Clinical Focus

Year 1 of fellowship with further development durings Years 2 & 3

The first year of the fellowship program includes 12 four-week clinical rotations aimed to develop a foundation of clinical experience that the fellow will build upon during the remainder of the fellowship and throughout his/her future career in pediatric hematology and oncology. All of the clinical activities of the fellows are performed under the supervision of an attending physician who is a faculty member in the Hematology and Oncology Section of the Department of Pediatrics. The rotations include seven months on the hematology/oncology service (inpatient and outpatient) and five rotations outside the division that cover a range of topics important to becoming an independent hematology/oncology clinician. In addition, a didactic curriculum covers clinical topics in the subspecialty area through required clinical and educational conferences.

The goals of the rotations during the first year are as follows:

Pediatric Hematology/Oncology - Seven four-week rotations

  • To be able to diagnose and manage patients with pediatric hematology/oncology diagnoses.
  • To learn how Children's Oncology Group protocols are employed to treat patients with cancer and to advance the field of pediatric oncology.
  • To become knowledgeable about chemotherapy drugs and develop expertise in ordering chemotherapy.
  • To become capable of managing complications of chemotherapy.
  • To develop effective communication skills for delivering important medical information to patients and families.
  • To become capable of coordinating the medical care of patients with complex hematologic and oncologic diagnoses.
  • To become capable of providing valuable consultative assessment and recommendations regarding hematologic and oncologic issues.
  • To become familiar with the model of comprehensive care for patients with sickle cell anemia and hemophilia.
  • To provide effective teaching in the clinical setting.
  • To develop skills for the preparation and delivery of oral presentations including clinical overviews, literature reviews, clinical cases, and journal clubs.

During the five additional rotations it is not expected that the fellow will acquire independent expertise in these areas. Rather, the goals are to become familiar with the content and functioning of other specialists and thereby to enhance the fellow's clinical effectiveness.

1. Radiation Oncology (two weeks - elective)

  • To learn how various tumors are treated with radiation therapy.
  • To become familiar with treatment planning by the radiation oncologist.
  • To understand the basic principles of radiation damage to tissues.
  • To become familiar with the short- and long-term side effects of radiation therapy.

2. Laboratory Medicine (four to six weeks - elective)

  • To learn to recognize and manage transfusion reactions.
  • To become familiar with blood product supply including blood typing, antibody screening, crossmatching, and TTD testing.
  • To become familiar with immunophenotyping of blood and marrow.
  • To understand special coagulation laboratory techniques, interpretation, and limitations.
  • To learn how to utilize and interpret special hematology laboratory testing.

3. Adult Hematology Consult Service (four weeks - required)

  • To have an exposure to complex hematology problems that affect hospitalized adults.
  • To learn to diagnose and manage heparin induced thrombocytopenia.
  • To understand how nutritional anemias may present during adulthood.
  • To gain a broader appreciation of hematologic complications of systemic disease.

4. Hematopoietic stem cell transplantation (SCT) (eight weeks - required)

  • N.B. This training for the fellows currently occurs at an active SCT program. The goals are to become familiar with the evaluation, education, and management of stem cell transplant patients as well as issues of toxicity and long-term complications.

The fellows' clinical education continues during years 2 and 3 of the program during which time the fellows follow their own patients in a weekly continuity clinic and take call for the clinical service one weekend per month. In addition, the didactic program and weekly conferences enhance the fellows' knowledge, skills, and clinical expertise toward becoming an independent clinician.