hematology/oncology fellowship overview

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  • 1.Hematology/Oncology Fellowship Overview The University of Wisconsin provides a unique environment for the training of physicians in pediatric hematology/oncology. Our program is designed to train primary careeducated pediatricians to become academic leaders in the care of hematologic/oncologic disorders in children, adolescents, and young adults. Fellowship training will provide the clinical and research experience necessary to treat a wide variety of related problems and will allow the physician to become a teacher, clinician, and researcher as well as to receive board certification in pediatric hematology/oncology. The primary purpose of our program is to prepare trainees for a career in academic pediatrics and to develop their clinical competence in the field of pediatric hematology/oncology. We provide diverse basic scientific training opportunities with an extensive program of clinical investigation. The program has the following goals: General goals: Development of strong, effective interpersonal skills to lead a multidisciplinary care team and interact effectively with patients who are either chronically or acutely ill. These patients come from diverse backgrounds and have different needs. Development of critical skills in the analysis of scientific literature Development of teaching skills Dedication to lifelong self-education Clinical competence in pediatric hematology/oncology: Development of a knowledge base in the pathophysiology of hematologic, immunologic, and oncologic disorders; the pharmacology and use of chemotherapeutic agents; the fundamental principles of radiation oncology; blood banking; coagulation; nutrition and bone marrow transplantation; and the diagnosis and management of infectious complications seen in the immunosuppressed host Development of a systematic, logical approach to clinical decision making. Expert use of the broad databases of history, physical examination, and laboratory evaluation to establish a diagnosis. Inclusion of ethical, socio-economic, and physiological considerations to develop a comprehensive treatment plan appropriate to the unique circumstances of each patient. Development of competence in design and conduct of a research project (clinical or basic): Identification of research/study questions Formulation of testable hypotheses Experimental design, along with identification and use of appropriate controls Analysis of obtained results and application of statistical principles Preparation of a manuscript that reports research results

2. Clinical Experience The University of Wisconsin Hospital and clinics provide primary multidisciplinary care for approximately two million people in Wisconsin and northwestern Illinois. The division of pediatric hematology/oncology treats approximately 100 new oncology patients and 150 new hematology patients each year. On average, ten children undergo bone marrow transplantation each year. The division participates in pediatric phase I, II, and III trials of cytotoxic and biologic anticancer therapies. The division is responsible for the care of infants, children, and adolescents with primary hematologic or oncologic disorders, and participates in the care of infants, children, and adolescents with hematologic complications of other disorders. The division shares responsibility for the training of medical students, residents, and fellows. Fellows will receive broad clinical experience in the practice of pediatric hematology/oncology in concert with guidelines from the American Board of Pediatrics and Sub-board of Pediatric Hematology/Oncology. Objectives 1. To gain broad clinical experience in the diagnosis and management of pediatric hematology/oncology, including, but not limited to, malignancy of infants, children, adolescents, and young adults, nonmalignant hematology, including bone marrow failure syndromes, autoimmune diseases of the blood, coagulopathies, thrombophilias, hemoglobinopathies, thalassemia syndromes, BMT, and peripheral stem cell transplant 2. To achieve competence in marrow ablative therapy and stem cell rescue, as well as in the safe administration of non-ablative chemotherapy to children with cancer. 3. To achieve competence in the interpretation of peripheral blood smears, bone marrow aspirates, bone marrow biopsies, CSF cytospins, tests of blood clotting and fibrinolysis, platelet function, neutrophil function, hemoglobin electrophoresis, osmotic fragility, RBC enzyme assays, immune function, DNA repair, tissue typing, and blood typing 4. To achieve competence in the performance of bone marrow aspirates and biopsies and lumbar punctures with intrathecal administration of chemotherapy 5. To demonstrate initiative and skill in self-teaching and the use of information to devise sound management strategies for patients with novel or unique problems 6. To demonstrate understanding of the methodologies of clinical research for thoughtful evaluation of results published or presented 3. Summary of Clinical Rotations Inpatient Rotations Goals and Objectives: 1. To develop a broad fund of knowledge regarding the pathophysiology of all childhood malignancies, bone marrow failure syndromes, coagulopathies, thrombophilias, hemoglobinopathies, and thalassemia syndromes 2. To understand and execute the most efficient and cost-effective evaluation processes for the diseases mentioned above 3. To design a treatment plan for all diseases mentioned above 4. To conduct consent for treatment conference with the family 5. To implement changes of therapy, goals, and end-of-life care conferences with families 6. To write chemotherapy orders according to hospital policy 7. To perform lumbar punctures, bone marrow aspirates, and bone marrow biopsies on primary patients and keep a log of such procedures 8. To direct inpatient rounds with residents and students 9. To provide didactic teaching sessions to pediatric residents on inpatient service 10. To be the primary on-call physician at night and on the weekends with attending backup 11. To understand acute and chronic side effects associated with chemotherapy 12. To understand indications for and risks of transfusion therapy 13. To assist in bone-marrow harvesting The first year is largely devoted to clinical training and the development of expertise in procedures, diagnosis, and treatment plans. In addition, fellows gain expertise in terminal care of oncologic patients. Approximately half the year is spent on the inpatient service. Fellows oversee the delivery of pediatric care and take progressively increased responsibility for the diagnosis and management of subspecialty patients. They participate in the supervision and education of the general pediatric house staff, in collaboration with the faculty physician, and gain increased independence as warranted by demonstrated perception, knowledge, judgment, and communication skill. Fellows perform all procedures until they are completely competent, after which time, they teach pediatric residents how to 4. perform the procedures. They write all chemotherapy orders and have them checked by the attending and the pharmacy. The inpatient attending takes primary responsibility for all new inpatients. Whenever the fellow is on the inpatient service, these patients are assigned the fellow as their primary with the faculty attending as the supervisory physician. The inpatient service is composed of the attending, fellow, PGY-2, and two PGY-1. The PGY-1 follows the patients assigned to him or her, writes routine orders (except for chemotherapy), and provides general pediatric care. Fellows and PGY- 2 supervise PGY-1 along with the attending on service. The fellow is responsible for subspecialty diagnosis, performance of procedures, writing chemotherapy orders, and supervising chemotherapy administration. The fellow is continuously supervised, but he or she is expected to assume an increasing role in patient care and teaching of the house staff. Summary of duties of the inpatient fellow: Perform all histories and physicals on new patients and inpatient consults Perform all procedures on patients (lumbar puncture with intrathecal chemotherapy, bone marrow aspirate and biopsy, and bone marrow harvest) Read all peripheral blood smears, bone marrow morphology, CSF cytology, and surgical pathology with pathology faculty Review all imaging studies with radiology faculty Supervise general pediatric workups and management and discharge plans of pediatric residents Write all chemotherapy orders and review with inpatient attending and pharmacy Conduct family conferences regarding diagnosis, management plans, prognosis, and participation in research studies Participate in the teaching sessions for pediatric house staff The fellow is expected to gradually increase his or her role in all these duties and ultimately to act as a team leader. During the third year, fellows spend four to eight weeks pre-tending. They are expected to function as junior faculty, round with pediatric residents without attending, and organize the didactic sessions for the team. After rounds with the team, fellows round alone with the attending on service and help prepare documentation for the attending. This stage serves as the final preparation period to ensure the fellows readiness to assume faculty status the following year. 5. Outpatient Rotations Goals and Objectives: 1. To attend every clinic held by Pediatric Hematology/Oncology faculty 2. To evaluate outpatients who are seen on an urgent basis or for scheduled chemotherapy 3. To communicate promptly and effectively with referring physicians and consultants by phone and dictation of correspondence 4. To perform diagnostic and therapeutic procedures on patients seen 5. To understand policies and procedures regarding chemotherapy and blood- product administration 6. To attend outreach clinics (as schedules allow) dedicated to hematology consults and off-therapy surveillance

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