Clinical Education

Objectives

• To develop 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
• To use the broad databases of history, physical examination, and laboratory evaluation to develop a systematic, logical approach to clinical decision making
• To include ethical, socio-economic, and physiological considerations when developing a comprehensive treatment plan appropriate to the unique circumstances of each patient

Fellow Roles on the Inpatient Service

• Lead daily family-centered, multidisciplinary rounds
• Perform inpatient consults at American Family Children’s Hospital and the NICUs at Meriter Hospital and St. Mary’s Hospital.
• With attending staff, deliver inpatient lectures for resident team
• Take home call four nights per service week
• Triage and evaluate hematology and oncology consults and referrals from outside facilities
• Assume primary hematologist/oncologist responsibilities for patients who are newly diagnosed during the fellow’s inpatient service blocks
• Perform procedures such as bone marrow aspirate and biopsy, lumbar puncture, intrathecal administration of chemotherapy, bone marrow harvest, hematopoietic stem cell infusion and exchange transfusion on all patients admitted to the inpatient service

Fellow Roles in Outpatient Clinics

• See primary patients and new referrals in continuity clinic one half day per week
• Write electronic chemotherapy orders for primary oncology patients
• See patients in each attending’s clinic (during first-year clinic rotations), including weekly bone marrow transplant clinic
• Perform procedures such as bone marrow aspirate and biopsy, lumbar puncture, intrathecal administration of chemotherapy, bone marrow harvest, and exchange transfusion on all patients seen in outpatient clinics

Multidisciplinary Clinics

• Hematopoietic stem cell transplant clinic (one to two afternoons per week during first year clinics rotations)
• Comprehensive sickle cell clinic (each fellow attends every three months)
• Comprehensive bleeding disorders clinic (each fellow attends two to four clinics annually)
• Comprehensive neuro-cutaneous disorders clinic (first year fellow attends four to six clinics)
• Comprehensive neuro-oncology clinic (first year fellow attends four to six clinics)
• Caring For Life clinic (late effects and long term followup)
• Vascular anomalies clinic

Supplemental Rotations

• Hematopathology: two weeks during first year
• Radiation oncology: two weeks during first year
• Palliative care medicine: two weeks during second year
• Blood bank: two weeks during second or third year
• Coagulation laboratory: one week during second or third year
• Outreach clinics: held monthly, travel with attending faculty based on availability

Quality Improvement

Each fellow is expected to participate in a clinical QI project, either devised by the fellow or as part of a prior project that receives substantial contribution from the fellow. Ongoing QI efforts in our division include:

• Developing hospital-wide guidelines for sharing life-altering information with pediatric patients and their families;
• Tracking influenza infections, vaccination rates and vaccine refusal rates within pediatric hematology and oncology patients with an aim toward improving prevention;
• Working with the emergency department, pharmacy and nursing to reduce the time between admission of a febrile neutropenic patient and administration of first antibiotic dose;
• Establishing discharge readiness criteria for common admissions and creating a discharge readiness checklist to assist the inpatient team; and
• Evaluating the effectiveness of family-centered rounds hospital-wide and improving our interdisciplinary model of care to better include patients and families in daily decision making.