the end of the rotation, the attending physician will receive a “New Innovation” formal evaluation form by e‐mail and will complete this evaluation within a reasonable time. The New innovation evaluation form allows documentation of the fellow competency (competencies: patient care, medical knowledge, professionalism, and interpersonal and communication skills). The evaluation should be discussed with the fellow at the end of the rotation.
Fellows document milestones of their training: interesting cases, presentations, unusual or new situation faced on the service, etc. in their portfolios. They will also complete an attending evaluation trough New Innovations.
Medical students and residents rotating on the service complete an evaluation of the fellow’s teaching
abilities adapted from the ACGME toolbox.
Attitudes / Behaviors
Patient Care: fellows must provide patient care that is compassionate, appropriate, and effective for the treatment oncologic diseases. They must communicate effectively and demonstrate caring and respectful behaviors when interacting with patients; gather accurate information about their patient; advise diagnostic and therapeutic plans based on patient information, up‐to‐date scientific evidence, and clinical judgment; use information technology to support patient care decisions; work with health care professionals, including those from other disciplines, to provide patient‐focused care
Medical Knowledge: fellows must demonstrate knowledge about basic and clinical sciences in the area of oncology, and apply this knowledge to patient care.
Practice‐Based Learning and Improvement: fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. They must locate, appraise, and assimilate evidence from scientific studies related to their patients' disease; apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; use information technology to manage information, access on‐line medical information; and support their own education; facilitate the learning of students and other health care professionals
Interpersonal and Communication Skills: fellows must demonstrate interpersonal and communication skills that result in effective information exchange especially within the team and when acting as consultants to other physicians. They need work effectively with others as a member and leader of the oncology team.
Professionalism: fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. They must demonstrate respect, compassion, and integrity; a commitment to excellence and on‐going professional
49
development; a commitment to ethical principles; sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.
System‐Based Learning: fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. They are expected to practice cost‐effective health; advocate for quality patient care, and assist patients in dealing with system complexities.
Resources
NCCN.ORG
‐Website provides up to date guidelines for evaluation, staging, treatment and follow up
of all oncologic diseases
Chemoregimen.com
‐Provides various chemotherapies depending on patient’s diagnosis and stage of disease
ASCO.org
‐American Society of Clinical Oncology website
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Hematology & Oncology Consultation Services and Longitudinal Clinic
Jesse Brown VA Medical Center
I. Educational Goals (knowledge, skills, attitudes) The educational goals of the Hematology & Oncology rotations and outpatient clinic at the Jesse Brown VA Medical Center are to prepare fellows to act as qualified physicians to provide longitudinal care in the outpatient setting as well as consultants, specifically in the setting of a hematology‐oncology consultation service at a tertiary hospital.
Fellow Year 1:
First year fellows rotate on the Hematology & Oncology services usually for 3 to 4 months. Therefore, it
is expected that they will develop greater and greater knowledge and skills in the field of hematology
and oncology. Fellows need also adopt the right attitudes to make this rotation successful. In addition
to the inpatient rotations, first year fellows will be managing a diverse outpatient population in both
oncology and hematology diseases with 1 to 2 half day clinics per week at the VA Medical Center. The
outpatient clinic is not disease specific so this will also first year fellows to be exposed to a broad
diversity of hematology and oncology diseases early on in their training.
Knowledge
Hematology‐oncology consultants are mostly called upon for their expert knowledge in the broad and
complex field of hematology and oncology. “General hematology and oncology disease” includes a
broad spectrum of diagnoses. Fellows will also follow patients admitted from the longitudinal clinic as
inpatients to better understand the major complications of hematology and oncology diseases as well as
toxicities of treatment that require close supervision in an inpatient setting.
Fellows in the first year of their fellowship must acquire a lot of new knowledge in general hematology
and oncology. Because there is much to learn, this process takes time, and the depth of knowledge must
increase progressively. At every stage of their training, fellows need to challenge themselves by reading
further about patients they evaluate on the inpatient service and longitudinal clinic. They should actively
look for relevant articles about any unfamiliar situation. Progressively, they must develop expertise at
recognizing the major clinical syndromes and treatment options. Fellows must also learn how to
coordinate information and care between surgeons, radiation‐oncologists, and pathologists. During the
outpatient and inpatient experiences, fellows will also learn what toxicities to expect, how to prevent
them, and how to treat any that may arise from chemotherapy or the primary disease. In the
longitudinal clinic, patients will be followed for 6 to 12 months by a specific fellow from diagnosis
onwards to gain a better understanding of disease course, treatment options, and complications of
different diseases.
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More specifically, first year fellows need to learn about all the areas of knowledge listed below. Within
each area of knowledge, they should first learn the information most relevant to the care of their
patients. They should read regularly about their patients either from the Hoffman’s Textbook of
Hematology and Devita’s Textbook of Oncology(available on line, with regular updates) or from review
articles published frequently in either oncology journals (such as Journal of Clinical Oncology, Cancer,
and British Journal of Oncology), hematology journals (such as Blood, British Journal of Hematology,
Blood and Bone Marrow Transplantation), or core internal medicine journals (New England Journal of
Medicine, Annals of Internal Medicine, Archives of Internal Medicine, Journal of the American Medical
Association).
During the first year of their fellowship, fellows need to build their differential diagnosis trees in
hematology and oncology, initial workups required to stage a disease, and the most important
diagnostic and therapeutic approaches to common hematology and oncology diseases and clinical
situations. These include hematology problems such as coagulation disorders, cell count abnormalities
as well as more common oncology diagnoses such as lung cancer, colon cancer, and prostate cancer.
First year fellows will focus on the initial work up of new hematology and oncology diagnoses such as
staging, whom and when to treat based on disease and patient’s ECOG status, and when palliative care
or hospice is indicated.
As fellows become increasingly knowledgeable, they improve the quality of their teaching and
consultations. They also become more independent over time, although attending back‐up is available
24/7 and must be sought for any unfamiliar situation.
Skills
Fellows in the first year of their fellowship must acquire new skills in the field of hematology & oncology.
They are already familiar with these skills in the context of general internal medicine.
1. How to obtain a comprehensive history, perform a good physical exam, and focus the history and physical examination for each hematology or oncology disease syndrome
2. How to gather important data from the electronic medical records, looking for information on medications, laboratory data (including labs to monitor disease such as tumor markers, labs to follow toxicity from treatment such as renal and liver function, complete blood counts, and molecular biology results), imaging studies, and surgical findings of recent or relevant surgical procedures.
3. How to seek more information from other persons, including family members, outside hospitals who transferred the patient (primary or hematology‐oncology physicians, hematology and/or pathology laboratories), patient’s primary care physician, hospital physicians at UIC (primary team, surgeons about OR findings not documented fully in the record, other consultants about their opinions)
4. How to determine a patients performance status based on ECOG grading. 5. How to select appropriate tests to help with medical decisions
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6. How to use the relevant information to develop an assessment and diagnostic and therapeutic plan
7. How to interpret special laboratory tests, such as tumor markers, PCR tests, genetic studies, or biopsy results, paying attention to the positive and negative predictive values of these tests.
8. How to perform and interpret bone marrow aspirations and biopsies. 9. How to perform and interpret lumbar punctures to obtain CSF for analysis and to administer
intrathecal chemotherapy. 10. How to provide guidance on indications and types of red blood cell, platelet, and white blood
cell transfusions and for indications and quantity of phlebotomy to perform. 11. How to interpret blood bank reports to understand the safety and potential complications of
transfusion. 12. How to monitor responses to transfusions and know when and how to treat potential
complications of transfusion. 13. How to obtain and transport clinical specimens in an appropriate manner 14. How to offer phone advice that is relevant and to the point, while knowing when a curbside
consultation is not appropriate and a full consultation is required 15. How to lead the team of fellow, resident(s) and student(s) in order to be effective in completing
clinical tasks within a reasonable time 16. How to review the medical literature to gather evidence supporting patient care decisions 17. How to teach the medical students and residents on the consultation team 18. How to present cases seen on the hematology‐oncology service at case conferences 19. How to discuss end of life issues with patients and family members.
Fellow Year 2 & 3:
Second year fellows rotate on the hematology‐oncology consultation service usually for 1 to 2 months.
Typically, they are already familiar with many of the areas of knowledge and skills required for this
rotation. Still, they will emphasize further their supervision of the team (Team Leaders), and their
involvement with teaching residents and students (Clinical Teachers). Senior fellows should be seen as
role models by the more junior members of the team and consulting services.
Knowledge
At this level of training, fellows need to develop a deeper knowledge of the areas of listed below. They
should already be familiar with most diagnoses being evaluated. They will explore the recent literature
to deepen their level of understanding of interesting cares. Within the areas of knowledge, they will
select the areas they do not know as well for improvement. They will emphasize further hematology and
oncology diseases that are more complicated to treat such as leukemias as well as a better
understanding of the therapeutic options, what evidence is behind them, and creating more
complicated treatment plans required for advanced malignancies or when first line therapy fails.
Skills
Fellows in the second and third year of their fellowship must perfect their skills. The most important
may be for the senior fellow to function as a junior attending in many ways. They manage the
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consultation team in a more independent manner, although still under the supervision of the attending
on service. They should be capable of providing reasonable diagnostic and therapeutic plans in most
consultations except in the most complex cases. Second and third year fellows should also perfect their
skills for bone marrow aspiration and biopsies as well as lumbar punctures being familiar with the
different patient positioning for the procedures based on the patient’s clinical status. As fellows
progress through their second and third year, they will also learn how to use research skills to answer
unknown areas of hematology and oncology. This includes both clinical and laboratory research that are
available at the Jesse Brown VA Medical Center.
Areas of Knowledge
Fellows will learn about many of these areas of knowledge in hematology‐oncology during the three‐
year fellowship, but will need to supplement their knowledge by reading about areas of knowledge not
addressed during the training. Fellows review this list to identify any gap in their knowledge.
FYI first‐year fellow objective
FYII second‐year fellow objective
FYIII third‐year fellow objective
Overview of the Rotation:
The Hematology‐Oncology Consult Rotation is a high pace clinical rotation. During this rotation, fellows
work with an attending, one or more resident(s) and medical student(s) to offer consultations in
hematology and oncology diseases to guide the care of patients with hematology or oncology disorders.
The hematology‐oncology disease team takes care of very sick and very complex patients. Over the
course of the rotation, fellows see quite a significant number of new consultations and follow‐ups.
The outpatient clinic is also a very high pace rotation. The fellow follows his or her own clinic list, seeing
new patient consultations/referrals, creating differential diagnoses and appropriate work up testing, an
devising a treatment plan with the approval of the 1‐2 attendings supervising the clinic. The fellow also
learns how to coordinate the care plan with the hematology‐oncology nurses and pharmacist in both the
outpatient and inpatient setting.
II. Core Competencies and Curriculum
Teaching Methods / Clinical Encounters
During this rotation, fellows evaluate outpatients and inpatients referred to the hematology‐oncology
consultation service and also follow hematology or oncology patients admitted from the longitudinal
clinic. This consultation services deal with all patients in the Jesse Brown Medical Center. Patients are
first evaluated by one medical student, resident, or fellow, then discussed when possible with the
fellow, and finally presented formally to the attending and the rest of the team. Prior to the
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presentation, whenever a case is difficult, unusual, or challenging, fellows and residents will locate and
print an article that addresses the problem being evaluated. Pathology specimen and peripheral blood
smears should be reviewed with the pathologist and heme‐pathologist, respectively, either prior to the
presentation or as a team during rounds.
This rotation values and emphasizes teaching. Frequently, every person on the team participates in
teaching: attendings, fellows, residents, and medical students. Students, residents, and fellows present
cases at conferences, usually presenting their own patients. Students who review the literature about
one of their patients may present a short summary to the group. Students interested in hematology‐
oncology may chose to review a particular hematology or oncology disease or chemotherapy agent and
present a short summary to the group. Fellows teach during short lectures to the team usually when the
attending is not present, for example on hematology or oncology diseases commonly seen on the
general medicine service. Attendings teach both during sitting rounds (presentation of new
consultations and follow‐up problems) and during walking rounds (at the bedside). They also present
“mini‐lectures” usually on chemotherapy or common hematology or oncology diseases, and more
formal lectures on the topic of their choice. Frequently, the fellow or one member of the team will
request a specific topic. Abnormal or difficult cases will be presented at multi‐disciplinary conferences
(e.g. lung diseases at the chest tumor board conference, head and neck cancer cases at the weekly head
and neck conference, and hematology diseases at heme‐pathology conference). Fellows or residents
present the case with the attending available for guidance and the fellow and residents learn how to
formulate treatment plans with a team of physicians from different backgrounds.
Patient Characteristics / Disease Mix
Being at a Veteran’s Hospital, the majority of patients seen are male. Thus cases seen in high
frequencies in men will be most studied. This offers a unique opportunity because whenever there are
high frequencies of specific diseases, then broad presentations arise of those diseases. Patients will
present with a wide spectrum of stages of disease, complications or severity of that disease, and the
different treatment options and success rates. There is also a wide age range of patients so both
hematology and oncology diseases of the young and elderly adults will be seen and treated. The degree
of illness severity is variable. Many patients are evaluated in one of the intensive care units: medical ICU,
surgical ICU, and neurosurgical ICU. Others are evaluated on the wards within the medical, surgical, or
psychiatry areas. Many new diagnoses of malignancies will be made in the hospital and the proper
differential diagnosis, workup and staging will be managed by the hematology‐oncology service. The
consultation service also evaluates many patients with coagulation disorders or blood cell count
abnormalities seen on laboratory testing.
A unique opportunity at the Jesse Brown VA Medical Center is that there is a palliative/hospice service
available which allows fellows to learn when it is appropriate to start end‐of life and comfort care, how
to coordinate care with palliative/hospice nurses, and the setting where this kind of care can be
provided. Social work teams are also available to help patients’ with their home needs as per the
severity of their disease or complications of therapy.
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A heme‐pathologist is available throughout the day so that bone marrow and peripheral blood smear
specimens can be reviewed with teaching points from an expert. There is also a centralized computer
system and radiograph system allowing unique opportunities for research in better understanding
diseases.
Procedures and Skills
Procedures specific to the hematology‐oncology subspecialty include bone marrow aspirations and
core biopsy and lumbar punctures with intrathecal chemotherapy administration. These procedures
are performed during the inpatient consultation rotation.
The diagnostic and therapeutic procedures required for Hematology‐Oncology are:
1. Performance and interpretation of peripheral blood smears: Determining cell counts and morphologies of red blood cells, platelets, and white blood cells. This will be evaluated by the supervising attending during Consult rounds as well as in consultation with a heme‐pathologist.
2. Bone marrow aspiration and core biopsy. 3. Interpretation of bone marrow aspiration and core biopsy slides. This will be evaluated by the
supervising attending during Consult rounds as well as in consultation with a heme‐pathologist. 4. Interpretation of special testing on pathology specimens including genetic and molecular
studies. 5. Institution of chemotherapy. 6. Monitoring response to chemotherapy
Hematology‐Oncology consultants also frequently recommend the performance of invasive procedures
to help with diagnosing or monitoring disease. Therefore, attending physicians will advise that the
trainees properly explain any invasive procedures performed to the patient, discuss the possible risks
and discomforts of the procedure, and obtain informed consent.
Additional procedural skills will be determined by the trainee’s personal preference and practice
expectations.
Faculty Supervision
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Fellow ability to clinically approach hematology and oncology disease syndromes will be judged by the
supervising attending physician during the clinic and inpatient consult rotation. The attending
physicians will outline the goals of the rotation to the fellows early during the rotation and provide
feedback mid‐rotation and at the end of the rotation. Importantly, they will report to the Program
Director any significant problem that is identified so that early corrective action can be implemented.
They will complete a formal evaluation through the “New Innovations” software in a timely manner
once they receive a request via e‐mail.
Methods of evaluation
At the end of the rotation, the attending physician will receive a “New Innovation” formal evaluation form by e‐mail and will complete this evaluation within a reasonable time. The New innovation evaluation form allows documentation of the fellow competency (competencies: patient care, medical knowledge, professionalism, and interpersonal and communication skills). The evaluation should be discussed with the fellow at the end of the rotation.
Fellows document milestones of their training: interesting cases, presentations, unusual or new situation faced on the service, etc. in their portfolios. They will also complete an attending evaluation through New Innovations.
Medical students and residents rotating on the service complete an evaluation of the fellow’s teaching abilities adapted from the ACGME toolbox.
Attitudes / Behaviors
Patient Care: fellows must provide patient care that is compassionate, appropriate, and effective for the treatment, monitoring of, and prevention of hematology‐oncology diseases. They must communicate effectively and demonstrate caring and respectful behaviors when interacting with patients; gather accurate information about their patient; advise diagnostic and therapeutic plans based on patient information, up‐to‐date scientific evidence, and clinical judgment; use information technology to support patient care decisions; work with health care professionals, including those from other disciplines, to provide patient‐focused care
Medical Knowledge: fellows must demonstrate knowledge about basic and clinical sciences in the areas of hematology and oncology diseases, and apply this knowledge to patient care.
Practice‐Based Learning and Improvement: fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. They must locate, appraise, and assimilate evidence from scientific studies related to their patients’ disease; apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; use information technology
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to manage information, access on‐line medical information; and support their own education; facilitate the learning of students and other health care professionals
Interpersonal and Communication Skills: fellows must demonstrate interpersonal and communication skills that result in effective information exchange especially within the team and when acting as consultants to other physicians. They need work effectively with others as a member and leader of the hematology‐oncology consultation team.
Professionalism: fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. They must demonstrate respect, compassion, and integrity; a commitment to excellence and on‐going professional development; a commitment to ethical principles; sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
System‐Based Learning: fellows must demonstrate an awareness of and responsiveness to the
larger context and system of health care and the ability to effectively call on system resources to provide
care that is of optimal value. They are expected to practice cost‐effective health; advocate for quality
patient care, and assist patients in dealing with system complexities
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General Hematology and Oncology Service MacNeal Hospital Rotation/ UIC Cancer Center at MacNeal
Description of the Rotation During the fellowship, fellows will rotate at MacNeal Hospital for an average of 4 weeks per year of fellowship. This rotation provides fellows the opportunity to practice hematology‐oncology in an urban community teaching hospital. Patients at MacNeal are frequently non‐English speaking, minorities, undocumented, and lack formal health insurance (diverse ethnic and cultural backgrounds). Fellows will perform inpatient consultations on both hematology (benign and malignant) and oncology topics on patients from all services (medical, surgical, Rehab, psychiatry, OB, etc). Fellows will participate in weekly Tuesday tumor board and be responsible for teaching of the house staff. Fellows are expected to participate in the clinics. Educational Goals (knowledge, skills, attitudes) The educational goals of the General Hematology and Oncology rotation at MacNeal Hospital are to: ‐ to provide clinical training experiences in Hematology in the context of a community hospital environment with an ethnically diverse referral population. ‐ to provide clinical training experiences in Medical Oncology in the context of a community hospital environment with an ethnically diverse referral population. ‐ to provide training experiences in the conduct of clinical research in the context of a community hospital environment with an ethnically diverse referral population. ‐to enhance systems based learning in the context of a community hospital with a preponderance of managed care patients. ‐to sensitize trainees to the special needs and concerns of patients from diverse ethnic and cultural backgrounds. Patient Characteristics / Disease Mix The rotation at MacNeal Hospital will provide fellows with exposure to a wide variety of hematology/oncology patients in the setting of community hospital. This rotation provides a diverse and intensive outpatient and inpatient experience. It will allow fellows to provide primary care to patients and to participate in clinical research efforts in the community setting. The strength of the MacNeal Hospital rotation is that it focuses on community which has a diverse ethnic and cultural backgrounds. The Hematology/Oncology practice sees a variety of tumors and hematological conditions. Rotation Fellows rotate at MacNeal service for 1 month/year. Therefore, it is expected that they will develop greater and greater knowledge and skills in the field of general Hematology and Oncology. Faculty Fellows will be supervised by UIC Faculty at MacNeal. The currently faculty include Sandeep Chunduri, MD (Medical Director/Fellowship director at MacNeal) and John Berry, MD The attending physicians will outline the goals of the rotation to the fellows early during the rotation and provide feedback mid‐rotation and at the end of the rotation.
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Evaluation At the end of the rotation, the attending physician will receive a “New Innovation” formal evaluation form by e‐mail and will complete this evaluation within a reasonable time. The New innovation evaluation form allows documentation of the fellow competency (competencies: patient care, medical knowledge, professionalism, and interpersonal and communication skills). The evaluation should be discussed with the fellow at the end of the rotation. Miscellaneous
Call: The fellow will take call daily (Monday thru Friday) from 8 AM until 5:00 PM. This will include all hospital calls (consults, nursing questions). Overnight call (5:00 PM until 8:00 AM will be handled by either Dr. Chunduri or Dr. Berry. Weekend call will be decided on the start of the rotation between the fellows and the individual attendings.
Pager Numbers: Dr. Berry 708‐324‐0242; Dr. Chunduri 708‐324‐0734. The fellow will have a MacNeal pager which will be shared amongst the fellows
Office Location: 6801 West 34th Street, Berwyn 60402; 708‐484‐8400
Outpatient: Both Drs. Chunduri and Berry generally see patients every day. Usually the fellow makes sure the new consults and follow up inpatients are evaluated and then proceeds to clinic. Clinics generally start at 8:30‐8:40 AM. Fellows will maintain their continuity clinic at the Jesse Brown VA while rotating at MacNeal. The fellow will be excused to attend two ½ day continuity clinics at UIC or the VA. For the remainder of the day the fellow shall report to MacNeal Hospital/UIC Cancer Center. Fellows who have 3 clinics a week will be assigned coverage for one of those while rotating at MacNeal.
ID Cards: You must obtain an ID card that is issued by MacNeal. MacNeal GME will help you with this.
Parking: Your MacNeal ID will allow you to get into the parking structure. Again, the GME will help with this.
Medical Records: The outpatient clinic uses Cerner. All documentation must be in the chart within 24 hours (this is different than the main campus). MacNeal Hospital also used an EMR for labs and radiology reports. Currently, charts are being utilized for inpatient notes and consultations.
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General Hematology and Oncology Service Mercy Hospital Rotation
I. Educational Goals (knowledge, skills, attitudes) The educational goals of the General Hematology and Oncology rotation at Mercy hospital are to (i) develop fellow’s skills in the area of comprehensive care of cancer patients and in the diagnosis and management of hematological disorders in both in‐patient and outpatient settings at a tertiary community hospital. (ii) Train fellows in the specifics of hematopathology, radiation oncology, blood banking and gynecology oncology. Teaching Methods / Clinical Encounters During this rotation, fellows evaluate inpatients referred to the hematology and oncology consultation service and patients admitted to hematology and oncology service. Patients are first evaluated by one medical student, resident, or fellow, then discussed when possible with the fellow, and finally presented formally to the attending and the rest of the team. Prior to the presentation, whenever a case is difficult, unusual, or challenging, fellows and residents will locate and print an article that addresses the problem being evaluated. This rotation values and emphasizes teaching. Frequently, every person on the team participates in teaching: attendings, fellows, residents, and medical students. Students, residents, and fellows present cases at conferences, usually presenting their own patients. Students who review the literature about one of their patients may present a short summary to the group. Students interested in infectious diseases may chose to review an antibiotic or antibiotic group and present a short summary to the group. Fellows teach during short lectures to the team usually when the attending is not present, for example on infections commonly seen on the general medicine service. Attendings teach both during sitting rounds (presentation of new consultations and follow‐up problems) and during walking rounds (at the bedside). They also present “mini‐lectures” usually on antibiotics or common infections, and more formal lectures on the topic of their choice. Frequently, the fellow or one member of the team will request a specific topic. Patient Characteristics / Disease Mix The rotation at Mercy Hospital will provide fellows with exposure to a wide variety of hematology/oncology patients in the setting of a busy inner city, community hospital. This rotation provides a diverse and intensive inpatient and outpatient experience. It will allow fellows to provide primary care to patients and to participate in clinical research efforts in the community setting. Fellows are encouraged to concentrate on a specialized are of hematology or oncology. The strength of the Mercy Hospital rotation is that it focuses on community teaching and the patient population comprises of the surrounding ethnic groups. The Hematology/Oncology practice sees a variety of tumors and hematological conditions. A limitation of the program is the amount of BMT transplant conducted at the Mercy site. The base program (UIC) will provide the BMT transplants to patients seen at Mercy Hospital.
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Fellow Year 1: First year fellows rotate on the Mercy hospital service for 1 month. Therefore, it is expected that they will develop greater and greater knowledge and skills in the field of general Hematology and Oncology. Fellows need also adopt the right attitudes to make this rotation successful. Knowledge Hematology and Oncology consultants are mostly called upon for their expert knowledge in the broad and complex field of Hematology and Oncology. “General Hematology and Oncology” includes a broad spectrum of hematology and oncology conditions in both inpatient and outpatient settings. Fellows in the first year of their fellowship must acquire a lot of new knowledge in general hematology and oncology, during their Mercy rotation. Because there is much to learn, this process takes time, and the depth of knowledge must increase progressively. At every stage of their training, fellows need to challenge themselves by reading further about patients they evaluate on the service. They should actively look for relevant articles about any unfamiliar situation. Progressively, they must develop expertise at recognizing the major clinical syndromes, use anti‐neoplastic therapy effectively, and learn about the major pathology in some details. More specifically, first year fellows need to learn about all the areas of knowledge listed below. Within each area of knowledge, they should first learn the information most relevant to the care of their patients. They should read regularly about their patients either from the DeVita Principles and Practice of Oncology (available on line, with regular updates) or from review articles published frequently in hematology and oncology journals (such as Journal of Clinical Oncology, Blood) or core internal medicine journals (New England Journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, Journal of the American Medical Association). As fellows become increasingly knowledgeable, they improve the quality of their teaching and consultations. They also become more independent over time, although attending back‐up is available 24/7 and must be sought for any unfamiliar situation.
Educational Objectives:
1. Learn diagnostic and therapeutic approaches to new and complex patients with hematologic
malignancies
2. Learn diagnostic and therapeutic approaches to new and complex patients with breast cancer
3. Learn diagnostic and therapeutic approaches to new and complex patients with lung cancer,
mesothelioma or other thoracic malignancies.
4. Learn diagnostic and therapeutic approaches to new and complex patients with genitourinary
malignancies
5. Learn diagnostic and therapeutic approaches to new and complex patients with gastrointestinal
malignancies
6. Learn diagnostic and therapeutic approaches to new and complex patients with head and neck
malignancies
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7. Learn diagnostic and therapeutic approaches to new and complex patients with brain, spinal
cord, and other rare neurologic malignancies and CNS metastatic disease
8. Learn diagnostic and therapeutic approaches to new and complex patients with gynecologic
malignancies
9. Learn diagnostic and therapeutic approaches to new and complex patients with bone and soft
tissue sarcomas
10. Pathology and Radiology correlations
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Hematology/Oncology Consults Rotation
Mount Sinai Hospital
Description of the Rotation: During the fellowship, fellows will rotate at Mount Sinai Hospital for an
average of 4 weeks per year of fellowship. This rotation provides fellows the opportunity to practice
hematology‐oncology in an true urban community hospital which has a very different patient population
that that seen at UIC, the VA, or Mercy Hospital. Patients at Mt. Sinai are frequently non‐English
speaking, minorities, undocumented, and lack formal health insurance. Fellows will perform inpatient
consultations on both hematology (benign and malignant) and oncology topics on patients from all
services (medical, surgical, Rehab, psychiatry, OB, ect). Fellows will participate in Mt. Sinai’s weekly
Thursday tumor board and be responsible for teaching the Mt. Sinai housestaff. When time allows,
fellows will also help out in the daily outpatient hematology oncology clinic.
I. Educational Goals (knowledge, skills) The educational goals of the Mt Sinai rotation are to prepare fellows to act as qualified consultants in the sub‐specialty, specifically in the setting of a general hematology oncology consultation service at an urban community hospital.
A. Fellow Year I: First year fellows rotate on the Mt Sinai service usually after they have had at least 4‐5 months of rotations at UIC and the VA. It is expected they will already have some knowledge of basic heme onc and how to approach a consultation and be moderately comfortable performing bone marrow aspiration and biopsies by the time they start here at Mt Sinai. Fellows need also adopt the right attitudes to make this rotation successful.
1. Knowledge: while the spectrum of conditions seen at Mt. Sinai is wide and varied, the majority of consults will be new diagnoses of solid tumors, the continued care of patients with an established malignancy, anemia, thrombocytopenia, DVT/PE/other thrombotic events. First year fellows will be expected to read about all cases they are following to build their knowledge base. They should become familiar with the presenting signs and symptoms of various hematologic/oncologic disorders. They should be able to recognize a heme onc emergency and take the necessary immediate actions for good clinical care of the patient. They should be able to assemble all the clinical information on the patient and pose a potential “next best step” in either management or diagnosis to the attending. They should be able to write chemotherapy orders with some supervision. They should be familiar with the staging and prognosis of various malignancies and know the optimal first line therapies for common tumor types.
First year fellows will cover the general UIC heme onc fellowship knowledge objectives (listed below) as theses specific topics arise on the Mt. Sinai consultation service, with emphasis on breast, lung, prostate, colorectal, head and neck cancers and lymphomas. The first year fellow should be moderately comfortable with the following knowledge objectives by the end of the rotation.
UIC heme onc fellowship knowledge objectives:
1. Morphology, physiology, and biochemistry of blood, marrow, lymphatic tissue, and the spleen
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2. Basic molecular and pathophysiologic mechanisms, diagnosis, and therapy of diseases of the blood, including anemias, diseases of white cells, and disorders of hemostasis and thrombosis
3. Etiology, epidemiology, natural history, diagnosis, pathology, staging, and management of neoplastic disorders
4. Immune markers, immunophenotyping, cytochemical studies, and cytogenetic and DNA analysis of neoplastic disorders
5. Molecular mechanisms of neoplasia, including the nature of oncogenes and their products 6. Chemotherapeutic drugs, biologic products, and growth factors and their mechanisms of action,
pharmacokinetics, clinical indications, and limitations, including their effects, toxicity, and interactions
7. Multiagent chemotherapy protocols and combined modality therapy in the treatment of neoplastic disorders
8. Principles and application of surgery and radiation therapy in the treatment of neoplastic disorders
9. Management of the neutropenic and/or immunocompromised patient 10. Effects of systemic disorders, infections, solid tumors, and drugs on the blood, blood‐forming
organs, and lymphatic tissues 11. Indications and application of imaging techniques in patients with blood and neoplastic
disorders 12. Pathophysiology and patterns of solid tumor metastases 13. Principles of gynecologic oncology 14. Pain management in the cancer patient 15. Rehabilitation and psychosocial management of patients with hematologic and neoplastic
disorders 16. Hospice and home care for the cancer patient 17. Recognition and management of paraneoplastic disorders 18. The etiology of cancer, including predisposing causal factors leading to neoplasia 19. Cancer prevention and screening 20. Leading an active multidisciplinary tumor board 21. Personal development, attitudes, and coping skills of physicians and other health‐care
professionals who care for critically ill patients 22. Human immunodeficiency virus‐related and other immunodeficient states associated
malignancies 23. Management of chemotherapy related toxicities including nausea and vomiting, neuropathy,
and fatigue
2. Skills: It is expected that 1st year fellows already be moderately comfortable with bone marrow aspiration and biopsy procedures by the time they rotate at Mt. Sinai. Other general UIC heme onc fellowship core skills (listed below) will be covered as these procedures arise on the Mt. Sinai consultation service. The first year fellow should be moderately comfortable with the following skills by the end of the rotation.
UIC heme onc fellowship skill set:
1. Bone marrow aspiration and biopsy, including preparation, staining, examination, and interpretation of blood smears, bone marrow aspirates, and touch preparations and interpretation of bone marrow biopsies.
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2. Measurement of the complete blood count, including platelets and white cell differential, using automated or manual techniques with appropriate quality control.
3. Administration of chemotherapeutic agents and biological response modifiers through all therapeutic routes.
4. Management and care of indwelling venous access catheters. 5. Therapeutic phlebotomy 6. Therapeutic thoracentesis and paracentesis 7. Serial measurement of palpable tumor masses 8. Lumbar puncture and administration of intrathecal chemotherapy
B. Fellow Year II: Second year fellows rotate on the Mt Sinai service for 4‐6 weeks. As they have completed at least one year of training in heme onc, it is expected that they now have a greater knowledge and skill set than year 1.
1. Knowledge: Second year fellows will be expected to know the evidence behind major therapeutic interventions for the common tumor types seen at Mt Sinai (i.e. breast, lung, colorectal, head and neck, and lymphoma). They will be expected to present at tumor board and give lectures to the housestaff on various topics in heme onc when asked. They should be able to propose a management plan for the patient independent of discussion with the attending. They should be able to write chemotherapy orders with minimal supervision or edits by the attending. They should be comfortable discussing end of life issues with patients and their families. They should become familiar with rarer tumor types and clinical scenarios (i.e. neuroendocrine tumor, acute leukemia, sarcomas). They should be familiar with the treatment of relapsed/refractory malignancies and identify patients appropriate for clinical trial.
Second year fellows will cover the general UIC heme onc fellowship knowledge objectives (listed above) as theses specific topics arise on the Mt. Sinai consultation service, with emphasis on breast, lung, prostate, colorectal, head and neck cancers and lymphomas. The first year fellow should be very comfortable with the above knowledge objectives by the end of the rotation.
2. Skills: It is expected that 2nd year fellows be very comfortable with bone marrow aspiration and biopsy procedures by the time they rotate at Mt. Sinai. They should also be moderately comfortable with lumbar puncture and the administration of intrathecal chemotherapy. Other general UIC heme onc fellowship core skills (listed above) will be covered as these procedures arise on the Mt. Sinai consultation service. The second year fellow should be very comfortable with the above skills by the end of the rotation.
C. Fellow Year III: Third year fellows rotate on the Mt Sinai service for 4 weeks. As they have completed at least two years of training in heme onc, it is expected that they are very knowledgeable in the diagnosis and management of a patient with malignancy.
1. Knowledge: They will be expected to take on a greater teaching role to housestaff and be able to supervise procedures. They will be able to implement a management plan that follows the standard of care and practice evidence based medicine with minimal supervision
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from the attending. They will be able to write chemotherapy orders that are error free. They should have an even more extensive knowledge of rarer tumor types and treatment of relapsed/refractory malignancies. They should be able to perform as a heme onc consultant almost completely independently from the attending.
Third year fellows will cover the general UIC heme onc fellowship knowledge objectives (listed above) as theses specific topics arise on the Mt. Sinai consultation service, with emphasis on breast, lung, prostate, colorectal, head and neck cancers and lymphomas. The first year fellow should be proficient with the above knowledge objectives by the end of the rotation.
2. Skills: It is expected that 3nd year fellows be proficient with bone marrow aspiration and biopsy procedures by the time they rotate at Mt. Sinai. They should also be very comfortable with lumbar puncture and the administration of intrathecal chemotherapy. They should be able to instruct and supervise housestaff in the performance of these procedures successfully. Other general UIC heme onc fellowship core skills (listed above) will be covered as these procedures arise on the Mt. Sinai consultation service. The third year fellow should be proficient with the following skills by the end of the rotation.
II. Core Competencies and Curriculum
A. Teaching Methods / Clinical Encounters:
At Mt Sinai, fellows will evaluate patients referred to the hematology oncology consultation service with a wide variety of benign hematology, malignant hematology, and solid tumor cases. There will be 1‐2 Mt. Sinai residents also on the service who will help the fellow see consults. The fellow will see consults independent of the resident if it is very busy and the resident will discuss cases he/she sees with the fellow before attending rounds. Prior to the presentation, whenever a case is difficult, unusual, or challenging, fellows and residents will locate and print an article that addresses the problem being evaluated.
Rounds are conducted with the attending on service at the bedside and teaching can occur at the bedside on PM rounds or during the day in clinic. Fellows will usually be asked to present at tumor board at least once during their 4 week rotation and may be asked to give a noon conference on a topic in heme onc to the Mt. Sinai Internal Medicine residents.
B. Patient Characteristics / Disease Mix:
The large advantage and unique aspect the Mt Sinai rotation brings to the UIC hematology oncology fellowship is the patient mix. Most patients are Hispanic, African American, or another minority. Many are non‐English speaking, undocumented, have no formal health insurance, and lack familial and social support. Some may be homeless. Providing quality cancer care to this marginalized group of patients is the mission of Mt. Sinai; here fellows learn how to provide excellent care to people despite their race or socioeconomic status. Given their lack of access of healthcare and screening, many patients seen here have much more advanced disease than seen at UIC or other sites fellows rotate at. Fellows will learn how to communicate with patients about sensitive issues such as the diagnosis of cancer, end of life issues, pain control, keeping in mind their cultural and educational barriers to understanding.
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C. Procedures/Skills: As listed above, the UIC Hematology/Oncology Fellowship Program provides the opportunity to gain competence or expertise in the performance and (where applicable) interpretation of the following:
1. Bone marrow aspiration and biopsy, including preparation, staining, examination, and interpretation of blood smears, bone marrow aspirates, and touch preparations and interpretation of bone marrow biopsies.
2. Measurement of the complete blood count, including platelets and white cell differential, using automated or manual techniques with appropriate quality control.
3. Administration of chemotherapeutic agents and biological response modifiers through all therapeutic routes.
4. Management and care of indwelling venous access catheters. 5. Therapeutic phlebotomy 6. Therapeutic thoracentesis and paracentesis 7. Serial measurement of palpable tumor masses 8. Lumbar puncture and administration of intrathecal chemotherapy
Heme onc fellows will be expected to be able to explain to patient undergoing any procedure the risks and benefits, alternatives to procedures, reason for performance of procedure, and to obtain informed consent for any invasive procedure including the administration of oral or intravenous chemotherapy.
D. Faculty Supervision Fellows will be supervised by Mt. Sinai heme onc attending Dr. Pam Khosla (section chief) and Dr. Keith Schulman. The attending physicians will outline the goals of the rotation to the fellows early during the rotation and provide feedback mid‐rotation and at the end of the rotation. Importantly, they will report to the Program Director any significant problem that is identified so that early corrective action can be implemented. They will complete a formal evaluation through the “New Innovations” software in a timely manner once they receive a request via e‐mail.
E. Methods of evaluation At the end of the rotation, the attending physician will receive a “New Innovation” formal evaluation form by e‐mail and will complete this evaluation within a reasonable time. The New innovation evaluation form allows documentation of the fellow competency (competencies: patient care, medical knowledge, professionalism, and interpersonal and communication skills). The evaluation should be discussed with the fellow at the end of the rotation.
Fellows will also complete an attending evaluation trough New Innovations. Fellows should ask residents or students who have rotated with them at Mt Sinai for feedback as well, especially in regards to their teaching abilities.
F. Attitudes / Behaviors
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Patient Care: fellows must provide patient care that is compassionate, appropriate, and effective for the treatment and the prevention of hematologic diseases and malignacies. They must communicate effectively and demonstrate caring and respectful behaviors when interacting with patients; gather accurate information about their patient; advise diagnostic and therapeutic plans based on patient information, up‐to‐date scientific evidence, and clinical judgment; use information technology to support patient care decisions; provide immunization advice and counseling about preventing the spread and acquisition of infectious diseases; work with health care professionals, including those from other disciplines, to provide patient‐focused care. Given the patient population at Mt. Sinai, fellows must be even more sensitive to barriers to knowledge or understanding i.e. education level or language barriers. Fellows should make every effort to use an official interpreter every time they encounter a non‐English speaking patient, including but not limited to taking the history, discussing diagnoses, therapies, procedures. Fellows should make sure non‐English speaking patients have information/resources in the patient’s native language available on various malignant conditions and chemotherapy drugs that will be given.
Medical Knowledge: fellows must demonstrate knowledge about basic and clinical sciences in the area of hematology oncology, and apply this knowledge to patient care.
Practice‐Based Learning and Improvement: fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. They must locate, appraise, and assimilate evidence from scientific studies related to their patients’ diagnosis; apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; use information technology to manage information, access on‐line medical information; and support their own education; facilitate the learning of students and other health care professionals.
Interpersonal and Communication Skills: fellows must demonstrate interpersonal and communication skills that result in effective information exchange especially within the team and when acting as consultants to other physicians. They need work effectively with others as a member and leader of the infectious disease consultation team.
Professionalism: fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. They must demonstrate respect, compassion, and integrity; a commitment to excellence and on‐going professional development; a commitment to ethical principles; sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.
System‐Based Learning: fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. They are expected to practice cost‐effective health; advocate for quality patient care, and assist patients in dealing with system complexities. At Mt Sinai, fellows will learn the obstacles and solutions to deliver quality cancer care to uninsured patients.
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G. Resources 1. Education Books: Each year ASH and ASCO publish review articles prepared by the
chairs of the Education sessions at the annual meetings of the societies. The ASH Education book, Hematology is referenced in PubMed. Links are available on the Societies’ website.
2. ASH‐SAP: Provided by ASH to all first year fellows, and when new editions are published a copy is provided to all current fellows. Available online for free to all fellows in UIC’s heme onc program 2010‐2011 (the program has signed each fellow up for this online access). This is an excellent review material as well as a source for an excellent annotated bibliography in hematology.
3. ASCO‐SEP: Medical Oncology Self‐Assessment Program, available for purchase.
4. Textbook: Hoffman‐ Hematology‐ Basic Principles and Practices
5. Textbook: Abeloff’s Clinical Oncology: available in UIC outpatient clinic.
6. Useful websites: The American Society of Hematology and the American Society of
Clinical Oncology maintain websites that address educational needs and pertinent curricular issues for trainees in Hematology and Medical Oncology. Both sites provide a detailed curriculum and prioritized reading list.
7. www.nccn.org
The National Cancer Center Network provides an extensive and frequently updated set of evidence‐based guidelines for the management of wide variety of human malignancies. National Cancer Institute provides general information related to cancer. This range of information includes patient care guidelines for the common tumors, basic biology of tumorigenesis, update of current trials, and research funding opportunities
8. www.chemoregimen.com
List of common chemotherapy regimens for wide variety of tumors with references
9. https://hccapps.musc.edu/hemonc/carboplatin_dose_calculator.htm Carboplatin dose calculator
10. www.adjuvantonline.com The purpose of Adjuvant! is to help health professionals and patients with early cancer discuss the risks and benefits of getting additional therapy (adjuvant therapy: usually chemotherapy, hormone therapy, or both) after surgery.
H. Conferences at Mt. Sinai: may change periodically, check with the attendings when you start the rotation. Fellows are expected to attend or participate in the following educational experiences.
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1. Tumor Board Thursday: Noon‐1pm 2. Medicine Resident, heme onc Lecture 3rd Tuesday: Noon‐1pm 3. Visiting Lecture Mon or Tues, once a month 4. Multidisciplinary Lung Cancer Conference 3rd Monday: 1‐1:30pm
I. Nuts and Bolts of Mt. Sinai Rotation
Location: Mount Sinai
Duration: 4 to 6 weeks per year, fellows are expected to arrive at 8:30am
Call: The fellow assigned to this rotation is on first call Monday‐Friday and rounds one day of the
weekend (either Sat or Sun, depending on which day the on service attending wants off). Dr. Khosla
generally prefers to have the fellow round Sat and she rounds Sun. Dr. Hire generally prefers to round
on Sat and have the fellow round Sun. This should be confirmed with them at the beginning of the
rotation.
Hospital floors: Main floor: ER, cafeteria 2nd floor SICU, Surg stepdown; surgical and gyn patients on 2N 3rd Floor Gen Med pts; radiology 4th Floor Peds, L&D 5th Floor Telemetry,Gen Med, Mother/Baby 6th Floor Gen Med, Oncology pts (in‐pt chemo only on 6N); Psych 8th Floor MICU/CCU; Heme lab 9th Floor Internal medicine offices Attendings: Dr. Pam Khosla MSH pager 1699 Dr. Erwin Hire MSH pager 1251
Dr. Keith Schulman
Description
The fellow, together with the medical resident (and medical student if present), will be responsible for
all new consults and follow‐up patients on the service. It is desirable that the fellow provide team
leadership, direction, and teaching to the junior team members. The rotation at Mt. Sinai Hospital will
provide fellows with exposure to a wide variety of hematology/oncology patients in the setting of a busy
inner city community hospital. This rotation provides a varied and intensive inpatient and outpatient
experience and will allow the fellow to provide care to these patients.
The fellow works with the Mt Sinai resident/s, and medical students. Patients are either consults (fill out
consult sheets found in the fellow’s office/on the patient’s floor) or clinic patients of the attendings
(followed by medicine residents in house, but a note needs to be written on them by the heme onc
consult team every day, even on weekends). Daily notes are written on the consult patients and rounds
are done daily with the attending. There is no inpatient oncology service. Consults are called to the
fellow or Attending by Medicine office (x6552), or by the floor team. Use a consult sheet to record the
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H&P. All charting at Sinai is paper. Labs, reports, and dictated consults appear on a computerized
system, Meditech. Orders have recently been made electronic through Meditech and need to be
entered by the primary service or you can ask the Sinai resident rotating with you to enter orders.
Occasionally you will have a consult at Schwab Rehabilitation center, which is across the street from the
hospital.
The average inpatient load for the team is 10‐15 patients, and 15‐20 patients in the outpatient clinic.
Case and Pathology Mix:
Inpatient‐ 30%
Outpatient‐ 70%
Solid Tumors‐70%
Liquid Tumors ‐10%
Benign Hematology‐ 20%
Fellows are expected to participate in the Mt. Sinai clinics. Both Drs. Khosla and Hire generally see clinic
patients every day and see new consults with you and the team in between their outpatients or after
clinic. Check with the attending on service how they want you to split your time between the in‐ and
outpatients. Usually the fellow makes sure the new consults and follow up inpatients are taken care of,
then goes to clinic to see if the attending needs help with seeing outpatients. They may occasionally
page your to come help out in clinic if there is an interesting pt or if it gets very busy down there.
Fellows will maintain their continuity clinic at the Jesse Brown VA while rotating at Sinai. The fellow will
be excused from Mt. Sinai to attend two ½ day continuity clinics at UIC or the VA. For the remainder of
the day the fellow shall report to Mt. Sinai Hospital. Fellows who have 3 clinics a week will be assigned
coverage for one of those while rotating at Sinai.
* Baring the continuity clinic or program directors approved absence, any and all time off needs prior
approval from Sinai Health System’s fellowship site director, Pam Khosla, MD.
ID Cards: You must obtain an ID card that is issued by Mt. Sinai; you can request one through the
Medicine office (9th floor x6552).
Parking: You also hold the Sinai parking card which is required for entry and exit; pass this to next fellow
with sign‐out and key to the office on 3rd floor. Beware, the parking lot fills up by 9am and you will then
need to use the Valet services on the roof, if you can’t find a space. Valet service is free.
Offices: Offices are located on the third floor‐ take the B elevators (from the entrance, that’s all the way
down the main hallway and to your right). Make a Left when you get off the elevators and walk past an
intersecting hallway. You will see offices on your right hand side. There is no private fellows office, but
we have access to an office K351 (last door on the right, next to the fire exit), shared with the clinical
trials staff, to store belongings. This office is adjacent to the Attending office on the 3rd floor of Kurtzon
Building
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You will be responsible for holding the key, pager, and parking access card and passing it to next fellow
on service with sign‐out.
IMPORTANT SCHEDULING INFORMATION
To schedule an inpatient bone marrow biopsy, call the Heme lab 6783 the day before to schedule. You
MUST pre‐order the bone marrow tray, syringes, gloves, lidocaine, and heparin under patient’s Doctor’s
Orders to be at the bedside for the procedure the next morning. The bone marrow techs work 9‐11am
only. MSH heme path requests 3 tubes of aspirate; first pull un‐heparinized 1cc for slides, 2nd pull
heparinized 2.5cc, 3rd pull heparinized 2.5cc
Outpatient bone marrows: Traditionally the fellow as done all the outpatient bone marrows. These are
set up by the clinic MA’s and they will page you when the patient is ready. They will take care of
notifying the tech and bringing all the supplies.
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Blood Bank/ Transfusion Medicine Rotation University of Illinois Hospital and Health Sciences System
Description The blood bank/transfusion medicine rotation provides the hematology/oncology fellow exposure to a wide array of problems encountered by personnel within an active blood bank service. The laboratory evaluation of patients with various types of blood disorders will be learned during this rotation. In addition, the fellow will learn techniques of therapeutic apheresis and will gain understanding in the principles of stem cell pheresis. It is the fellow’s responsibility to maximize the benefit you gain from this experience. A great deal of independent reading is required of the fellow. Dr. Sally Campbell‐ Lee will coordinate the Blood Bank/Transfusion Medicine rotation. The Blood Bank/Transfusion Medicine laboratory supplies blood components, plasma derivatives and tissues to the hospital clinical departments. Basic and advanced immunohematologic procedures are performed to provide the most suitable blood components. The Blood Donor and Hemotherapy Center provides clinical and donor apheresis services as well as therapeutic apheresis consultations. During the three years of fellowship, the fellow will rotate for 2 weeks on blood bank/Transfusion medicine, usually during the 1st year.
I. Educational Goals (knowledge, skills): The following topics are available in Blood Bank/Transfusion Medicine Fellowship Syllabus; Referenced Chapters refer to the main reference material: Technical Manual, most recent edition, American Association of Blood Banks (AABB); ask the blood bank fellow on service at the time of your rotation for access
A. Knowledge
1. BLOOD DONATION AND COLLECTION:
Demonstrate knowledge of current eligibility criteria for blood donors
List all donor screening tests required by FDA
Understand current donor reentry algorithims
Contrast eligibility requirements for allogeneic and autologous donors
2. Immunohematology: a. RED CELL BLOOD GROUP ANTIGENS AND ANTIBODIES (Chapter 13 – 15)
Describe the genes coding for antigens in the ABO system
Describe the characteristics of anti‐A and Anti‐B antibodies
Describe the Bombay phenotype and its clinical significance
Demonstrate ability to distinguish clinically significant from insignificant RBC specific antibodies
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Become proficient in evaluating patients with immune mediated and non immune mediated hemolytic anemia and in the testing and transfusion management of these patients
b. Identification of red cell alloantibodies (Chapter 19):
Demonstrate knowledge of specialized test methods in immunohematology including elution, absorption and use of enzymes
Interpret difficult antibody panels including those containing multiple Alloantibodies, autoantibodies and antibodies to high frequency antigens
c. PLATELET SPECIFIC ANTIGENS AND ANTIBODIES (Chapter 16):
List three platelet antigens that are of clinical significance
Describe two methods used in detecting platelet antibodies 3. BLOOD BANK METHODS:
Pre‐transfusion testing (Chapter 18):
List three sample labeling requirements for samples submitted for pre‐transfusion testing
Describe the purpose and methods used in ABO forward and reverse typing
Describe the method used for routine testing for D antigen
Describe the method used for the detection of unexpected antibodies to red cell antigens
Describe two types of crossmatch method used and the conditions under which a method is selected
List three differences in pre‐transfusion testing requirements for infants comparing to adults Transfusion reaction work‐up:
Show detailed knowledge of the clinical evaluation of transfusion reactions and related testing and management
4. CLINICAL CONSIDERATIONS:
Component transfusion:
Describe the indication and dosage of red cell transfusion for adult and pediatric patients
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Describe the indication and dosage of platelet transfusion for adult and pediatric patients
Describe the indications and dosage FFP and cryoprecipitated AHF
Describe the indications and dosage of granulocytes
Describe the indications washed red cells/platelets, irradiated red cells/platelets, leukoreduced red cells/platelets and CMV‐seronegative red cells/platelets
Describe the indication and dosage for Rh immunoglobulin (IM and IV formulations)
Review the process of five emergency release of blood products investigations Platelet issues:
Describe the clinical and laboratory features, and management of Neonatal Alloimmune Thrombocytopenia (NAIT)
List four non‐immune related causes for platelet refractoriness
Describe the role of HLA antibodies in platelet transfusion
Describe three strategies in preventing immune‐mediated platelet refractoriness
Describe three steps in diagnosing immune‐mediated platelet refractoriness
Describe three strategies for managing patient with immune‐mediated platelet refractoriness Transfusion reactions:
Evaluate and provide interpretation for twenty transfusion reaction work‐ups
Describe the clinical and laboratory features, and management of acute hemolytic transfusion reactions, delayed hemolytic transfusion reactions, septic transfusion reactions, severe allergic transfusion reactions, transfusion related acute lung injury (TRALI), transfusion related fluid overload, non‐hemolytic febrile reaction and mild allergic transfusion reactions
Describe the clinical/laboratory features, prevention and management of transfusion associated graft verses host disease (TaGVHD).
Describe the clinical/laboratory features, prevention and management of transfusion associated CMV infection
Describe the clinical and laboratory features, and management of Post‐Transfusion Purpura (PTP)
5. Apheresis
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Know three techniques used for separation of blood components for component collection and therapeutic applications using apheresis
Know eight common indications for therapeutic plasmapheresis
Describe three advantages/ three disadvantages of using each of the following replacement fluid in plasmapheresis: crystalloids, albumin and fresh frozen plasma
Define the five major clinical features associated with Thrombotic Thrombocytopenic Purpura (TTP)
Describe three features useful in differential diagnosis of TTP vs. DIC.
Know three indications for emergency leukopheresis
List three indications for emergency red blood cell exchange transfusion for sickle cell patients
List four common adverse reactions (and management) associated with apheresis 6. Stem Cell Processing (AABB Technical Manual Chapters 29 and 30)
Know some of the current indications for allogeneic and autologous hematopoietic progentior cell (HPC) transplant
Be familiar with HPC‐A vs HPC‐C vs HPC‐M selection criteria (apheresis, cord blood or marrow)
Understand the role of HLA compatibility and donor CMV status in allogeneic donor selection
Be familiar with the allogeneic donor screening questionnaire (current version available at
http://www.factwebsite.org/main.aspx?id=241) and FDA HPC donor requirements (http://www.fda.gov/cber/gdlns/tissdonor.pdf)
Develop familiarity with infectious disease testing requirements for HPC products and understand differences between testing for HPC products and blood components
Understand why and how the CD34 antigen is used in processing HPC products
Know the potential problems that can occur with ABO and Rh incompatible HPC transplants; including engraftment impact and blood component usage impact
Recognize the different storage methods (liquid refrigeration, liquid nitrogen storage) and the impact of donor type (auto vs allo), donor disease testing results, and other factors on decisions made regarding storage and shipping of HPC products (for example, liquid vs vapor phase in liquid nitrogen storage).
Understand the thawing and infusion process of HPC products
Develop familiarity with quality assurance of HPC products, including CD34 cell counts, microbial cultures, colony forming cell assays, tumor cell detection and engraftment data
HLA Laboratory (AABB Technical Manual Chapter 19)
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Learn the differences between HLA Class I and Class II antigens and understand basic information on the patterns of inheritance
Understand what is meant by “splits”, crossreactive groups, and public vs private antigens
Learn about the current molecular, serologic and cellular assays used to identify HLA antigens and the clinical applications of each method
Understand adverse events of transfusion mediated by the HLA system (TRALI, platelet refractoriness, TA‐GVHD, FNHTR)
B. Skills:
1. Under supervision of the attending, participate in the care and medical management of patients undergoing therapeutic apheresis.
2. Under supervision of the attending, participate in the care and management of donors who experience adverse events associated with donation.
3. Under supervision of the attending, participate in the care and medical management of patients undergoing transfusion or medication infusion.
4. Under supervision of the attending, assist in the assessment of donor eligibility 5. Under supervision of the attending, obtain informed consent of patients to be transfused
6. Under supervision of the attending, obtain informed consent of patients for therapeutic apheresis
procedures.
II. Core Competencies and Curriculum Competencies Graduate Medical Education involves the development of competency as a physician in six areas: Patient Care, Medical Knowledge, Professionalism, Interpersonal and Communication Skills, Practice Based Learning and Improvement, and Systems Based Practice. Patient Care The fellow must demonstrate a satisfactory level of diagnostic competence and the ability to provide appropriate and effective care in the context of Pathology services. The fellow is expected to:
Develop a diagnosis or differential diagnosis for specimens referred to the service. Gather essential and accurate information from the medical record and health care providers
(and patients, as appropriate), including patient, family, and clinical histories, clinical findings, medication, occupational and toxin exposures, etc., as necessary for interpretation of specimens.
Explain and demonstrate the role of the Blood Bank Medical Director in promoting and ensuring
patient safety. Medical Knowledge The fellow must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social‐behavioral) sciences and the application of this knowledge to Blood Banking/Transfusion Medicine. The fellow is expected to:
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Demonstrate an investigative and analytic thinking approach to clinical and pathologic
problems. Apply the basic and clinically supportive sciences appropriate to Blood Banking/Transfusion
Medicine. Practice‐based Learning and Improvement The fellow must be able to demonstrate the ability to investigate and evaluate his/her diagnostic and consultative practices, appraise and assimilate scientific evidence, and improve individual care practices. The fellow is expected to:
Analyze practice experience and perform practice‐based improvement activities using a systematic methodology.
Locate, appraise, and assimilate evidence from scientific studies related to Blood Bank issues /
problems.
Apply knowledge of study designs and statistical methods to the appraisal of clinical and pathologic studies.
Facilitate the learning of students, other health care professionals, patients, and patients’
families.
Formulate and support patient care decisions, using information technology to:
o Gather patient data. o Find literature support. o Document decisions, recommendations, and reports.
Manage patient information, access on‐line medical information, and support education of other health‐care providers, patients, students, and self, using information technology.
Contribute to scholarly activity through involvement in research projects, literature
searches/clinical correlation, journal clubs, case studies, etc. Interpersonal and Communication Skills The fellow must be able to demonstrate interpersonal and communication skills that result in effective relationships, information exchange and learning with other health care providers, patients, and patients’ families. The fellow is expected to:
Obtain information using effective nonverbal, explanatory, questioning, and writing techniques. Communicate effectively when interacting with others, including communication of test results,
reports, and consultations
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Demonstrate caring and respectful behaviors when interacting with health care providers, patients, and patients’ families.
Work effectively with others as a member of a health care team to provide patient‐focused care.
Professionalism The fellow must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. The fellow is expected to:
Demonstrate respect, compassion, and integrity.
Exhibit responsiveness to the needs of patients and society that supersedes self‐interest.
Display accountability to patients, society, and the profession.
o Describe the importance of confidentiality, particularly applied to pathology clinical practice and research issues
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.
Demonstrate a commitment to excellence and on‐going professional development.
Perform duties consistently in a dependable, responsible manner.
Demonstrate a commitment to ethical principles in clinical care and business practices.
Systems‐based Practice The fellow must demonstrate an awareness and responsiveness to the larger context and systems of health care and the ability to call on system resources to provide pathology services that are of optimal value. The fellow is expected to:
Outline the role of the Blood Bank Medical Director and other laboratory professionals in the patient management team.
o Describe how his or her professional practices affect other health care professionals, the
health care organization, and the larger society and how these elements of the system affect their own practice.
Compare and contrast health care delivery systems.
Compare and contrast methods of controlling health care costs and allocating resources.
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Practice cost‐effective health care and resource allocation that does not compromise quality of care.
Advocate for quality patient care.
Form effective partnerships with health care managers and health care providers to assess,
coordinate, and improve health care.
Describe how these activities can affect system performance.
Demonstrate knowledge of institution‐specific policies, procedures, and requirements for patient care.
Educational Materials: The University of Illinois Blood Bank is stocked with a number of texts focusing on hemostatic disorders. In addition, the University of Illinois Health Library has a number of journals focusing on hemostatic disorders. The University Health Library has a number of journals focusing on blood bank and coagulation concerns. Blood Bank/Transfusion Medicine Fellowship Syllabus Referenced Chapters refer to the main reference material: Technical Manual, most recent edition, American Association of Blood Banks (AABB) Evaluation Method: After each rotation the fellow and attending are required to meet and discuss the fellow’s progress. The chief fellow or program director will receive feedback from Dr. Campbell‐Lee regarding the fellow’s performance. A formal evaluation is also filled out each month through New Innovations. Daily attendance is mandatory during this rotation and attendance will count towards a large portion of the evaluation. Conferences:
Clinical pathology rounds (Fridays at 12 noon) Hematology Grand Rounds (Tuesdays, 12 noon, room 3175 COMRB) Biweekly Blood Bank Manager and Supervisor meetings (every other Thursday at 3pm) Biweekly Blood Donor and Hemotherapy Center Manager and Supervisor meetings (alternate
Thursdays at 11am) Monthly Transfusion Medicine Continuing Education conference (3rd Thursday, 3pm) Quarterly QA meeting Quarterly Transfusion Practices Committee meetings
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Monday Tuesday Wednesday Thursday Friday Hematology
Grand Rounds 12 noon
CP Rounds 12 noon
2:30 Stem Cell Planning Meeting
Oncology conf room, 1st floor Outpatient center
2:00 PM Renal
Transplant Planning Meeting 515CSN
BB Manager/Supervisor Meeting, every other
Thursday 3pm (unless CME conf)
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Hematology Pathology Rotation
University of Illinois Hospital and Health Sciences System
I. Educational Goals (knowledge, skills, attitudes)
The educational goals of the Hematology Pathology rotation at UIH are to prepare fellows to act as
qualified sub‐specialty physicians in the setting of reviewing peripheral blood smears and bone marrow
biopsies/aspirate and diagnosing various hematologic disorders/diseases based on histologic data.
Hematopathology provides diagnostic evaluation of blood, bone marrow, lymph nodes, spleen and
hematolymphoid lesions. Fellows should display competency in the reviewing slides and making
diagnosis based on morphologic appearance of cells.
Fellow Year 1, 2, and 3:
Fellows will typically have 1 month of dedicated hematopathology during each year of their fellowship.
They should be familiar with basic disease pathology and continue to sharpen skills and be able to
identify increasingly complex disease morphologies.
Knowledge
The fellows should be able to incorporate traditional microscopy with ancillary techniques including
general laboratory values, immunohistochemistry, flow cytometry and molecular diagnostic tests to
make the most accurate diagnosis.
Skills
Fellows must continue to perfect their skills throughout their fellowship. Fellows should be able to
prepare peripheral blood smears, obtain and evaluate bone marrow biopsies and bone marrow aspirate
and analyze laboratory values immunohistochemistry, flow cytometry and molecular diagnostic tests.
Areas of Knowledge
Will be learned throughout the three years of fellowship
Basic Principles of Hematopathology
1. Identify the various hematopoietic cells that originate from the bone marrow and cellular components of blood including:
a. Red blood cells (erythrocytes) b. White blood cells (leukocytes) c. Platelets
2. Utilize different labs techniques in the diagnosis and management of patients’ diseases a. Immunohistochemistry b. Flow Cytometry c. Molecular diagnostics
3. Identify the following disorders a. RBC disorders
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i. Hypochromic microcytic anemia on smear ii. Hypersegmented neutrophil with megaloblastic anemia on smear iii. Schistocytes (fragmented rbc’s) on smear iv. Cbc with microangiopathic hemolytic anemia (MAHA) v. Howell‐Jolly bodies in red blood cell on smear vi. Spherocytes vii. Basophilic stippling in red blood cells on smear viii. Atypical lymphocytes on smear ix. Pelger‐Huet anomaly on smear x. Sickle cell anemia
b. Leukemias i. Acute lymphocytic leukemia in marrow and on smear ii. Chronic lymphocytic leukemia in marrow and on smear iii. Acute myeloblastic leukemia in marrow and on smear iv. Chronic myelogenous leukemia in marrow and on smear
c. Lymphomas i. Hodgkin Lymphoma ii. Non‐Hodgkin’s Lymphomas
1. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma 2. Follicular Lymphoma 3. Marginal Zone Lymphoma 4. Mantle Cell Lymphoma 5. Diffuse Large B‐Cell Lymphoma 6. Burkitt’s Lymphoma 7. Lymphoblastic Lymphoma 8. AIDS‐Related B‐Cell Lymphoma 9. Peripheral T‐Cell Lymphoma 10. Mycosis Fungoides/Sezary Syndrome 11. Primary Cutaneous B‐Cell Lymphoma 12. Adult T‐Cell Leukemia/Lymphoma
d. Myeloma i. Multiple Myeloma ii. Systemic Light Chain Amyloidosis
Resources
Hematology.org
‐American Society of Hematology website
‐Provides up to date information on how to evaluate and treat basic diseases
library.med.utah.edu/WebPath/.../HEMEIDX.htm
‐ Image database to aid in understanding/describing basic pathology
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Research Rotation University of Illinois Hospital and Health Sciences System
GOALS AND OBJECTIVES FOR RESEARCH ROTATIONS
1. PATIENT CARE
a. Makes accurate and informed decisions about diagnostic and therapeutic interventions
b. Communicates effectively and demonstrates caring and respectful behavior when interacting
with patients and families
c. Responds to emergency situations and/or changes in the condition of the patient
d. Provides healthcare services aimed at preventing problems and maintaining health
2. MEDICAL KNOWLEDGE
a. Demonstrates an understanding of basic science and its relationship to hematology and oncology
b. Demonstrates an investigatory and analytical thinking approach to research.
c. Understands how the basic and clinically supportive sciences apply to the discipline of
hematology and oncology.
3. INTERPERSONAL AND COMMUNICATION SKILLS
a. Uses effective verbal and non‐verbal skills when gathering information or communicating
research findings to others
b. Uses effective writing and documentation skills
c. Conducts clinical presentations with clarity and quality
4. PROFESSIONALISM
a. Demonstrates respect and commitment to ethical principles in research.
b. Demonstrates sensitivity and responsiveness to cultural, age, gender and disability issues
c. Acknowledges errors, accepts criticism
5. SYSTEMS‐BASED PRACTICE
a. Adheres to departmental and hospital rules and regulations
b. Utilizes resources effectively and systematically to enhance research and improve patient care
6. PRACTICE‐BASED LEARNING AND IMPROVEMENT
a. Attends conferences promptly
b. Identifies areas for self‐improvement, takes initiative for own education
c. Analyzes practice experience and performs practice based improvement activities using a
systematic methodology
d. Locates, appraises and assimilates evidence from scientific studies related to hematology and
oncology
e. Uses information technology to manage information, access on line medical information and
support their own education
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f. Facilitates the learning of students and other healthcare professionals
Research requirements:
All fellows are required to develop a basic understanding and comply with the current rules for basic
and clinical research. In our program fellows spend up to 18 months developing and managing a
research project usually involving basic or clinical research.
After selecting one research mentor usually during their first year, fellows decide with their mentor
what project(s) they will pursue in the second year of the fellowship. The research project may be a
clinical research project, a basic research project or a translational research project.
The second and third years of training are focused on research and scholarly activities. The structure
during these years is individualized to accommodate the fellow’s research interests and career goals.
During these years, the fellow spends most of their time engaged in research, under the mentorship of a
faculty member, while continuing a longitudinal outpatient clinic experience. At UIC, there are many
opportunities for cancer‐related clinical, transitional, or basic research with the section of Hematology
and Oncology. Most importantly, fellows may pursue cancer related research in other departments or
sections within the School of Medicine, and have access to a broad array of research projects in clinical,
basis, or transitional arenas.
Fellows learn how to design and conduct clinical trials. Fellows are encouraged to take an active role in
clinical research by developing and implementing the treatment of patients in clinics and enrolling them
in protocols.
It is expected that the research project will lead either to a presentation at a national hematology or
oncology conference or to publication in a peer‐reviewed medical journal
Educational Goals
This rotation stresses the core competencies of Medical Knowledge, Practice‐based learning and
Professionalism. The purpose is to provide a well‐rounded research experience for the hematology‐
oncology fellow. The goal is to have the fellow complete at least a research project during the training
program and through conferences to expose the fellows to additional ongoing projects. In this fashion,
they will learn scientific methodology and statistics, which will enable critical reading and analytical
thought throughout his/her career.
This exposure to research may also stimulate the fellow to obtain further specific post fellowship research training in order to pursue basic or clinical research as part of a career.
Fellows during their second and third years of fellowship have enough protected time to learn how to
design and complete either clinical or bench research that is relevant to hematology or oncology field. In
our fellowship, there are opportunities for both clinical research and lab research.
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Fellows should select a research mentor during their first year of fellowship. It is useful to look at every
faculty experience and research activities, and identify an area of interest within these activities or at
least related to these activities. Once a mentor is considered, fellows should meet with him / her and
ask as many questions as necessary to decide whether this mentor would be a good fit for their research
interests. Once a mentor and fellow decide to work together on a project, both should notify the
program director and the program coordinator. It is expected that the mentor will be responsible for
monitoring all the fellow’s research activities during the fellowship years.
Fellow Year 1:
Knowledge
Research projects are started in the first year or early second year. Reading about the state of
knowledge in the area of research being considered is encouraged during the first year.
Skills
Fellows in the first year of their fellowship must select a research mentor and if possible a research
project at least 3 months before the end of the first year.
Fellow Year 2 and 3
Knowledge
Fellows are expected to conduct their research projects and become experts within their specific area of interest. By the end of their research experience, they must present the results of their research and discuss the state of knowledge in this area in front of the fellowship faculty and fellows.
Skills
Fellows in the second and third year of their fellowship must conduct a research project with their
mentor and review the state of knowledge in this area of research.
1. Review the literature to select and understand the state of knowledge in an area of research
2. Design a research protocol
3. Submit the research protocol to the institutional review board and obtain approval for the study
4. Enroll patients (randomization, obtaining proper consent, and adhering to inclusion and exclusion
criteria)
5. Perform the research adhering to federal and other requirements
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6. Perform an interim analysis to identify the need for modifying or interrupting the study
7. Report adverse events
8. Perform the final data analysis
9. Prepare and submit a manuscript for publication in peer‐reviewed journals
10. Present the results of the research at Conferences
11. Be professional and ethical during the conduct of the research project
Conferences and Formal research Teaching
Research Presentations
The faculty members are involved in a variety of research projects , including basic laboratory bench
research, translational research, clinical trials. These conferences aid the fellows in identifying a faculty
mentor who will work with them to develop their own research project during their training.
Faculty members involved in bench or clinical research present data from their own research and
summarize the state of the research to give the fellows instruction in the conduct of biomedical
research.
The Research Conference also is critical in the development of the fellow’s skills. The fellows will
periodically present their project beginning with the inception and will explain the hypothesis, rationale,
design and methodology employed. Subsequently, new data will be presented during the course of the
training program.
Fellows are encouraged to present the result of their research at research conferences or during clinical
trials meetings. These research conferences occur once a week, typically on Tuesday. Clinical trials
meetings occur once a month, typically on Friday.
Outcomes
The program director requests input from the research mentor before the PD evaluation of fellows
every six months. Research progress is also discussed with the fellow.
Productivity of research is evaluated, including:
1. Publications
2. Presentations at conferences
3. Awards
4. Funding