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Hematology Oncology Fellowship

Education

Our trainees receive both formal and informal education throughout their three years. They also play a role in the education of pediatric residents, medical students, and other trainees.

Rounds, Seminar Series, and Lecture Series

  • Bone marrow morphology rounds is a weekly meeting where trainees gain experience in interpreting normal and abnormal morphology under the instruction of an attending oncology physician trained in morphology as well as a hematopathologist. Peripheral smears and cytospins of cerebrospinal fluid also are reviewed during this meeting.
  • Fellow seminar series is a weekly meeting where the trainees have a formal detailed discussion with one of the hematology oncology, stem cell transplantation, immunology, transfusion medicine, lab medicine or radiation oncology attending physicians about a general topic that the trainees are required to know at the end of a three-year fellowship in hematology oncology.
  • Psychosocial rounds meet every other month and are a conference presented by the hematology and oncology psychologist. The focus of these meetings is centered on the psychological aspects associated with children that have chronic and/or life threatening illnesses.
  • Institutional fellows lecture series is a series of talks centered on hypothesis testing, statistical analysis, oral presentations, manuscript writing, grant writing, and critical review of the literature. Adult learning theories also are addressed during this series.
  • Palliative Care rounds occur every other month.

Conferences and Boards

  • Departmental education conference occurs monthly as a two hour, evening program and includes a weekly journal club, and current research activities/special presentations

  • Hematology conference is a weekly meeting where we present interesting hematology cases, review the literature and discuss best practices.

  • Hematopathology conference is a monthly conference where one trainee presents several cases and reviews all laboratory findings. The aim of this conference is to interpret diagnostic studies in association with clinical findings. Similar cases that have alternative diagnoses are used to compare and contrast diagnostic findings with the current case.

  • Two tumor boards each meet weekly. One is for the solid tumor program and the other is for the neuro-oncology program. The tumor boards are interdisciplinary conferences where all patients newly diagnosed with a malignancy are reviewed. Presenting signs and symptoms, radiological findings, surgical approach, pathologic findings, and plan of treatment, including radiation oncology, are addressed at each conference. Additionally, patients with a change in status or relapse are reviewed.

Clinical

 The first year of training is dedicated to an intensive clinical exposure in hematology, oncology, immunology, and stem cell transplantation. All clinical training is based at Children's National Medical Center.

Oncology Inpatient Service
Three months of the first year are spent on the oncology inpatient service, which includes caring for both acute and chronic patients.

During the inpatient rotation, the trainee is responsible for:

  • Conducting daily work rounds with the house staff along with a senior resident
  • Providing immediate support and supervision to the house staff and nursing staff
  • Writing all chemotherapy orders
  • Performing all procedures (bone marrow aspirates, bone marrow biopsies, and lumbar punctures with intrathecal chemotherapy)
  • Educating patients and their families on their illness
  • Communicating with patients and their families on the plan of care
  • Communicating with the patient’s primary care physician
  • Obtaining consent for treatment protocols for newly diagnosed oncology patients.

Routine daily orders are handled by the house staff. All activities are performed under the direct supervision of an attending physician in oncology. Oncology consults are seen by the inpatient oncology team.

Hematology Inpatient Service
Three months of the first year are spent on the hematology inpatient service.

During these three inpatient months, the trainee is responsible for:

  • Conducting daily work rounds with the house staff.
  • Providing immediate support and supervision to the house staff and nursing staff
  • Educating patients and their families on their illness
  • Communicating with patients and their families on the plan of care
  • Communicating with the patient’s primary care physician and coordinating care for the patient.

All activities are performed under the direct supervision of an attending physician in hematology oncology. Hematology consultations are performed by the inpatient hematology team. Occasionally, immunology consultations also will be done by the hematology fellow.

Stem Cell Transplantation Service
Two months of the first year are spent on the stem cell transplantation service.

The trainee is responsible for:

  • Conducting morning rounds
  • Supervising all aspects of the patient's care
  • Communicating with patients and their families
  • Performing all procedures (lumbar punctures, bone marrow aspirates and biopsies, bone marrow harvest, and skin biopsies)

All activities are performed under the direct supervision of an attending in stem cell transplantation. Immunology consults are seen by the BMT/Immunology team.

Consultations
For consultations, the trainee is responsible for:

  • The initial evaluation
  • Formulation of a diagnostic approach and therapeutic plan of action
  • Review of the literature
  • Communicating recommendations with the referring team
  • Providing follow up on further evaluation and management

All activities are reviewed and directly supervised by either an attending physician in hematology, oncology, or immunology.

Leukemia/Lymphoma and Solid Tumor Patients
Fellows identify new patients with leukemia/lymphoma and solid tumors which will be their patients to follow longitudinally for three years. Fellows will have a one-half day continuity clinic for managing these patients. One new hematology patient will be filtered into the fellows’ continuity clinics each week in order to get exposure to the hematology new patient consultation. Fellows in their third year will go to neuro-oncology clinic every other week alternating with their continuity clinic. Fellows also will rotate into the procedure schedule once every eight weeks in the second and third year to maintain their procedural skills.

Outpatient Oncology Clinic
Fellows will attend the outpatient oncology clinic for one block month and the outpatient hematology schedule for one block month.

Fellows are expected to:

  • Evaluate the patient
  • Develop a diagnostic and therapeutic plan
  • Follow up on outstanding laboratory, radiology, or pathology tests

The fellow is also responsible to perform any procedures required at the visit. All activities are under the direct supervision on an attending in hematology oncology, stem cell transplantation or immunology.

Opportunities for Trainees

  • Academic Services Assistance Program, provided by the institution, includes training in biostatistics, informatics, software, finance and budget, IRB, leadership training, and medical education.
  • Second and third year trainees have the opportunity to present topics for the residents and medical students during attending rounds, the Resident Core Lecture series, professorial rounds, and medical student education conferences.
  • Trainees provide informal teaching through the five-minute preceptor technique as part of their supervisory role in both the inpatient and consultation services.
  • Educational stipends are given to trainees in the second and third year which may be applied to educational materials and/or attendance at national meetings. First year trainees receive Nathan and Oski’s Hematology of Infancy and Childhood, Pizzo and Poplack Principles and Practices of Pediatric Oncology, and Altman Supportive Care of Children with Cancer.
  • Trainees are eligible for an adjunct instructor level academic appointment at the George Washington University (GWU) School of Medicine and Health Sciences.
  • Trainees have the opportunity to obtain a Masters in Public Health or a Masters in Clinical and Translational Sciences during their second and third years of training. Course work is offered through the GWU School of Public Health.
 


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