Download Competency-based Goals and Objectives

Stony Brook Pediatrics
Hematology/Oncology Outpatient Elective Rotation
Competency-based Goals and Objectives
Primary Goals for this Rotation
Competencies
GOAL I: Prevention, Counseling and Screening (Hematology/Oncology).
Understand the role of the pediatrician in preventing hematologic or
oncologic conditions, and in counseling and screening individuals at risk
for these diseases.
1. Provide routine preventive counseling about hematology to all patients and
families, addressing:
a) Adequate diet and iron intake to prevent iron deficiency
b) Signs, symptoms and risk of sickle cell crises
c) Signs, symptoms, and risks for thrombotic events in a child identified
of being at risk
K, PC, IPC, P
2. Provide preventive counseling to parents and patients with specific
hematology/oncology conditions, addressing:
a) In a child with a sickle hemoglobinopathy, the importance of antibiotic
prophylaxis, pneumococcal and routine immunizations, folic acid
supplementation, and urgent need for evaluation for fever
b) Risk of infections related to transfusion of blood or blood products, and
K, PC,
alternatives to routine transfusion (i.e., direct donation, irradiation,
freezing, filtration)
SBP, P
c) Expected course of common childhood malignancies, with good and bad
prognosticators
d) Support groups and information available for children with cancer
e) Thrombosis risks in patients with known inherited risk factors for
thrombosis
3. Describe regular hematology/oncology screening for patients:
a) Screen for hemoglobinopathies in the newborn period.
b) Screen for iron deficiency anemia during the first two years of life, with
particular emphasis on premature infants.
c) Screen adolescent females for signs of iron deficiency and anemia
yearly after menses has begun.
d) Screen for -thalassemia trait
GOAL II: Normal Vs. Abnormal (Hematology/Oncology). Distinguish
normal from pathologic states of the hematologic and lymphatic systems.
K, PC
IPC,
1. Explain the findings on clinical history and examination that suggest a
hematologic or oncologic disease that requires further evaluation and
K,
treatment.
2. Interpret clinical and laboratory tests to identify hematologic or
oncologic disease (CBC, including indices and blood smear review,
reticulocyte count, PT, PTT, hemoglobin electrophoresis, iron, iron
K,
binding capacity, ferritin, transferrin, uric acid, LDH, electrolytes, renal
function, urinalysis).
3. Describe the changes that occur over time in the hematologic indices of K
the normal infant and child (e.g. Hemoglobin, hematocrit, MCV)
4. Discuss the interpretation of a bone marrow aspirate.
K
PC
PC
GOAL III: Undifferentiated Signs and Symptoms
(Hematology/Oncology). Evaluate, treat, and/or refer patients with
presenting signs and symptoms that may indicate a hematologic or
oncologic disease process.
Evaluates, treats and/or refers patients with presenting signs and
symptoms of commonly or less commonly or rarely seen
conditions
Develops a strategy to determine if the following presenting signs and
symptoms are caused by a hematology/oncology disease process and
determine if the patient needs treatment or referral:
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Fatigue/malaise
Fever
Bruising/bleeding
Headache
Limb pain/limp
Lymphadenopathy
Hepatomegaly and/or splenomegaly
Weight loss
Abdominal pain
Vomiting
Dizziness and gait disturbances Pallor
Mass
K, PC
GOAL IV: Common Conditions Diagnose and manage patients with
common hematological disorders
1. Diagnose, explain, and manage the following hematologic or oncologic
conditions:
a)
b)
c)
d)
e)
f)
Iron deficiency
Idiopathic thrombocytopenic purpura
Major and Minor reactions to blood or blood product transfusions
Hemoglobinopathies
Transient erythroblastopenia of childhood
Bone lesions (differentiation between benign and malignant
lesions)Congenital and acquired bleeding disorders
GOAL V: Conditions Generally Referred (Hematology/Oncology).
Diagnose and initiate management of patients with hematological or
oncological disorders that generally need referrals.
K, PC
1. Identify and explain conditions a – m (below):
Initially manage, and seek consultation or refer the following
hematology/oncology conditions:
a) Anemia (exclusive of common iron deficiency or transient erythropenia
b) Abnormal bruising or bleeding (inherited and acquired)
c) Hemoglobinopathies (sickle cell and other sickling disorders), including
severe pain crisis, fever, stroke, sequestration and aplastic crises
d) Urgent conditions in children under treatment for cancer, including fever
and neutropenia, chicken pox exposure or illness, bleeding
e) Neutropenia
f) Thrombocytopenia including ITP
g) Abdominal masses
h) Major complications of inherited bleeding disorders
i) Mediastinal masses
j) Suspected or confirmed CNS tumor
k) Conditions that might predispose to malignancy (e.g.. , Bloom syndrome
(retinoblastoma), and familial cancer), hemihypertrophy
l) Coagulation disorders
K, PC, IPC
2. In cases of serious or life-threatening disease, counsel the patient's families
with sensitivity to their desire and need to know about:
a)
b)
c)
d)
Prognosis and possible impact of the disease
Likely steps in immediate and future treatment
Decisions about treatment options which they may face
Support services that they may seek in the hospital and community
3. Identify the role and general scope of practice of hematology/oncology;
recognize situations where children benefit from the skills of specialists
trained in the care of children
Identify the role and general scope of practice of hematology/oncology;
recognize situations where children benefit from the skills of specialists
trained in the care of children; and work effectively with these professionals
in the care of children with hematologic or oncologic diseases.
K, PC, IPC, P,
SBP
K, PC, IPC,
SBP
GOAL VI: Common Malignancies. Discuss the presentation,
pathophysiology, and prognosis of important malignancies in children
and adolescents.
1. Summarize the common ages, presenting signs and symptoms, diagnostic
procedures for the following malignancies and conditions:
a)
b)
c)
d)
e)
f)
g)
h)
Leukemia (ALL, AML)
Brain tumor
Hodgkin's and non-Hodgkin's lymphoma
Neuroblastoma
Wilms' tumor
Soft tissue sarcomas (rhabdomyosarcoma)
Bone tumors (osteosarcoma and Ewing's sarcoma)
Retinoblastoma
K
i)
Langerhans cell histiocytosis
2. Compare and contrast the common acute side effects of commonly used
chemotherapeutic agents.
3. Discuss the common late complications of childhood cancer treatment that
may present in childhood or adolescence. These include: learning
disabilities, endocrine suppression and second malignant neoplasms.
4. Be familiar with adjunctive medications that increase patients' tolerance of
chemotherapy, e.g. folinic acid, recombinant human erythropoietin, GCSF.
K, PC
K, PC
K, PC
GOAL VII: Iron Disorders. Discuss the appropriate methods of
diagnosis and management of a patient with iron disorders.
1. Describe the normal requirements, absorption, and metabolism of iron from
birth through adolescence.
2. Differentiate iron deficiency anemia from other causes of anemia common
to children.
3. Describe the diagnosis and treatment of iron deficiency, and discuss the
follow-up necessary to assure success in treatment.
4. Develop a treatment and education plan for managing iron deficiency. This
should include: dietary management, replacement therapy, parent
education, and follow-up.
K
K
K, PC
K, PC, IPC
GOAL VIII: Blood Products. Understand indications for and
complications related to the use of blood products.
1. Explain the appropriate indications for and potential risks of various blood
products (e.g., red blood cell products, platelet concentrates, coagulation
factors).
2. Describe the indications for leukofiltration, irradiation of blood products, and
use of CMV negative blood products.
3. Summarize the signs and symptoms of a transfusion reaction. Develop an
effective treatment plan to manage a transfusion reaction.
4. Describe alternatives to blood transfusions. These should include:
erythropoietin
K
K
K, PC
K
GOAL IX: Sickle Cell Disease. Understand the general pediatrician's
role in the diagnosis and management of patients with sickle cell disease.
1. Explain the findings on clinical history, examination, and laboratory tests
(including newborn screening) that suggest a diagnosis of sickle cell
disease.
2. Compare and contrast the different sickle cell syndromes, including
presentation, treatment and complications. These syndromes include sickle
cell anemia, hemoglobin SC, and hemoglobin S -thalassemia.
3. Discuss the common complications seen in a child with sickle cell disease.
These include: hemolysis, hand-foot syndrome, anemia, aplastic crises,
bone infarction, stroke, skin ulcers, pain episodes, priapism, sepsis and
infections, cholelithiasis, chest syndrome, retinopathy, renal failure, and
sequestration crises. Pulmonary hypertension
4. Outline the management of a patient who presents with a sickle crisis.
These should include discussion and proper use of IV fluids, analgesics,
antibiotics, blood transfusions, and indications for hydroxyurea and stem
cell transplant.
K
K
K
K, PC
5. Develop a preventive care plan for a patient with a sickle disease. These
should include use of folate, prophylactic antibiotics, immunizations, prompt
evaluation of febrile episodes and stroke screening.
K, PC
Procedures
GOAL X: Technical and therapeutic procedures.
PL-1 & PL-3:
Describe the following procedures, including how they work and when they
should be used; competently perform those commonly used by the
pediatrician in practice.
Bone marrow: aspiration/biopsy (not expected to perform this)
Central line: use/care
Lumbar puncture
(not expected to perform this)
GOAL XI: Diagnostic and screening procedures.
PL-1 & PL-3: Describe the following tests or procedures, including how
they work and when they should be used; competently interpret reports of
procedures and correlate clinically those commonly used by the pediatrician
in practice.
Radiologic interpretation: abdominal ultrasound
Radiologic interpretation: Abdominal CT (with and without contrast)
Radiologic interpretation: CT of head
Radiologic interpretation: extremity X-ray
Radiologic interpretation: MRI of head
Radiologic interpretation: renal ultrasound
Radiologic interpretation: PET scan
Radiologic interpretation: MIBG
Core Competencies: K Medical Knowledge
PC - Patient Care
IPC - Interpersonal and Communication Skills
PProfessionalism
PBLI - Practice-Based Learning and Improvement
SBP - Systems-Based Practice
K, PC
K, PC
K, PC
K, PC
K, PC
K, PC
K, PC
K, PC
K, PC
Performance Expectations by Level of Training
Beginning
Developing
Accomplished
Competent
Description of
identifiable
performance
characteristics
reflecting a
beginning level of
performance.
Description of identifiable
performance
characteristics reflecting
development and
movement toward
mastery of performance.
Description of
identifiable
performance
characteristics
reflecting near
mastery of
performance.
Description of identifiable
performance
characteristics reflecting
the highest level of
performance.
Medical
Knowledge
Patient Care
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL1, PL2
PL2, PL3
PL3
Interpersonal and
Communication
Skills
Professionalism
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL2, PL3
PL3
Practice-Based
Learning and
Improvement
Systems-Based
Practice
PL1
PL1, PL2
PL2, PL3
PL3
PL1
PL1, PL2
PL2, PL3
PL3