Hematology/Oncology
Clinical Training
Goals and Objectives for Each Rotation
One full year is devoted to the acquisition of clinical skills. During that year, fellows spend five months working on the in-patient service, under the direct supervision of the Division faculty and six months on the outpatient service. The in-patient service carries an average census of 12-20 patients, including the bone marrow transplant patients. During the clinical year, fellows accept increasing responsibility for diagnosis, therapeutic decisions, initial consultations and teaching (of patients, families, house staff, and students). A senior resident and 2 interns make up the Hem/Onc ward team and are also involved with seeing patients in the clinic. A lecture series is given on Hem/Onc topics. All team members participate in this, giving opportunity to improve teaching skills. Toward the end of the first (clinical) year, fellows are expected to have developed the skills to lead the in-patient team. They show this by participating in a 2-4 week period of “pre-tending”, managing the service under the observation of the faculty on service, usually in the second or third year.
During the clinical year, the fellows attend three-four Hematology/Oncology clinics per week while on the out-patient rotation. There is one "life after cancer" clinic per week, two hematology clinics, and two clinics for patients on chemotherapy. In addition, there are monthly outreach clinics at Bakersfield, Olive View Hospital and Santa Clarita.
These clinics provide continuity of care to our patients, as well as outpatient consultations and “second opinions”. All clinics are supervised by the Division faculty. The experience also provides an opportunity to assess the long-term consequences of cancer and its treatment.
Clinical fellows rotate through the blood bank, the hemostasis service, and Radiation Oncology. The purpose of these rotations is to provide an understanding of these disciplines, which are integral to Pediatric Hematology/Oncology.
All peripheral blood smears, bone marrow aspirations, bone marrow biopsies, and CSF cytology’s are reviewed with the Division faculty; thus, fellows gain clinical experience in marrow and CSF histopatholgy. All fine needle aspirate and surgical pathology specimens are reviewed with a designated pathologist (Dr. Michael Teitell – Pediatric Pathology, Dr. Jonathan Said – Lymphoma Pathology). Immunophenotyping of leukemia cells is reviewed regularly with Dr. Sophie Song of the Department of Pathology.
Additional clinical experience is obtained through responsibility for night and weekend call. All fellows rotate “on call” for a week at a time, usually one week in six. The fellow is on first call; a faculty person is on second call, to provide clinical teaching and experience. Fellows may take call from outside the hospital, but must be available to respond promptly by phone, and, if necessary, to come in to the hospital to see patients. The faculty and fellow on-call make daily rounds on all inpatients on weekends and holidays.
Fellows are evaluated based upon the level of experience (training), according to the six basic competencies. The rating scale has three points; 1=below expectations, 2=meets expectations, and 3=exceeds expectations. Evaluations are sought from faculty, nurses, child life specialists, social workers, and patients (families). Immediate feedback is provided, as needed. Fellows meet with the Division Chief and Program Director no less often than twice a year to receive a comprehensive written performance evaluation and to provide feedback to the faculty regarding program improvement.
During the 2 years of fellowship when the major focus is on scholarly activity, trainees are expected to share call and to attend one outpatient clinic per week. This provides an opportunity for continuity of care and a further honing of clinical skills, especially those judgmental skills required for the diagnosis and care of unique and difficult, chronic clinical problems, and the further development of teaching and leadership skills. They are expected to demonstrate progressive team leadership , teaching skills, and independence in decision-making (in clinic and when on call).
Goals and Objectives for Each Rotation
