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Rotations

Clinical Training: Rotations (about 30 days each)

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Halloween on the oncology service

Inpatient Medical Oncology (6 North) - 2 rotations. On this service, the hematology/oncology fellow covers the 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, most importantly, for supervising 4 general pediatric 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). The fellow makes morning rounds daily with the attending, residents 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 considerable education of residents and nursing staff and conducts sign out rounds in the evenings.

Oncology Consult Service (OCS) - 2 rotations. During this rotation, the hematology/oncology fellow is solely responsible for supervising the medical and oncologic care of newly diagnosed oncology patients on several of the services at Children's Hospital, as well as new patients referred to the Jimmy Fund Clinic by regional primary care providers. The fellow also supervises medical oncology patients who are primarily cared for by other services, including surgical oncology patients and patients in the intensive care unit, and the fellow has the opportunity to join in the consultation for patients coming from other centers with complicated oncologic issues. Finally, he/she often supervises a medical student assigned to an elective course in clinical oncology.

On the way to do a bone marrow exam

Inpatient Hematology and Hematology Consult Service - 2 rotations. During this rotation the hematology/oncology fellow is directly responsible for the management of private hematology patients hospitalized on the hematology/oncology service at Children's and is the hematology consultant for all services at Children's.

The fellow usually supervises 1 medical student. In addition, Children's general pediatric residents sometimes do an elective on this rotation. As on the other services, daily work rounds, attending rounds and sign-out rounds are made. 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 - 2 rotations. During this rotation the fellow attends the hematology clinics, including the hemophilia and sickle cell disease comprehensive clinics, works up about 12 to 15 new patients per week, is responsible for thalassemia, sickle cell anemia 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.

Dr. Leslie Lehmann meets with nurses on the new stem cell transplantation unit.

Stem Cell Transplantation Service - 2 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 - 1 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 - 2 rotations. The fellow on elective can choose 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 his or her own elective experience. The fellow does some weeknight overnight call in the hospital and 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. The first combines one week of vacation with three weeks of elective during the first 6 months of the fellowship program. The second block, during the second half of the year, combines two weeks of vacation with two weeks of elective.


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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