Cancer and Blood Diseases Center

Rotations

Fellows do one year of clinical training and rotate through six services: hematology, hematologic malignancy, solid tumor, stem cell transplantation, ambulatory hematology, and neuro-oncology. They also receive training in transfusion medicine and laboratory medicine. Fellows follow 20-25 oncology patients, 5-10 stem cell transplant patients and 30-40 hematology patients, on average, for all three years of fellowship (and beyond), and function as their primary caregiver.

Hematologic Malignancy Service

Two rotations. On this service, the hematology/oncology fellow covers all inpatients with hematologic malignancies, and participates in workups of new patients with suspected hematologic malignancies.  The inpatient hematologic malignancy service includes oncology patients on a 21 bed, geographically distinct hematol­ogy/oncology ward. He or she is responsible for running morning work rounds and evening sign-out rounds, for co­ordinating the relationship between the attending and the ward service, and for supervising two PL-2 residents in all aspects of the medical and oncologic management of the patients on this service (there is no PL3 resident on this service). A third, night float resident takes overnight call. The fellow makes morn­ing rounds daily with the attending, residents, nurse practitioner, and nurses, at which time medical problems are discussed, oncologic and medical therapy is planned, and support services (psycho­therapy, social services, pain control, etc) are organized. The fellow is responsible for all aspects of the oncologic care of the patients on the service including chemotherapy orders, monitoring for chemotherapy complications and patient procedures. The fellow is also responsible for education of residents and conducts sign?out rounds in the evenings.  In addition, the fellow on the Hematologic Malignancy Service provides consultative care of hematologic malignancy patients in the intensive care unit and on other inpatient services throughout the hospital.

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Solid Tumor Service

Two rotations. During this rotation, the he¬matology/oncology fellow is directly responsible for supervising the medical and oncologic care of patients with solid tumors, including those receiving inpatient care, newly diagnosed oncology patients on several of the serv¬ices at Children's Hospital, as well as new patients with suspected solid tumors referred to the Jimmy Fund Clinic. Like the hematologic malignancy fellow, the solid tumor fellow cares for solid tumor patients on the 21-bed hematology/oncology ward, in conjunction with a solid tumor attending, a nurse practitioner, and a daytime PL2 resident (with a night float resident overnight.) The fellow also supervises solid tumor patients who are primarily cared for by other services, including surgical oncology patients and patients in the intensive care unit. The fellow also has the opportunity to join in the consultation for patients coming from other centers with complicated oncologic issues. Finally, s/he often supervises a medical student assigned to an elective course in clinical oncology.

Inpatient Hematology and Hematology Consult Service

Two rotations. During this rotation the hematology/oncology fellow is directly responsible for the management of non-malignant hematology patients hospitalized on the hematology service at Children's Hospital, and is the hematology consult fellow for all services at Children's Hospital and affiliated neonatal ICUs. Most Hematology patients are admitted to 6E or 6N, in close proximity to the Oncology and Stem Cell Transplant Services. The fellow usually supervises one medical student. In addition, Children's Hospital second year pediatric residents are also assigned to this rotation, and visiting fellows from adult hematology/oncology programs sometimes share in consultations. As on the other services, daily work rounds, attending rounds and sign-out rounds are made. A major part of this rotation is learning blood morphology both with the Hematology Attending and with the Hematopathology faculty. The hematology fellow is also responsible for hematology patients seen in the emergency room, and for cross-covering the ambulatory hematology fellow when he or she is in oncology (Jimmy Fund) clinic.

Ambulatory Hematology / Transfusion Medicine / Laboratory Hematology

Two rotations. During this rotation the fellow attends the hematology clinics, including the hemophilia, bone marrow failure, and sickle cell disease comprehensive clinics, works up about 12 to 15 new patients per week in the ambulatory hematology clinic, is responsible for thalassemia, sickle cell anemia, bone marrow failure or other patients (about 3/day) admitted to the ambulatory transfusion unit (called the CAT/CR) for blood or platelet transfusions or IV gamma globulin therapy. The fellow also participates in a short course in laboratory hematology and transfusion medicine, and helps to handle outside calls to the hematology service.

Stem Cell Transplantation Service

Two rotations: Each fellow is responsible for the care of patients undergoing hematopoietic stem cell transplantation on the 13-bed transplantation unit at Children's Hospital (6 West). The stem cell transplant team consists of one attending, one fellow, one daytime PL-2 resident, as well as one to two nurse practitioners with expertise in stem cell transplant care and occasionally a rotating fellow from another institution. The primary fellow organizes rounds with the attending physician and daily nursing team, supervises and teaches the PL-2 resident, writes chemotherapy and detailed admission orders for patients being admitted for transplantation, and performs procedures when necessary (including bone marrow harvests one to two times each month). The fellow also conducts sign-out rounds in the evenings.

Neuro-oncology

One rotation. While on the Neuro-oncology service, fellows are responsible for evaluations of new Neuro-oncology patients, participating in second opinions and the Brain Tumor Clinic, and participating in the care of all Neuro-oncology inpatients. The fellow may work with a dedicated Neuro-oncology fellow. In addition to clinical responsibilities, conferences with an emphasis on Neuro-oncology are held throughout the week.

Elective

Two rotations. The elective fellow can chose between a variety of pre-arranged selectives which include pathology, surgical oncology, palliative care, radiation oncology, late effects of chemotherapy and the pain management service or can arrange their own elective experience. The fellow on elective continues to attend his or her hematology and oncology clinics.

Vacation

Fellows receive a total of 3 weeks of vacation during their clinical year, divided into two blocks.