Rotation:
Hematology-Oncology Subspecialty Selective
Goals:
1. Provide medical residents and students with knowledge necessary to evaluate and treat a diverse group of hematologic and oncologic disorders.
2. Emphasize the need to know internal medicine in the management of hematologic and oncologic disorders.
3. Teach the importance of cancer prevention and expose medical residents and students to tools available to educate their patients.
Objectives:
Malignant Hematology
Medical Knowledge and Patient Care
1. Evaluate, treat, and follow-up neutropenic patients both febrile and afebrile.
2. Evaluate and treat thrombocytopenic patients both bleeding and not bleeding.
3. Identify indications and procedures for blood component therapy.
4. Describe chemotherapy principles including concepts of induction, adjuvant and
intensification therapy.
5. Explain concepts of dose intensity including rationale for marrow ablative therapy
and transplantation.
6. Recognize classic toxicities of chemotherapy.
7. Describe etiology, prevention and treatment of tumor lysis syndrome.
8. Review indications and appropriate use of cytokines in hematologic disorders.
9. Identify the clinical characteristics and morphologic characteristics of all leukemias with bone marrow review.
10. Describe classification, diagnosis, and management of Hodgkins and non Hodgkins
lymphomas.
11. Diagnose and management myelodysplastic syndromes and myeloproliterative syndromes.
12. Describe the pathophysiology, diagnosis, and management of graft vs. host disease.
13. Evaluate and manage opportunistic infections.
14. Evaluate and manage organ toxicities from chemotherapy.
Oncology
Medical Knowledge and Patient Care
1. Choose a cost-effective evaluation of patients suspected to have a malignancy.
2. Identify the risk factors, screening, and early detection of breast cancer, lung cancer, colon cancer, prostate cancer, skin cancers and cervical cancer.
3. Evaluate and manage oncologic emergencies including, but not limited to: hypercalcemia, spinal cord compression, brain metastasis, SIADH, tumor lysis syndrome, superior vena syndrome, respiratory failure and effusions.
4. Discuss chemotherapy principles including concepts of radiation, adjuvant, and intensification therapy.
5. Recognize and management the classic toxicities of chemotherapy.
6. Describe the TMN staging of cancers and prognosis/survival related to stage.
7. Demonstrate proper timing and compassionate delivery of bad news to patients and family.
9. Evaluate and management somatic and neutropathic pain both acute and chronic. Demonstrate correct titration of pain medications both narcotic and non-narcotic, choosing the appropriate route of administration, and recognition of limitations due to metabolic pathways.
10. Apply principles of palliative care including but not limited to: management of fatigue, anorexia, pain, dyspnea and recognition of the benefits of appropriate medical therapy.
11. Use ancillary tests in radiology, pulmonology, cardiology and gastroenterology properly in the evaluation of malignant disease.
12. Identify correct indications for use of radiation therapy and describe the basic principles of radiation oncology.
13. Evaluate and manage some less common tumors including but not limited to sarcoma, GU, GI, and head and neck tumors.
14. Employ critical reading skills in reviewing clinical trials involving oncologic literature.
15. Discuss the importance of clinical trials in medical oncology.
Benign Hematology
Medical Knowledge and Patient Care
1. Distinguish among microcytic, macrocytic, and normocytic (including hemolytic) anemia and describe evaluation and management of all types.
2. Distinguish primary from secondary thrombocytopenia describing evaluation and management.
3. Identify cause of leukopenia and make appropriate diagnosis and management.
4. Identify indications and procedures for blood component therapy.
5. Diagnose and treat DIC.
6. Diagnose and treat TTP.
7. Diagnose and treat platelet dysfunction.
8. Diagnose and treat Von Willebrand's disease.
9. Describe the hematological complications of liver disease.
10. Identify the pathophysiology, diagnosis and treatment of Vitamin K deficiency both dietary and warfarin induced.
11. Describe the multiple causes of thromophilia and demonstrate a cost-effective work-up.
12. Explain the pathophysiology of hemophilia and demonstrate how to evaluate and manage its complications.
Learning Venues:
1. Inpatient General Admissions
2. Inpatient and Outpatient 1 month long Hematology-Oncology rotations
3. Optional additional continuity clinic in Heme-Onc for those with a special interest
A reading list is provided to all residents.
Optional Procedures:
1. Accessing indwelling venous catheters
2. Bone marrow aspirate and biopsy
3. Pheresis
4. Bond marrow harvest
5. Intrathecal chemotherapy
Competency Evaluation:
ABIM Global Assessment Form - all six competencies must be rated as satisfactory or superior. A written examination at the end of the rotation will be given to assess medical knowledge and patient care with either an 80% score expected on the closed book exam or a 100% score on the open book test. A procedure log should be maintained on all procedures.
Outcomes Assessment:
1) Hematology-oncology scores on the in-service examination of all residents successfully completing the elective and 2) hematology-oncology scores on the ABIM certifying examination. Our goal is for all residents to score > 50 percentile.