All first-year fellows have three half-day clinics per week – two in solid tumor oncology and one in hematology. Second- and third-year fellows on the Clinical Educator track have five half-day clinics per week. Second- and third-year fellows on the Clinical Investigator track have four half-day clinics per week. Second- and third-year fellows on the Laboratory Research track have one half-day continuity clinic per week. A sample schedule can be found on the Training Schedule & Stipends page.
In this half-day clinic, fellows learn about the management of patients with a variety of common and rare benign hematologic problems such as sickle cell disease, cytopenias, hemophilia and coagulopathies. Fellows boarding in hematology are required to maintain a hematology or BMT/Leukemia/Lymphoma continuity clinic throughout the fellowship.
Fellows in BMT, Leukemia, or Lymphoma clinics learn about the management of patients with leukemia, lymphoma, or those undergoing autologous or allogeneic stem cell transplantation. Fellows boarding in hematology are required to maintain a hematology or BMT/Leukemia/Lymphoma continuity clinic throughout the fellowship.
Fellows are able to select from a variety of specialty oncology clinics with a diverse mix of oncology patients. By following individual patients from their initial diagnosis, fellows develop an appreciation for the natural history of the disease process. Fellows learn to evaluate, stage, and treat all major cancer types, write chemotherapy orders, provide supportive care, and manage patients through Home Health and Hospice. Fellows can elect to work with one or more faculty members in oncology who see patients with the fellow and offer suggestions for patient management. On average, fellows will see one to two new patients and 4-8 follow-up patients each half-day of clinic. In addition, patients initially seen by fellows in consultation in the hospital may be referred to a fellow's oncology clinic.
Fellows have an opportunity to participate in additional outpatient clinics beyond those required by their chosen clinical track. Options for additional clinics include BMT/Leukemia/Lymphoma, Benign Hematology, or Oncology. Up to four fellows per year may elect to have a combined Hematology/Oncology clinic at the VA Hospital.
On the Oncology Consults rotation, fellows become proficient in the work-up, diagnosis, and management of patients with lymphomas and solid tumors. Fellows see approximately 2-4 new consults per day that are staffed with one of the oncology faculty members. Fellows review all pathology specimens, recommend further diagnostic and staging workup, and make treatment recommendations for all new consults. Fellows perform bone marrow biopsies on new lymphoma patients, and learn how to administer intrathecal chemotherapy. Fellows are encouraged to refer new consults to appropriate disease-specific fellows' clinics.
While on the Hematology Service, fellows become adept at managing the complications of a variety of common and rare hematologic disorders, including sickle cell disease, cytopenias, and coagulation disorders. Fellows also learn to perform and interpret bone marrow aspirates and peripheral smears. This service acts as the primary team for hematology inpatients (predominantly patients with sickle cell anemia that are well-known to the hematology clinic) and as consultants for a variety of hematologic disorders. The hematology team is composed of a first-year fellow, Internal Medicine resident(s), medical student(s), nurse practitioners, and an upper level Hematology/Oncology fellow. This is a busy service with approximately 4-6 inpatients at any given time, and approximately 4 new consults per day.
The upper level hematology rotation is assigned to second-year fellows, who provide teaching and serve as backup to the Heme I fellow. Upper level hematology fellows are expected to attend Hematology patient rounds when they are not in clinic. They are also expected to carry the service pager while the Heme I fellow is in clinic, provided their own outpatient clinic does not run concurrently. The Heme II fellow is responsible for presenting at the weekly Hematology Case Conference.
On the Acute Leukemia and Bone Marrow Transplantation Services, fellows learn about the diagnosis and treatment of malignant hematologic diseases, to care for patients undergoing peripheral stem cell/bone marrow transplantation for both hematologic malignancies and solid tumors, and to manage the complications of these diseases and their treatment.
On the Bone Marrow Transplantation Service, one fellow, a medicine resident, nurse practitioner, and a hospitalist physician are overseen by a BMT/Leukemia attending. The team provides care to patients undergoing autologous or allogeneic stem cell transplant and to patients with post-transplant complications. This unit has the capability of providing critical care to up to six ICU patients. All first-year fellows are required to participate on this service.
The two Acute Leukemia Service teams each consist of 2 hospitalists and 1-2 nurse practitioners who are overseen by a BMT/Leukemia attending. Patients are admitted to this service for management of acute leukemia and other hematologic malignancies, as well as for post-transplant complications. Fellows may participate on this service as an elective rotation.
Fellows attend the BMT Patient Review Conference every week where patients undergoing treatment or being considered for transplantation are discussed. While on either the Acute Leukemia or Bone Marrow Transplantation Services, fellows may be asked to present at the BMT Morbidity and Mortality Conference.
The Bone Marrow Biopsy rotation was designed to help first-year fellows become comfortable with performing bone marrow biopsies. Within the first 2 weeks of fellowship, first-year fellows are scheduled in the outpatient clinic to learn how to perform and become proficient at doing bone marrow biopsies. Fellows conduct at least 5 supervised bone marrow biopsies.
The Gynecologic Oncology rotation allows fellows to learn about the diagnosis, treatment, and complications of malignant gynecologic diseases. Fellows rotate with the Gynecology/Oncology Division faculty in their clinics. They learn to diagnose and manage a variety of gynecologic malignancies including cervical cancer, ovarian cancer, endometrial cancer, vaginal/vulvar cancer, and pelvic sarcoma.
The Hematopathology rotation was designed to help fellows gain a basic understanding of bone marrow and peripheral blood smear interpretation. Fellows gain an understanding of the hematopathologic abnormalities seen in the diagnosis of myeloma, leukemia, lymphoma, and other hematologic disorders under the instruction of a hematopathologist.
On the Palliative Care rotation, fellows have the opportunity to work with a multidisciplinary team dedicated to the evaluation and implementation of palliative care to patients. Fellows will see palliative care consults in order to learn about pain and non-pain symptom control, emotional/psychosocial aspects of care, spiritual aspects of care, communication, systems and venues of care, and special therapeutic issues (e.g. artificial hydration and nutrition at the end of life, antibiotics, resuscitation measures, and therapeutic issues in the imminently dying patient).
First-year fellows are assigned one month of solid tumor oncology outpatient clinics and one month of BMT/Lymphoma outpatient clinics. On each rotation, fellows can expect to attend 2-3 weekly clinics in addition to their regular clinic assignments. Fellows are encouraged to use this rotation to explore areas of interest that are not included in their standard schedule.