Download Description of Rotation or Educational Experience

VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
Second- and Third-Year Fellow Hematology Ambulatory and Elective
Block Rotations
Description of Rotation or Educational Experience
The Second and Third Year Fellow Hematology Ambulatory Rotation is a combination of experiences in various clinical and
clinical pathology laboratory facilities designed to provide a broad exposure to the clinical practice of outpatient hematology.
Clinical exposures afforded during this rotation include the following:
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Hematology faculty clinics: Responsible faculty: J. Christian Barrett, MD and Shejal Patel, DO
Sickle cell clinic. Responsible faculty: Wally Smith, MD
Anticoagulation management clinic. Responsible faculty: J. Christian Barrett, MD; Stacy Dean, PharmD; Ann Scott, NP.
Hemophilia Comprehensive Care Clinic. Responsible faculty: J. Christian Barrett, MD; Janice Kuhn, RN.
Hematology and Coagulation Laboratories. Responsible faculty: Roger Riley, MD; Ann Tidwell
Location:
MCVH/VCUHS Massey Cancer Center Dalton and Stony Point Oncology Clinics; Department of Internal Medicine Subspecialties
Clinic; and MCVH/VCUHS Clinical Laboratories
Length of Experience:
4-8 week block – days only, no weekend or night call
Educational Goals
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Gain additional experience and knowledge in the diagnosis and management of outpatients with benign hematologic
problems.
Gain additional experience and knowledge in the diagnosis, staging, and management options of outpatients with
hematologic malignancies
Gain additional experience and knowledge in the role and function of a subspecialty consultant
Gain experience in the laboratory techniques in benign hematology and coagulation laboratories
Patient Care
Goal
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health
problems and the promotion of health. Please refer to overview of the fellowship curriculum for competencies/objectives for
patient care.
Specifically, fellows will see patients in all of these clinic settings under the supervision of the appropriate subspecialty faculty
member. Fellows will participate in the evaluation and management of acutely and chronically ill hematology outpatients in
order to learn the different approaches to outpatient consultative hematology. Fellows will additionally work with clinical
pathology faculty and laboratory supervisors to develop an understanding of the technical aspects of performing and
interpreting various laboratory tests used in the diagnosis and provision of therapeutic interventions for the care of patients
with hematologic disorders.
Competencies
Fellows are expected to:
• Gather appropriate clinical information
• Synthesize information into a care plan
• Partner with patients/families in the implementation of the plan
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Coordinate care plans with referring physicians, social workers, and home health agencies
Objectives
Fellows are expected to:
• Develop skills in history/physical examination of the patient with hematologic disorders
• Develop skills as an outpatient subspecialty consultant
• Integrate clinical data in the formation of a comprehensive care plan
• Recognize the common sources of error in the performance and interpretation of hematology laboratory assays
• Document the encounter in the medical record in sufficient detail to communicate to other physicians and meet
billing requirements
• Provide compassionate, appropriate, and comprehensive patient care through:
o Responding to requests for outpatient consultation, evaluation and/or management in a timely and
appropriate fashion,
o Providing appropriate follow-up management
Medical Knowledge
Goal
Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral
sciences, as well as the application of this knowledge to patient care.
Competencies
Fellows are expected to demonstrate skills in:
 Acquisition of knowledge
 Analysis of information
 Application of knowledge
Objectives
All fellows are expected to:
 Demonstrate the ability to perform a comprehensive and accurate physical examination; demonstrate the ability to
arrive at an appropriate differential diagnosis; outline a logical plan for specific and targeted investigations pertaining
to the patient’s complaints; and formulate a plan for management and follow-up treatment of the patient
 Demonstrate their knowledge by presenting the results of a consultation orally and in writing and by defending the
clinical assessment, differential diagnosis, and diagnostic and management plans
Content-Specific Objectives
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Normal Hematopoiesis
 The Hematology trainee should demonstrate a working understanding of hematopoiesis. This should include
understanding the developmental processes of all hematopoietic cell lineages beginning with the pluripotential
stem cell.
 The Hematology trainee should demonstrate an understanding of cell surface receptor and cell surface protein
changes that occur in the normal development and differentiation of hematopoietic cells. There should also be
an understanding of the role of growth factors and cytokines on the development and differentiation of these
cells. The impact of gender, pregnancy and age on hematologic parameters and functions should be recognized.
Red Blood Cell Disorders
 Anemia.
 Demonstrate a comprehensive working knowledge and practical competency of the basic molecular and
pathophysiologic mechanisms, diagnosis and therapy of anemia.
 Use a complete blood count with RBC indices to categorize the likely causes of anemia. Likewise, the trainee
should understand what the RBC indices represent and what leads to their abnormality.
 Interpret and recognize morphologic variations of RBCs (on peripheral blood smear and bone marrow
aspirate) and correlate these with their likely pathophysiological conditions.
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Demonstrate a working knowledge and practical competency of the indications and interpretation of a bone
marrow aspirate and biopsy in the evaluation of anemia.
Demonstrate a comprehensive working knowledge of the physiology of iron, vitamin B12 and folate
utilization, storage and transport and determine the appropriate replacement therapy for nutritional
deficiency anemia. This includes demonstrating the ability to calculate the magnitude of the deficit and the
proper replacement regimen.
Demonstrate knowledge of the underlying causes, the pathophysiologic basis, the diagnostic criteria,
differential diagnosis, and management of anemia of chronic disease.
Demonstrate a comprehensive working knowledge and practical competency of the underlying causes,
diagnosis and management of red cell aplasia and hypoplasia inclusive of understanding the direct toxicity to
the bone marrow of infectious diseases, toxins and metabolic insults and the role and use of immunologic
modifier therapy (e.g. antithymocyte globulin, cyclosporine, glucocorticoids) and stem cell transplantation.
Demonstrate a comprehensive working knowledge and practical competency in the genetics,
pathophysiology, diagnosis pathophysiology, diagnosis (including interpretation of a bone marrow aspirate
iron stain), and management of the sideroblastic anemia.
Demonstrate a comprehensive working knowledge of the genetics and pre-natal diagnosis of the
thalassemia; the ability to make a diagnosis of thalassemia with the ability to distinguish between the
different “types” of thalassemia (i.e. , , major, minor, etc.); and the ability to manage the various types of
thalassemia along with their clinical sequelae (iron overload, skeletal abnormalities and organomegalies).
Demonstrate a comprehensive working knowledge of the genetics and physical properties of hemoglobin S.
The trainee should be capable of establishing the diagnosis of sickle cell disease and the variant sickle cell
syndromes (e.g. S/Thalassemia, SC disease, etc.) along with the recognition, diagnosis, and management of
their clinical sequelae (especially the life-threatening aspects, such as pain, acute chest syndrome, hemolytic
and aplastic crises, risk of infections, sickle cell lung disease, and strokes)
Demonstrate a comprehensive working knowledge and practical competency for the role and use of fetal
hemoglobin synthesis stimulators (e.g. hydroxyurea, butyrate), transfusion therapy, and stem cell
transplantation in the management of sickle cell disease.
Demonstrate a comprehensive working knowledge of the etiologies of autoantibody development. This
includes an understanding of primary autoantibody production and autoantibodies that develop as sequelae
of other diseases (secondary causes).
Demonstrate a comprehensive working knowledge of the different mechanisms by which autoantibodies can
lead to destruction of RBCs. This includes understanding how to distinguish between warm autoantibodies,
cold autoantibodies, cryoglobulins and cold agglutinins in the etiology of hemolytic anemias.
Demonstrate practical competency for evaluating, diagnosing and recognizing the clinical sequelae of the
hemolytic anemias. This should include demonstrating an understanding of the direct and indirect
antiglobulin tests and of the methods used to identify and classify autoantibodies.
Demonstrate practical competency in managing autoimmune hemolytic anemia. This should include
demonstrating the ability to recognize indications for treatment, the use of glucocorticoids, IVIg,
immunosuppression therapy, and RBC transfusions. In addition, the trainee should demonstrate the ability
to recognize and manage the sequelae of autoimmune hemolytic anemia.
The hematology trainee should demonstrate a comprehensive working knowledge of RBC metabolic
deficiencies that lead to hemolysis. This includes an understanding of deficiencies of glucose-6-phosphatedehydrogenase (G6PD) and pyruvate kinase (PK), among others, and the conditions that aggravate these
deficiencies. The trainee should demonstrate an understanding of the biochemical pathways affected by
these enzyme deficiencies.
The hematology trainee should demonstrate practical competency in diagnosing and managing the
metabolic enzyme deficiency hemolytic anemias.
The hematology trainee should demonstrate a comprehensive working knowledge and practical competency
for the pathophysiology, diagnosis and management of PNH and its associated complications.
The hematology trainee should demonstrate a comprehensive working knowledge of the relationship
between structure and function of the RBC membrane and how mutations in the different membrane
components lead to hemolytic syndromes.
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The hematology trainee should demonstrate practical competency for differentiating between these
disorders, recognizing microscopic morphologic presentations of these disorders, managing these different
disorders and their associated clinical sequelae, and counseling patients about their disease and associated
complications.
The hematology trainee should demonstrate a comprehensive working knowledge of the pathophysiology of
the different causes of MAHA. This should include demonstrating the ability to differentiate between
thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), among others.
The hematology trainee should demonstrate practical competency for diagnosing and managing TTP, HUS,
disseminated intravascular coagulation (DIC) and the other MAHA.
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The hematology trainee should demonstrate a working knowledge and practical competency of the
pathophysiology, diagnosis and management of a variety of other acquired etiologies of hemolytic anemia.
These etiologies should include physical (traumatic) fragmentation, infectious diseases, chemicals and toxins,
physical agents (e.g. burns), and the impact of disorders of other organ systems.
 Erythrocytosis
o The hematology trainee should demonstrate a working knowledge and practical competency of the basic
molecular and pathophysiologic mechanisms, diagnosis and therapy of disorders that cause an increase in
RBC number and/or mass. These include polycythemia rubra vera (see Section IV.C.2.) and secondary
causes. The trainee should be able to differentiate between primary (polycythemia rubra vera) and
secondary causes of erythrocytosis.
o The hematology trainee should demonstrate a working knowledge of the physiology and role of
erythropoietin in erythropoiesis and of the practical application and interpretation of measured
erythropoietin levels. The trainee should be familiar with the American Society of Clinical Oncology
(ASCO)/ASH evidence-based clinical practice guidelines for the use of erythropoietin in cancer patients.
 Hemochromatosis
o The hematology trainee should demonstrate a comprehensive working knowledge of the basic molecular
and pathophysiologic mechanisms that lead to the development of hemochromatosis. This should include
identifying risk factors and the common genetic mutations that are associated with an increased risk of a
person developing hemochromatosis.
o The hematology trainee should demonstrate practical competency for recognizing the presentation and
making the diagnosis of hemochromatosis. This should include the ability to use and interpret molecular
diagnosis assays, including those that identify the C282Y and H63D mutations of the hemochromatosis gene
(HFE).
o The hematology trainee should demonstrate the ability to recognize the clinical sequelae and complications
of hemochromatosis on systemic organ systems.
o The hematology trainee should demonstrate practical competency for managing patients with
hemochromatosis. This should include understanding the indications for the initiation and choice of therapy
and the expected outcome and toxicities of phlebotomy and iron chelation therapies.
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White Blood Cell Disorders
o Demonstrate a comprehensive working knowledge and practical competency of the basic pathophysiologic
mechanisms, diagnosis and therapy of qualitative granulocyte dysfunction disorders, including enzyme
deficiencies, enzyme storage disorders, Chediak Higashi syndrome, chronic granulomatous disease and leukocyte
adhesion deficiency. In order to accomplish this understanding of granulocyte disorders, a basic understanding
of normal white blood cell development, differentiation, migration and trafficking should be acquired by the
trainee.
o Demonstrate a comprehensive working knowledge and practical competency of the pathophysiologic
mechanisms that lead to generation of a differential diagnosis of granulocytopenia and understanding the
diagnostic approach to identifying the etiology of granulocytopenia and agranulocytosis.
o Demonstrate a comprehensive working knowledge of the risks associated with granulocytopenia along with an
understanding of the indication and role of cytokines (e.g. G-CSF, GM-CSF) in management of patients with
granulocytopenia and agranulocytosis.
o Discuss normal B and T lymphocyte differentiation and development and demonstrate a basic understanding of
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the genetics and pathophysiological mechanisms of B and T lymphocyte functional and numerical deficiencies
Demonstrate a comprehensive working knowledge and practical competency of recognizing, diagnosing and
managing specific diseases that consist of lymphocyte dysfunction, including common variable
immunodeficiency, severe combined immunodeficiency, adenosine deaminase deficiency, Wiskott-Aldrich
syndrome, ataxia-telangiectasia, DiGeorge anomaly, selective immunoglobulin deficiencies, Omenn syndrome,
reticular dysgenesis and others.
Demonstrate a working knowledge and a practical competency of the basic molecular and pathophysiologic
mechanisms that can lead to leukocytosis (e.g. neutrophilia, lymphocytosis, hypereosinophilia).
Generate a differential diagnosis, develop a diagnostic approach to identifying the etiology, and describe the
clinical consequences of both primary and secondary leukocytosis.
Demonstrate a working knowledge and practical competency of the indications and approaches for interfering
with increased white blood cell production by pharmacologic agents, biologic agents, and mechanical methods
(i.e. leukopheresis) to transiently decrease the elevated leukocyte number. The indications, pharmacologic
agents, and dosages and toxicities of these agents and approaches should be understood.
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Platelet and Megakaryocyte Disorders
 Demonstrate an understanding of the pathophysiologic mechanisms, the ability to identify and interpret the
appropriate studies needed to diagnose, and the ability to manage the various inherited disorders of platelet
phase hemostasis, i ncluding von Willebrand’s disease, Bernard-Soulier syndrome, platelet collagen receptor
deficiency, Glanzmann thrombasthenia gray platelet syndrome, dense granule deficiency, primary secretion
defects and platelet procoagulant activity disorders.
 Demonstrate a working knowledge of the technical aspects of performing and interpreting platelet aggregation
assays and platelet antigen identification assays.
 Demonstrate a working knowledge and practical competency of the basic pathophysiologic mechanisms,
diagnosis and therapy of acquired platelet function disorders.
 Demonstrate a comprehensive working knowledge and practical competency of the differential diagnosis, basic
molecular and pathophysiologic mechanisms, approach to diagnosis, and therapy of diseases that result in
qualitative diminishment of platelets due to a decreased production of or an increased destruction of platelets.
 Recall the Internaltional Consensus and ASH guidelines for the diagnosis and management of patients with
immune thrombocytopenic purpura (ITP).
 Assess the bleeding risk for a given level of thrombocytopenia.
 Demonstrate a comprehensive working knowledge and practical competency of the basic molecular and
pathophysiologic mechanisms that lead to primary and secondary thrombocytosis
 Generate an approach to diagnosis of the cause and management of thrombocytosis.
 Recognize the consequences associated with thrombocytosis that may range from bleeding to thrombosis and
the trainee should understand how to assess the associated risks of thrombocytosis to individual patients.
 The hematology trainee should demonstrate an understanding of the anti-platelet function drugs including
mechanism of actions, pharmacokinetics, toxicities, indications, dosages and interactions of all classes of antiplatelet drugs (i.e. aspirin, ticlopidine/clopidogrel, dipyridamole, GP IIb/IIIa inhibitors, etc).
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Bone Marrow Failure States
 List and describe the clinical characteristics of the inherited and congenital forms of bone marrow failure states.
The trainee should demonstrate a basic working knowledge and practical competency of diagnosing and
managing these disorders.
 Demonstrate the ability to provide a differential diagnosis and the acquisition of practical knowledge of the role
of medications, other drugs and environmental pathogens (including chemicals and infectious diseases) in the
development of bone marrow failure states. An understanding of the approach to diagnosis and management of
these disorders should be demonstrated.
 Demonstrate a comprehensive working knowledge and practical competency of the diagnosis and therapy of
aplastic anemia. An understanding of the indications and risks of various treatment approaches (including stem
cell transplantation, anti-thymocyte globulin, cyclosporine, other immune mediators) should be demonstrated by
the trainee.
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Generate a differential diagnosis of and an approach to diagnosis of the etiology of pancytopenia.
Hemostasis
 Discuss the basic mechanisms and components of normal hemostasis and thrombosis. This should include a
practical knowledge of the function and interactions of procoagulant and anticoagulant proteins, cellular
contributions and interactions between these components as well as with vascular endothelium.
 Bleeding Disorders
 Demonstrate a comprehensive working knowledge and practical competency of the basic molecular and
pathophysiologic mechanisms of genetic and accuired causes of disorders of hemostasis.
 Demonstrate an understanding of the pathophysiologic abnormalities associated with the different types of
von Willebrand's disease and recognize the clinical presentation, diagnose and characterize the different
types of von Willebrand's disease. The Hematology trainee should have knowledge of the clinical
implications of the different types of von Willebrand’s disease and should demonstrate practical competency
in the treatment of these disorders.
 Demonstrate a working knowledge of the cause of hemophilia A and B, and other inherited factor deficiency
states including their diagnosis and management in the acute bleeding and procedure prophylaxis settings
 Demonstrate a comprehensive working knowledge and practical competency for recognizing, diagnosing,
and managing acquired bleeding disorders. This should include recognizing the effects of systemic diseases
(e.g. liver disease, renal failure) on hemostasis, disorders caused by the acquisition of coagulation factor
antibodies (inhibitors), platelet disorders (see above), and effects of medications
 Recall the role of vascular abnormalities in the etiology of specific bleeding disorders.
 Demonstrate practical competency using various diagnostic tools, and interpreting their results, in patients
with bleeding disorders, including platelet function studies, bleeding time, coagulation factor assays, and
coagulation factor inhibitor screens and assays.
 Thrombotic Disorders
o The hematology trainee should demonstrate a comprehensive working knowledge and practical competency
of the basic molecular pathophysiologic mechanisms, diagnosis and therapy of diseases that lead to
thrombosis.
o Recall the methods for prophylaxis, diagnosis, and treatment of venous thrombosis, including the proper use
of anticoagulant therapies in both medical and surgical populations.
o Discuss the indication, approaches to and limitations of genetic testing to assess risk factors for thrombosis.
 Demonstrate a comprehensive working knowledge of the clinical presentation, pathogenic mechanism,
diagnosis and management of heparin-induced thrombocytopenia. The trainee should also demonstrate an
understanding of the risk and consequences of thrombosis in these patients.
 Demonstrate a comprehensive working knowledge and practical competency for diagnosing and managing
the manifestations of antiphospholipid syndrome. This should include a comprehensive working knowledge
of the different antibodies that can be assayed and used in the diagnosis of this syndrome and a practical
competency for the use of prophylaxis for those patients at risk of thrombosis. The trainee should also
demonstrate practical competency for recognizing and managing the clinical manifestations associated with
antiphospholipid syndrome, including the implications and risks associated with pregnancy and surgery.
 Pharmacologic Manipulation of Bleeding and Thrombosis
 Demonstrate a practical competency with the use of the various classes of antithrombotics and
anticoagulants that are available including their mechanisms of action, indications, appropriate dosing,
monitoring, means of reversal, and appropriate duration of therapy for various clinical situations.
 Demonstrate practical competency with various factor replacement products, inhibitor “bypass” products,
antifibrinolytic agents, and the role of blood products for the management of bleeding disorders. The
trainee should demonstrate a general understanding of the pharmacology dosing and administration of
these agents as well as of their toxicity and potential interactions with other medications and factors.
Hematologic Malignancies
o Demonstrate the knowledge of the WHO classifications of Hematologic malignancies
o Demonstrate an understanding of the pathophysiology of the hematologic malignancies including histologic
grade, role of infectious agents, and genetic factors
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Demonstrate an understanding of the diagnostic modalities used in differentiating hematologic malignancies
such as lymph node biopsy, bone marrow biopsy, flow cytometry, cytogenetics, and molecular diagnostics.
Demonstrate knowledge of staging and prognostic factors for lymphoma including the Ann Arbor Staging
System and the International Prognostic Index.
Demonstrate knowledge of treatment of Non-Hodgkins lymphoma based on grade (low, intermediate vs.
high), as well as aggressive vs. indolent nature and stage of disease
Demonstrate knowledge of options for treatment of indolent Non-Hodgkins lymphoma including but not
limited to: observation, chemotherapy, radiation therapy, immunotherapy, stem cell transplant, monoclonal
antibodies, and combination of aforementioned above
Demonstrate knowledge of treatment of aggressive Non-Hodgkins Lymphoma including those mentioned
above except observation
Demonstrate knowledge of referral for stem cell transplant in relapsed or refractory lymphomas
Demonstrate knowledge of the bcr-abl in CML, genetic and molecular abnormalities in CLL
Demonstrate knowledge of the diagnosis of chronic leukemias based on peripheral blood smear review, PCR
or FISH for CML, and flow cytometry for CLL
Demonstrate knowledge of the chronic, accelerated, and blast phase of CML
Demonstrate knowledge of the RAI and Binet staging in CLL
Demonstrate knowledge of treatment of CML including but not limited to chemotherapy, tyrosine kinase
inhibitors, interferon, treatment of blast phase, and the role of stem cell transplantation
Demonstrate knowledge of treatment options based on stage of CLL including but not limited to observation,
purine analogues, alkylating agents, combination systemic therapy, monoclonal antibodies, stem cell
transplant, radiation therapy, splenectomy, steroids
Demonstrate knowledge of hypogammoglobinemia, infection risk, and autoimmune hemolytic anemia and
thrombocytopenia in CLL
Demonstrate knowledge of treatment of Hodgkin lymphoma at all stages of disease (initial and relapsed)
distinguishing the role of radiation therapy, chemotherapy, and stem cell transplant.
Demonstrate knowledge of follow up and continued treatment of the acute leukemias after discharge from
the inpatient setting, including maintenance therapy in APL and ALL
Demonstrate knowledge of the pathophysiology, staging, prognosis, and therapeutic options for multiple
myeloma.
Demonstrate knowledge of the use of supportive therapies for bony disease including but not limited to
neuororadiologic interventions, radiation therapy, radioactive biologics, medical pain management, and
bisphosphonates.
Understand supportive care related to treatment of hematologic malignancies including fertility and
sexuality issues, monitoring for the development of secondary malignancy due to prior chemotherapy +/radiation exposure, and monitoring for long term cardiac complications
Understand the importance of clinical trials in hematologic malignancies
Practice- Based Learning and Improvement
Goal
Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific
evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.
Please refer to overview of the fellowship curriculum for competencies/objectives for practice based learning and improvement.
Systems Based Practice
Goal
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the
ability to call effectively on other resources in the system to provide optimal health care
Please refer to overview of the fellowship curriculum for competencies/objectives for systems based practice.
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Professionalism
Goal
Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
Please refer to overview of the fellowship curriculum for competencies/objectives for professionalism.
Interpersonal and Communication Skills
Goal
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and
teaming with patients, their families, and professional associates.
Please refer to overview of the fellowship curriculum for competencies/objectives for interpersonal and communication skills.
Teaching Methods
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Clinical teaching
Role modeling
Patient care/clinical experience
Didactic sessions (division, department, institution)
Performance feedback
Observation of laboratory methods
Hands-on interpretation of laboratory data
Self-directed learning
Assessment of Fellow Performance
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Evaluation by the attending of the fellow
Assessment of Rotation
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End of rotation assessment by the fellow of the faculty
Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision
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Direct supervision and indirect supervision with direct supervision immediately available by adult-trained hematology
and/or oncology physicians during the faculty clinics, sickle cell clinics, and hemophilia clinics
Direct supervision by the PharmD and NP specialists in the anticoagulation management clinic with oversight by the
faculty MD
Direct supervision and indirect supervision with direct supervision immediately available by clinical pathologists and
laboratory personnel in the hematology and coagulation laboratories
Educational Resources
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Devita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology (9th Edition)
Hoffman Hematology: Basic Principles and Practice (4th Edition)
UpToDate
ASCO University
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ASCO Practice and Guidelines
ASCO-SEP
ASH-SEP
NCCN Guidelines (www.nccn.org)
NCI Common Cancer Types and Clinical Trails by Cancer Type/Disease (www.cancer.gov)
Common Toxicity Criteria v4.0 (aka Common Terminology Criteria for Adverse Events)
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