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University of Oklahoma College of Medicine Residency Template VA Inpatient Consultation Hematology Oncology University of Oklahoma College of Medicine Oklahoma City, Oklahoma ROTATION DIRECTOR Rotation Director: Title: Samer A. Srour, MB ChB Clinical Assistant Professor E-mail: Office: Telephone: [email protected] 800 NE 10th St. 6th Floor 405-456-5315 Coordinator: Title: E-mail: Amanda Davis Staff Assistant/Fellowship Coordinator [email protected] ONLINE RESOURCES MedHub: https://ouhsc.medhub.com/index.mh READING LISTS AND OTHER EDUCATIONAL RESOURCES Access to the print and electronic library at the University of Oklahoma and multiple medical software including Uptodate and Mdconsult. ROTATION DESCRIPTION 1 month rotation on the Hematology/Oncology Inpatient Consultation service. The Hematology consult service provides a vital educational experience to the fellow. Fellows are first called as consultants by the primary team in order to address some aspect of the care or evaluation of a patient with confirmed or suspected diagnosis of cancer or hematologic disorder. Format o o o o Teaching and bedside rounds to include educational teaching as well as patient management on Monday through Friday. There will be one fellow assigned to this service every month. Fellows will have weekends off. During the w/end and after hours, consults will be done by the Hem/Onc fellow on call. The fellow will have the opportunity to work with other fellows in surgical oncology, gastroenterology, pulmonary, cardiology, rheumatology, dermatology, infectious disease, gynecology oncology, ophthalmology, and neurology. Patient Care Responsibilities between Housestaff, Fellows, and Attendings. o Fellow and Housestaff will share responsibilities. All consults will be initially evaluated by either the fellow or a house staff. All consult cases will be discussed Template updated 8/5/2011 1 University of Oklahoma College of Medicine Residency Template o o with the consult fellow whose role is to formulate a clear assessment and plan and to answer the consulting service’s questions. This will be closely supervised by the attending at final recommendations will be made after the attending has evaluated the case Fellow and Housestaff will follow patients under attending's supervision over time as long as follow up services are needed on consulted patients. The fellow will be the first call regarding questions of consult patients and in turn all patient-care decisions will be discussed with attendings. ROTATION GOALS To provide the fellow with training in assessing and developing skills in consultation of inpatient with benign and malignant hematology and oncology diagnoses. Goals o o o o o Technical Skills o o o o o o o o To provide supervised experience in developing skills in an inpatient consultation setting. To provide the skills of developing a diagnostic plan in work up of an unknown malignancy. To provide skills in treatment of patients with disorders of hemostasis, white blood cells, red blood cells, and platelets. To develop skills in cancer prevention, screening and awareness of predisposing causal factors leading to neoplasia. To provide the opportunity to be an active participant in a multidisciplinary tumor board. Supervision for competency in bone marrow aspiration and biopsy, thoracentesis, paracentesis, lumbar puncture, and intrathecal chemotherapy. Supervision for competency in morphological interpretation of peripheral smears, bone marrow aspiration, and hemostasis lab values. Appropriate management of blood products and transfusion principles. Organization of a diagnostic approach to an unknown malignancy. Management of multi-agent chemotherapy and immunotherapy, paraneoplastic disorders, growth factors, and hematology/oncology emergencies and oncologic emergencies such as leukostasis, febrile neutropenia, DIC, spinal cord compression, hypercalcemia. Management and recognition of paraneoplastic disorders. Indications and applications of radiographic imaging. Management of anti thrombotic therapy. Personal Skills o o o To understand, the impact of a malignant diagnosis on a patient and their family. To work with a multidisciplinary team in managing hematology and oncology diagnoses. To communicate to families and patients about the new diagnosis, prognosis, treatment options and the end-of-life decisions. Template updated 8/5/2011 2 University of Oklahoma College of Medicine Residency Template o To develop skills in educating patients about techniques, rationale, and ramification of procedures including obtaining appropriate informed consent. ROTATION OBJECTIVES Rotation Objectives: Patient Care Goal Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: Competencies Provide training in assessing and developing skills in consultation patients inpatient with benign and malignant hematology and oncology diagnoses. Objectives a. The fellow should develop a diagnostic plan in work up of an unknown malignancy. b. The fellow should manage patients with disorders of hemostasis, white blood cells, red blood cells, and platelets. c. The fellow should give recommendation on the workup and treatment of patients with cancer or hematologic disorders. Medical Knowledge Goal Residents 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. Residents are expected to: Competencies Develop skills in the diagnostic workup of oncologic and hematologic disorders. To provide the opportunity to be an active participant in a multidisciplinary tumor board Objectives a. To understand the evaluation and treatment of solid and hematologic malignancies. b. To understand the different uses of chemotherapy and biologic therapy for palliative treatment, curative treatment and adjuvant or neo-adjuvant treatment. c. To understand the common complications of treating patients with cancer including but not limited to neutropenic fever, mucositis, emesis, extravesation, brain metastasis, spinal cord compression, bone metastases and cancer pain. d. To understand the basic mechanisms which underlie the normal functioning of the bone marrow, blood and related components. e. To understand the evaluation and treatment of patients with benign hematologic disoreders f. To understand the evaluation and treatment of patients with disorders of hemostasis leading to either thrombosis or bleeding. g. To understand the use of various anticoagulants and their complications. h. To gain skills needed to interpret peripheral blood smears, bone marrow aspirations and biopsies, supervising clinical apheresis, as well as basic and advanced tests of thrombosis and hemostasis. Practice- Based Learning and Improvement Goal Template updated 8/5/2011 3 University of Oklahoma College of Medicine Residency Template Residents 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 life long learning. Residents are expected to develop skills and habits to be able to : Competencies Set learning and improvement goals Objectives a. To effectively utilize educational and evidence-based resources to seek answers to scientific and clinical questions. b. To identify perceived deficiencies in knowledge or experience and actively seek opportunities for correction. c. To effectively present and disseminate hematology case-based information with peers and others at weekly meetings and apply evidence-based medicine outcomes. Systems Based Practice Goal Residents 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. Residents are expected to: Competencies Coordinate patient care within the health care system relevant to their clinical specialty Objectives a. Understand the psycho-social implications and the impact of health-care delivery systems on the care of patients with cancer and blood disorders. b. To effectively understand, evaluate and treat hematologic disorders and cancer in intensive care inpatient environments. c. To develop the skills necessary for leadership within a healthcare team.. Professionalism Goal Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: Competencies Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Objectives a. To develop the skills needed to interact with patients and their families in a manner that demonstrates compassion, competence and professionalism. b. To develop in the role of consultant for other services always keeping the patient’s best interest as the primary goal, and performing these duties in a professional and courteous manner. c. To develop communication skills with patients and their families with attention not just to the medical aspects of clinical care, but also to the psychological, social and spiritual dimensions as well. Interpersonal and Communication Skills Goal Template updated 8/5/2011 4 University of Oklahoma College of Medicine Residency Template Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to: Competencies Communicate effectively with physicians, other health professionals, and health related agencies Work effectively as a member of leader of a health care team or other professional group Objectives a. To develop the skills needed to interact with patients and their families in a manner that demonstrates compassion, competence and professionalism. b. To provide education to the residents and students working with their patients. c. To understand the role of a consultant in assisting a primary team with the care of a patient. To refine peer-peer relationships and methods of handing off patient care responsibilities for safety and continuity of care. COMPETENCIES ACGME Competencies and Competency Attainment: Patient Care (PC): Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents: Medical Knowledge (MK): Residents 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. Practice-based Learning and Improvement (PBLI): Residents 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 life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals: (1) identify strengths, deficiencies, and limits in one’s knowledge and expertise; (2) set learning and improvement goals; (3) identify and perform appropriate learning activities; (4) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; (5) incorporate formative evaluation feedback into daily practice; (6) locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems; (7) use information technology to optimize learning; and, (8) participate in the education of patients, families, students, residents and other health professionals. Interpersonal and Communication Skills (ICS): Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to: (1) communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; (2) communicate effectively with physicians, other health professionals, and health related agencies; (3) work effectively as a member or leader of a health care team or other professional group; (4) act in a consultative role to other physicians and health professionals; and, (5) maintain comprehensive, timely, and legible medical records, if applicable. Template updated 8/5/2011 5 University of Oklahoma College of Medicine Residency Template Professionalism (Prof): Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: (1) compassion, integrity, and respect for others; (2) responsiveness to patient needs that supersedes self interest; (3) respect for patient privacy and autonomy; (4) accountability to patients, society and the profession; and, (5) sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Systems-based Practice (SBP): Residents 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. Residents are expected to: (1) work effectively in various health care delivery settings and systems relevant to their clinical specialty; (2) coordinate patient care within the health care system relevant to their clinical specialty; (3) incorporate considerations of cost awareness and risk benefit analysis in patient and/or population-based care as appropriate; (4) advocate for quality patient care and optimal patient care systems; (5) work in interprofessional teams to enhance patient safety and improve patient care quality; and, (6) participate in identifying system errors and implementing potential systems solutions. TEACHING AND ASSESSMENT METHODS Teaching Methods o Teaching and bedside rounds to include educational teaching as well as patient management o Fellow will be assigned to do reading, review and presentation related to the cases seen on the service. o Fellow is expected to review book chapters and review articles relevant to cases seen during the month. Assessment Methods o 360 degree evaluation in Medhub. The fellow will evaluate the attending as well as the monthly rotation. The attending will also evaluate the fellow. This evaluation will be signed and read by the fellow in the company of the attending physician. LEVEL OF SUPERVISION Progressive Responsibility a. As each fellow gains competence in caring for patients with hematological and oncologic problems he/she will be given more responsibilities of supervised chemotherapy ordering, and patient-care decision making. b. As each fellow gains competence in caring for patients with hematological or solid malignancies he/she will be given more responsibility of supervised teaching experiences to the housestaff and medical students. b. As outlined below, senior fellows will gain more independence in clinical management and for performing procedures. PGY-4 Template updated 8/5/2011 PGY-5 PGY-6 6 University of Oklahoma College of Medicine Residency Template Depends on regular faculty input. Relies on occasional faculty input and correction. Functions almost independently. RESIDENT EVALUATION OF FACULTY Anonymous evaluations of faculty and the rotation will be conducted using MedHub. Residents will receive an email with a link to complete a course survey. Your feedback will be supplied to faculty and rotation directors anonymously and in aggregate at the end of the year. We read your feedback and value your input regarding the rotation and use your feedback to help maintain rotation strengths and refine areas of improvement. Please evaluate the rotation thoughtfully and constructively. PROFESSIONALISM Dress Code Dress according to high professional standards. See the Resident Handbook. Attendance Conferences: Residents are required to attend all internal medicine teaching and encouraged to attend the Hematology/Oncology section conferences Clinics: Residents are welcome to attend the Hematology/Oncology outpatient clinics Rounds: Timing of attending rounds will be discussed at the beginning of the rotation Weekends: Coverage per internal Medicine call schedule Duty Hours You are expected to track your own duty hours, record them accurately in MedHUB, and adhere to ACGME-mandated restrictions. Time Off Weekends: Schedule according to the internal Medicine call schedule Vacations: Approval of the Hematology/Oncology attending is required prior to scheduling any vacation time Academic Integrity/Professionalism We expect professional behaviors at all times. Please refer to the Resident Handbook. Template updated 8/5/2011 7