Division of Hematology/Oncology

Fellowship

First-Year Curriculum

First-year hematology/oncology fellows have a primarily clinical year which is divided approximately equally between inpatient and outpatient experiences. The services are located at the Hospital of the University of Pennsylvania (HUP) and the Philadelphia VA Medical Center (VAMC).

The services include:

Approximately six months per year are dedicated to outpatient continuity practices that encompass experiences in solid tumors, hematologic malignancy and transplant, and non-malignant hematology. The other six months include inpatient rotations in hematology and hematologic malignancy/transplant, and the Philadelphia VA Medical Center which involves morning outpatient clinics and afternoon inpatient consults.

Throughout the year, fellows are entirely off duty at least one day out of seven; half of the rotations are outpatient based and have no weekend responsibilities. Penn adheres to the ACGME requirement for an 80-hour work week. There is no in-house overnight call. Penn fellows are permitted 4 weeks of vacation per year.

Hematology Consults

The hematology consult fellow sees all HUP hematology consult requests including those from the department of medicine, surgery and the surgical subspecialties, neurology, obstetrics and gynecology, and other departments. During this rotation, the fellow organizes and presents at the Friday afternoon hematology conference (1:30 to 2:30 pm). The fellow presents and discusses cases including formal literature summaries and management recommendations.

The goal of the program is to provide a varied and comprehensive experience in consultative hematology.

Principal teaching methods:

Teaching rounds, bedside presentation and discussion, conferences, direct supervision of bone marrow aspiration and biopsy procedures, literature review, intensive microscopic review of case materials, participation in hematopathology rounds, and experience in the methodologies and interpretation of laboratory-based testing.

Educational content:

Exposure to all aspects of adult hematology, including congenital and acquired coagulation disorders, transfusion medicine, the diagnosis and management of cytopenias and elevated blood counts, and the evaluation of patients with gammopathies. Detailed study of peripheral blood and bone marrow morphology, the laboratory evaluation of coagulation disorders, flow cytometry and cytogenetics are all included.

Mix of diseases:

The full range of congenital and acquired adult hematologic disorders.

Patient characteristics:

Men and women, adults and adolescents, including geriatric populations.

Types of clinical encounters:

Bedside consultations.

Procedures:

Bone marrow aspiration and biopsies.

Educational resources:

Dedicated fellows' hematology-oncology library, multiheaded teaching microscope and television, American Society of Hematology Slide Collection, as well as the Medical School Library collection.

Supervision:

All consults are supervised by the hematology consult attending.

Hematologic Malignancy and Hematopoietic Stem Cell Transplant Service

On this service, also known as 'Rhoads 7', the fellows coordinate patient care on the inpatient hematologic malignancy and transplant service. There is one fellow per house staff team, consisting of an attending, a resident, and two interns.

The fellow is responsible for diagnostic and therapeutic procedures including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or Ommaya reservoir tap. In addition, the fellow is responsible for obtaining consent for chemotherapy and writing all chemotherapy orders on the unit. The Rhoads 7 fellows continue to follow their patients when they are transferred to other units, such as the intensive care unit (ICU), physical medicine and rehabilitation or surgery.

Finally, the fellow also serves as liaison between hematopathology and the Rhoads 7 service, reviewing the new cases with the pathologists and reporting results to the team.

The purpose of the program is to provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic malignancies, the principles and practice of high dose therapies, and autologous and allogeneic hematopoietic stem cell transplantation; to provide experience in the diagnosis and management of oncology emergencies; to gain expertise in the management of pain control and family-centered terminal care.

Principal teaching methods:

Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

Educational content:

Explication of the pathogenesis and biology of myeloid and lymphoid malignancies and exposure to all aspects of hematologic malignancies requiring hospital-based therapies.

Mix of diseases:

All hematologic malignancies as well as myelodysplastic syndrome and aplastic anemia.

Patient characteristics:

Men and women, adults and adolescents, including geriatric populations.

Types of clinical encounters:

Daily bedside encounters.

Procedures:

Bone marrow aspiration and biopsy, chemotherapy infusion, stem cell and bone marrow infusion, intrathecal/intraventricular chemotherapy administration.

Educational resources:

As previously described.

Supervision:

All aspects of the fellows' clinical activities and training are supervised by the two Rhoads 7 inpatient attending physicians.

Continuity Practices

The fellows' continuity clinics consist of two three-month blocks which are purely based in the outpatient practices. Fellows are integrated directly into individual attendings' practices; there is no 'fellows' clinic' at Penn. The selection of clinics is tailored to each fellow's preferences, with all fellows required to have at least one half-day of non-malignant hematology and the remainder of the clinical experiences to include solid tumor, hematologic malignancy/transplant, or additional non-malignant hematology as desired by the fellow.

The fellow is expected to assume primary responsibility for the patients they see, which includes, a complete H&P, dictation, follow up on laboratory and radiographic data, presentation in conferences, and follow-up management. To ensure breadth of exposure, the fellows' schedules are hand-designed by the chief fellow and program director, working around their stated interests. For both hematology and oncology clinics, the fellow is assigned two or three new patients every week. The fellow follows the patient as necessary, formulates treatment plans and directs the care of the patients. The fellow continues to be the primary hematology/oncology physician for the patient, and is available by telephone or pager to the patients during the week and see them if an emergency should arise.

The program's purpose is to provide experience in performing hematology and oncology consultations and second opinions in the outpatient setting, and in devising and carrying out treatment plans, with long-term follow-up of the patients.

Principal teaching methods:

Outpatient teaching.

Educational content:

Exposure to a full range of hematologic and oncologic disorders, including hematologic malignancies and leukemias. Fellows will have the opportunity to teach patients and families about these diseases, and to counsel them, as well as to learn about the side effects of cancer therapy and the management of patients with all stages of disease, including its terminal stage.

Mix of diseases:

See above.

Patient characteristics:

Men and women of all ages and ethnic backgrounds.

Types of clinical encounters:

Interviews and examinations, review of medical records and radiographs.

Procedures:

Bone marrow aspirations and biopsies, lumbar punctures, the supervision of chemotherapy, administration of intrathecal/intraventricular chemotherapy.

Educational resources:

Multi-headed teaching microscope and television, textbooks, X-ray view boxes, computer terminals.

Supervision:

Fellows are be supervised by faculty in hematology/oncology in each clinic. Patient care coordinators are available for consultation to help with psychosocial problems.

Philadelphia VA Medical Center

Fellows see patients at the Philadelphia VA Medical Center under the general supervision of Kenneth Algazy, MD, chief of hematology/oncology, and under the direct supervision of an attending physician in hematology/oncology.

Hematology/oncology at the VAMC provides outpatient care to all patients with active hematologic or oncologic problems and both inpatient and outpatient consultative services.

The outpatient clinical practice consists of morning clinics that take place on successive mornings, Monday through Friday/ The clinics are staffed by Penn hematologists/oncologists and are organized such that each day has a different theme, including malignant hematology, GI malignancies, head and neck cancer and lung cancer. During the mornings, fellows work in these various outpatient clinics. In the afternoon, the fellow and the consult attending supervise the hematology/oncology inpatient consult service and oversee the care of hematology/oncology inpatients.

Several multidisciplinary tumor boards are held at the VAMC, and the fellow and consult attending serve as the medical oncologists for these conferences.

The purpose of the program is to provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic and oncologic diseases in both inpatients and outpatients.

Principal teaching methods:

Outpatient teaching, inpatient consults, clinical conferences and case reviews, literature reviews.

Educational content:

Exposure to the diagnosis, treatment, and prevention of a variety of hematologic problems and liquid and solid tumors, particularly intrathoracic neoplasms, aero-digestive cancer, head and neck malignancies, and prostate cancer.

Mix of diseases:

As above.

Patient characteristics:

Largely men, including a high representation of the geriatric population.

Types of clinical encounters:

Interviews and examinations in the outpatient office and on inpatient services.

Procedures:

Bone marrow aspiration and biopsies, supervision of chemotherapy infusion, intrathecal/intraventricular chemotherapy administration.

Educational resources:

As previously noted.

Supervision:

Fellows are supervised by members of the Penn faculty who serve primarily at the VAMC or at HUP.