Clinical Training & Responsibilities

The educational program is supported by a wide variety of educational conferences, lectures, journal clubs, and required classes.

• Faculty Teaching Series/Board Review (weekly – required)
•         Morphology Series
  
• Pediatric Tumor Board (weekly – required)
• Bass Center Grand Rounds (monthly – required)
•         Journal Club
  
•         Faculty Research Conference
  
•         Morbidity & Mortality Conference
  
•         Grant Writing Series
•         Professionalism Series
  
• Fellows Meeting (monthly – required)
• Protocol Meeting (monthly – required)
• Inpatient Rounds (daily – required during the inpatient blocks)
• Bereavement Rounds (monthly – optional; required when fellow’s patient is discussed)
• Pediatric Neuro-Oncology Tumor Board (weekly – optional; required during Neuro-Oncology Consult block)
• SCT Inpatient Rounds (weekly – optional; required during SCT block)
• SCT Outpatient Rounds (weekly – optional; required during SCT block)
• Psychosocial Rounds (weekly – optional; required when fellow's patient is discussed)
• Pediatric Cancer Immunotherapy Meeting (bi-monthly – optional)
• Pediatric Liver Tumor Board (monthly – optional)
• Fellows Support Group (monthly – optional)

The clinical training year is structured into 13 four-week blocks as follows:

• Inpatient Hematology/Oncology (4 blocks)
• Hematology Consult (3 blocks)
• Oncology Consult (2 blocks)
• Stem Cell Transplantation (2 blocks)
• Lab & Transfusion Medicine/Hematopathology (1 block)
• Neuro-Oncology Consult (1 block)

During the year, fellows receive four weeks of vacation, taken one week at a time during the Hematology, Oncology Consult, and Stem Cell Transplantation rotations.

The inpatient fellow is responsible for the care of all of the hematology/oncology inpatients in conjunction with the attending on service. The inpatient fellow will thus be responsible to:

• Attend work rounds with the housestaff on 1-North each morning serving as the supervisor and hematology/oncology consultant for the housestaff. The fellow will be responsible for ascertaining that decisions made on morning rounds are carried out as planned. The housestaff will be encouraged to make decisions appropriate to their level of training and experience, but all medical decisions on the inpatients will be discussed with the fellow. The fellow, in turn, will report to the attending on service who is present during work rounds and is ultimately responsible for the care of all hematology/oncology inpatients.
• Attend "signout rounds" each evening at 5:00pm. These rounds will be attended by the attending on service, the fellow on evening call, and other attendings, nurses and housestaff as necessary. These rounds will provide a quick review of all inpatients and their problems, status of workup, etc. It is also an opportunity for discussion and clarification of all problems and plans for the fellow on call that evening.
• Attend morning report with the 1-North housestaff where the subject matter is appropriate.
• Perform diagnostic/therapeutic procedures on inpatients when such procedures do not conflict with other patient care responsibilities.
• The fellow is responsible for contributing to the educational experience of the housestaff who are assigned to the inpatient service. Teaching may take the form of focused didactic sessions as well as less structured education which typically takes place during work rounds. Additionally, second and third year fellows will be assigned to resident teaching schedule.
  

Hematology Consult (3 blocks)
The fellow assigned to the hematology rotation will see and follow inpatient consultations with the Hematology attending on service as well as clinic patients under the supervision of the clinic attending. Fellows are encouraged to triage and see newly referred hematology patients. They are also expected to attend afternoon post-clinic conferences on Tuesdays and Fridays where all patients seen will be discussed. Fellows are expected to contribute to the educational experience of medical students and residents who may be rotating on Hematology.

Oncology Consult (2 blocks)
The fellow assigned to the oncology block rotation will see and follow all inpatient consults with the inpatient attending as well as workup new oncology referral patients with the oncology consult attending in the outpatient clinic. Fellows are expected to contribute to the educational experience of medical students and residents who may be rotating on Oncology.

Additionally, during the Oncology block rotation, the fellow will spend one morning each week gaining experience (under attending supervision) performing common procedures such as lumbar punctures, intrathecal chemotherapy instillation, and bone marrow aspirations and biopsies. They will additionally spend one afternoon a week in the Health After Therapy (“HAT”) Clinic under the supervision of its Medical Director, gaining experience in childhood cancer survivorship and late-effects of treatment.

Stem Cell Transplantation Consult (2 blocks)
The fellow on the stem cell transplantation rotation is expected to attend inpatient rounds on the Stem Cell Transplantation Unit, under the supervision of the inpatient Stem Cell Transplant attending.  Fellows are expected to contribute to the educational experience of any residents who may be rotating on the Stem Cell Transplant Unit.

Additionally, fellows will perform outpatient bone marrow transplantation consults under the supervision of the Stem Cell Transplant clinic attending. They will gain experience in consenting patients/families for the major types of stem cell transplants (autologous, allogeneic, and matched unrelated donor transplants). They will also follow their own hematology and oncology primary patients who undergo transplants longitudinally through their pre-transplant and post-transplant course.  They will gain experience with the major types of transplant related complications and side-effects.

Lab & Transfusion Medicine/Hematopathology (1 block)
Fellows assigned to the lab & transfusion medicine/hematopathology rotation are expected to gain (primarily didactic and lab-based) experience in a variety of areas, including blood-banking, transfusion medicine, hematopathology, flow cytometry, cytogenetics, and molecular diagnostics. They will attend a variety of didactic sessions (such as transfusion rounds) organized by the faculty, staff, and technologists in each of these areas.

Neuro-Oncology Consult (1 block)
Fellows assigned to the neuro-oncology rotation are expected to perform both inpatient and outpatient consultations under the supervision of the pediatric neuro-oncology faculty. They will gain experience in the workup and treatment of common Central Nervous System neoplasms and will assume responsibility for following two to three neuro-oncology patients in their continuity clinic. They will attend any didactic sessions mandated by the neuro-oncology faculty, including neuro-oncology tumor board while they are on the rotation. They will also attend lectures by the radiation oncology attending.

Our program is committed to providing protected time for research. All fellows are required to identify a research project/laboratory by the end of November their first year. The program allows for first-year fellows to have a half-day continuity clinic for the first three months in order for the fellow to explore research opportunities and meet with prospective mentors. Additionally, our division faculty will be able to assist the fellow in identifying a suitable research project.

Second and third year fellows will continue to participate in the clinical activities of the program in a limited way. During the second year of training, this includes night/weekend call coverage (shared with first year trainees) and one clinic day per week.  During the third year of training, this includes at least two weeks of “pre-attending” (under faculty supervision) on the inpatient team. Third year fellows will also continue to attend their continuity clinic one day a week and, when necessary, night/weekend call coverage.

During their first year of training, fellows will be assigned a panel of primary oncology, neuro-oncology, and hematology patients for longitudinal follow-up throughout their fellowship. It is expected that fellows will gain experience and expertise in managing a wide range of benign and malignant childhood diseases. They will also gain experience in the background scientific rationale, risks, benefits, side-effects, and long-term effects of a variety of Phase 1, 2, & 3 therapeutic protocols. Trainees will also gain experience in retrieval strategies for relapsed patients. All patients will be seen under the supervision of a primary (disease-based) attending or clinic attending. Fellows will assume responsibility for coordinating the care of their primary patients thereby gaining experience in health-care systems and practicing medicine in the current managed care environment. Fellows will also gain experience with palliative and end of life care as they follow their patients through their disease trajectory. Fellows are expected to have one primary clinic day per week during which they will see their primary patients. They will be excused from other responsibilities during that day (including attendance at inpatient rounds). They will endeavor to perform all procedures on their patients during their clinic day.

It is expected that fellows will follow approximately 20 primary patients. Their panel will include:

• 5-6 leukemia patients
• 2 neuro-oncology patients
• 1-3 hematology patients
• 1-2 stem cell transplantation patients
• remaining patients will represent solid tumors including both common and rare histologies

Fellows are expected to present their patients at the Pediatric Tumor Board (or Neuro-Oncology Tumor Board) for multidisciplinary faculty input in management. They will also present patients (when appropriate) at such combined adult/pediatric management conferences such as Sarcoma Tumor Board and Lymphoma Staging Conference. All patients seen by fellow must be staffed with a supervising attending prior to discharge from the clinic.

Night call will be shared among the first and second-year fellows. The program tries to protect the third-year fellows from night call, but when necessary, third-year fellows may be jeopardized for night/weekend call coverage. The fellow on call will be expected to attend "signout rounds" at 5:00pm each day to acquaint him/herself with the inpatients. The PNP's and other providers will notify the on-call fellow of any outpatients who may present problems during the evenings and weekends. The fellow will be expected to keep a record of all calls and notify the appropriate PNP or provider the next working day of any encounter which requires follow‑up.  Fellows are expected to return to the hospital to see any new patient with suspected malignancy, ICU transfers, unexpected death as well as any other situation deemed appropriate by the fellow or attending on-call. All management decisions should be discussed with the on-call attending to ensure patient safety and fellow supervision.

All fellows are required to take the Pediatric Hematology/Oncology In-Service Training Examination annually so faculty can assess and adjust the curriculum based upon their performance. The division will pay for the cost of this examination. Trainees will be excused from their clinical/research responsibilities so that they may attend the examination.