Download Training Program Curriculum

VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
Description of Educational Experience
The VCU Hematology-Oncology fellowship program MCV hospital is a 36-month duration combined training program in
hematology and oncology. The curriculum is developed to educate and produce compassionate physicians capable of
delivering the highest quality medical care to patients in a variety of settings; to foster physicians capable of
contributing to the science of medicine through research and scholarly activity; and to promote lifelong learning in
the context of a rapidly changing healthcare environment. The curriculum satisfies the requirements to sit for the ABIM
examinations in both hematology and medical oncology.
Location:
VCUHS MCV Hospital and affiliated clinics
McGuire Veterans Affairs Hospital and affiliated clinics
Length of Experience:
36 months
Educational Goals















Gain experience and knowledge in the diagnosis, prognosis, management, and complications of inpatients with acute
non-malignant, hematologic problems necessitating hospitalization.
Gain experience and knowledge in the diagnosis, prognosis, management, and complications of inpatients with
hematologic and solid tumor malignancies
Gain experience in the diagnosis, prognosis, and management of acute hematologic and oncologic emergencies
Gain experience in the diagnosis, prognosis, and management of complications of advanced malignancy
Gain experience in the administration, monitoring, and toxicities of chemotherapy
Gain additional experience in performing the procedures essential to the diagnosis and to the delivery of care of
acute hematologic and oncologic disorders, including bone marrow biopsy and aspiration; lumbar puncture with the
intrathecal administration of chemotherapy; and the access and administration of chemotherapy via an Omaya
reservoir.
Gain experience in communication with and the counseling of patients and families regarding their acute hematologic
and oncologic medical conditions and in providing the necessary support and ancillary services to effectively meet
their medical and psychosocial needs.
Gain experience and knowledge in effective establishment and communication of goals of care
Gain experience and knowledge in the evaluation, grading and management of acute and chronic pain from
malignant and non-malignant etiologies
Gain experience in the management of end-of-life issues, including advanced directives, resuscitation status,
surrogate decision-making, home/inpatient hospice resource utilization, and the resources available to the patient
and their families.
Gain experience and knowledge of the legal and societal issues as they pertain to the end-of-life management.
Gain experience in and respect for the cultural differences in response to severe illness and death
Gain experience in recognizing one’s own reaction to grief and stress as a provider
Gain experience and knowledge in the role and function of a subspecialty inpatient primary medical providermanager
Gain experience in working within and directing the care of a multi-disciplinary team of health professionals in the
acute inpatient hospital setting
1
Progressive Responsibilities by Fellow Year
YEAR 1
The first year fellow is expected to focus on primary medical knowledge, communication skill and procedural skill
development. Medical knowledge acquisition should focus on the routine diagnosis, natural history, staging, prognosis,
and first-line management of the hematologic-oncologic conditions. Additionally, the first year fellow should focus on
the pharmacologic mechanism of action, dosing considerations, and common toxicities of the medications being
employed for the treatment of the hematologic-oncologic condition. Care plans should be developed independently or
with conjunction with attending physician and health care team but reviewed in full with the attending physician in
advance of communication to the patient and family. Initial counseling of the patient and family regarding the goals of
care, the care plan, and chemotherapy counseling should be done with direct supervision of the attending physician or
only after full review of the goals of care and care plan with the attending physician. (The PharmD may provide the
direct supervision of chemotherapy counseling and consenting once the care plan has been established with the
attending physician).
In a teaching capacity, the first year fellow is expected to provide supervision of the housestaff participating in clinical
rotations within the division’s inpatient or ambulatory services. Additionally, the first year fellow is expected to actively
participate in educating the housestaff on the same hematology-oncology services. The first year fellow may assist the
attending with teaching/work rounds with the resident housestaff under the direct supervision of the attending
physician. The fellows may additionally supervise in the procedural training of their peers provided they have
themselves achieved independence and competence in the procedure being supervised.
In research and scholarship, the first year fellow is expected to focus on primary knowledge acquisition pertaining to the
scientific process and the regulatory aspects of conducting clinical investigation. This includes, but is not limited to,
mandatory participation by all fellows in the VCUHS GME research course with 100% completion of all related class
work. Additionally, the fellow is expected to identify at least one specific scholarly project including an appropriate
mentor. By the completion of the first year of training, the project design should be completed and any necessary IRB or
other regulatory body approval should be in progress. All fellows are expected to complete annual CITI certification
training.
YEAR 2
The second year fellow is expected to refine their medical knowledge by focusing on an understanding of the underlying
pathophysiology, the basis and use of molecular and genetic markers to refine prognostic determinations and treatment
planning; and considerations/options in second-line and beyond. Care plans should be developed independently with
only moderate need for input from the attending physician though reviewed in full with the attending physician in
advance of communication to the patient and family. Initial counseling of the patient and family regarding the goals of
care, the care plan, and chemotherapy counseling may be done independently but only after full review of the goals of
care and care plan with the attending physician. The second year fellow should assist or even lead teaching/work rounds
with the resident housestaff under the direct supervision of the attending physician.
In a teaching capacity, the second year fellow is expected to provide supervision of the housestaff participating in clinical
rotations within the division’s inpatient or ambulatory services. Additionally, the second year fellow is expected to
actively participate in educating the housestaff on the same hematology-oncology services. The second year fellow
should assist or even lead teaching/work rounds with the resident housestaff under the direct supervision of the
attending physician. The fellow is expected to supervise in the procedural training of their peers provided they have
themselves achieved independence and competence in the procedure being supervised.
In research and scholarship, the second year fellow is expected work further develop their knowledge of the scientific
process and the regulatory aspects of conducting clinical investigation but, additionally, the project specific skills and
knowledge acquisition to fully understand the background, rationale, design and conduct of their project(s). The fellow
is expected to make initiate the project and make steady progress throughout the year of training toward its
completion. The fellow should identify early in the project the targeted venue and method for dissemination of the
product of the project. All fellows are expected to complete annual CITI certification training.
2
YEAR 3
The third year fellow is expected to demonstrate proficiency and independence. The third year fellow is expected to
demonstrate full knowledge of the routine diagnosis, natural history, staging, prognosis, and first-line management of
the hematologic-oncologic conditions. They should demonstrate a proficient understanding of the underlying
pathophysiology, the basis and use of molecular and genetic markers to refine prognostic determinations and treatment
planning; and considerations/options in second-line and beyond. Care plans should be developed independently with
minimal input from the attending physician though still reviewed in full with the attending physician. Initial counseling
of the patient and family regarding the goals of care, the care plan, and chemotherapy counseling should be done
independently though reviewed with the attending physician. The third year fellow should be capable of independently
leading teaching/work rounds with the resident housestaff.
In a teaching capacity, the third year fellow is expected to provide supervision of the housestaff participating in clinical
rotations within the division’s inpatient or ambulatory services. Additionally, the third year fellow is expected to actively
participate in educating the housestaff on the same hematology-oncology services. The third year fellow should be
capable of independently leading teaching/work rounds with the resident housestaff. The fellow is expected to
supervise in the procedural training of their peers provided they have themselves achieved independence and
competence in the procedure being supervised.
In research and scholarship, the third year fellow is expected to achieve independent proficiency in the project specific
skills and knowledge base necessary to develop a scholarly project and to fully understand the background, the rationale
and the design of their work develop. Additionally, the fellow is expected to acquire the knowledge and skills needed
for the presentation of scholarly work in oral, poster, published, or new-media forms. The fellow is to complete at least
one scholarly project and to disseminate the product of the effort at the institutional level and to have submitted the
effort to a regional, national or international venue. All fellows are expected to complete annual CITI certification
training.
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. Fellows are expected to learn the practice of health promotion, disease prevention, diagnosis, care, and
treatment of both men and women from adolescence to old age, and at all stages of illness.
Specifically, fellows will see patients in acute inpatient hospital and ambulatory clinic settings under the supervision of the
appropriate subspecialty faculty member(s). Fellows will participate in the evaluation, counseling, and management of acutely
and chronically ill hematology-oncology patients. This will provide the opportunity to learn the different approaches to
patient management of these conditions. Fellows will additionally work within a multidisciplinary team of health
professionals including pharmacists, nurses, physical therapies, occupational therapists, social workers, care coordinators, and
junior medical learners. This will provide the fellow experience and feedback in effectively working within and directing the
care of a multi-disciplinary team of health professionals in both the inpatient hospital and ambulatory settings.
Competency Objectives:
Fellows are expected to:
 Gather appropriate clinical information
 Synthesize information into a care plan
 Perform the procedures necessary for the effective diagnosis and management of acute hematologic and oncologic
disorders
 Partner with patients/families in the implementation of the plan
 Coordinate care plans with the referring physicians, the inpatient multi-disciplinary team of health professionals, and
the home health agencies
 Develop skills in history/physical examination of the patient with hematologic and oncologic disorders
 Develop skills as an inpatient subspecialty heath care provider and manager
3




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
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. The fellows are expected to learn the scientific method of
problem solving, evidence-based decision making, a commitment to lifelong learning, and an attitude of caring that is derived
from humanistic and professional values.
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 medical assessment orally and in writing and by
defending the clinical assessment, differential diagnosis, and diagnostic and management plans
First year fellows:
 Medical knowledge acquisition should focus on the routine diagnosis, natural history, staging, prognosis, and first-line
management of the hematologic-oncologic condition. Additionally, the first year fellow should focus on the
pharmacologic mechanism of action, dosing considerations, and common toxicities of the medications being
employed for the treatment of the hematologic-oncologic condition.
Second year fellows:
 Medical knowledge acquisition should focus on an understanding of the underlying pathophysiology, the basis and
use of molecular and genetic markers to refine prognostic determinations and treatment planning; and
considerations/options in second-line and beyond.
Third year fellows:
 Medical knowledge acquisition should focus on mastery of the knowledge obtained as a first and second year fellow
Content-Specific Objectives

The medical conditions experienced during any single block of this rotation can be quite variable. However, in an
effort to provide guidance for areas of particular focus during each specific rotation have been outlines within the
individual rotation curriculum.
4
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. The fellow is
expected to present primary scientific and medical evidence to support their conclusions and care plans in the diagnosis,
prognosis, management, and monitoring of the patients on the service. The fellow is expected to recognize their areas of
deficiency. Depending upon the acuity of the care situation, the fellow is expected to be able to effectively utilize their
resources to arrive at necessary information and to apply the information to their patient care. Moreover, the fellow is
expected to recognize conditions and circumstances requiring escalation.
Competency Objectives
Fellows are expected to demonstrate skills in:
 Identifying strengths, deficiencies, and limits in ones knowledge and expertise
 Setting learning and improvement goals
 Identifying and performing appropriate learning activities
 Systematically analyzing their clinical practice, using quality improvement methods, and implementing changes with
the goal of practice improvement
 Incorporating formative evaluation feedback into daily practice
 Locating, appraising, and assimilating evidence from scientific studies related to their patients’ health problems
 Using information technology to optimize learning
 Participating in the education of patients, families, students, fellows, and other health professionals
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. Fellows will work within a
multidisciplinary team of health professionals including pharmacists, nurses, physical therapists, occupational therapists, social
workers, and care coordinators. This will provide the fellow experience and feedback in effectively simultaneously both
working within and directing the care of a multi-disciplinary team of health professionals in the acute inpatient hospital
setting. Additionally, working with the context of a broader health system includes the importance and necessity to recognize
conditions and circumstances requiring consultation and/or escalation for the effective and safe delivery of patient-centered
medical care.
Competency Objectives
Fellows are expected to demonstrate skills in:
 Working effectively in various health care delivery settings and systems relevant to the practice of hematology and
medical oncology
 Coordinating patient care within the health care system relevant to the practice of hematology and medical oncology
 Incorporating considerations of cost awareness and risk benefit analysis in patient and/or population based care
 Advocating for quality patient care and optimal patient care systems
 Working in interprofessional teams to enhance patient safety and improve patient care quality
 Participating in identifying system errors and implementing potential systems solutions
Professionalism
Goal
Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
The fellow is expected to model professional and courteous behavior in the treatment of the patient and in working with the
entire health care team. The fellow is expected to complete documentation of their patient care, of their communications with
the patient and health care providers, and of their procedures in a timely fashion within the medical record. The fellow is also
5
expected to recognize the critical importance of their own education and the importance of life-long learning as part of their
professional responsibility. As such, it is the obligation of the fellow to themselves, their profession, and their patients to
attend and complete in a timely fashion all of fellowship training program’s expected educational activities.
Competency Objectives:
Fellows are expected to demonstrate:
 Compassion, integrity, and respect for others
 Responsiveness to patient needs that supersedes self-interest
 Respect for patients, society, and the profession
 Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age,
culture, race, religion, disabilities, and sexual orientation
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.
Competency Objectives:
Fellows are expected to demonstrate skills in:
 Communicating effectively with patients, families, and the public, as appropriate, across a broad range of
socioeconomic and cultural backgrounds
 Communicating effectively with physicians, other health professionals, and health related agencies
 Working effectively as a member or leader of a health care team or other professional group
 Acting as a consultative role to other physicians and health professionals
 Maintaining comprehensive, accurate, timely, and legible medical records
Teaching Methods










Patient care/clinical experience
Modeling of observed behaviors of attending physicians
Direct observations of patient encounters
Professional patient simulation activities in communication
Case-based interactive discussions
Didactic and interactive conference sessions
Performance feedback
Practice performance evaluation and quality assessment
Self-directed learning
Mentored research/scholarly activities
Assessment of Fellow Performance





End-of-rotation evaluation of the fellow by the supervising attending physicians
360-evaluation by the medical students, interns, residents, nursing staff, and social worker/care coordination team
members
Mini-CEX by pharmacy staff, nurse practitioners, and/or supervising attending physicians of a counseling and
communication encounter
Bone marrow technique evaluations by bone marrow technicians and hematopathology attending physicians
Semi-annual self-assessment by the fellow
6
Assessment of Program and Rotations




End-of-rotation evaluation of the supervising attending physicians by the fellow
Annual program review and survey
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision

Varies by rotation. See individual rotation curriculum for details.
Educational Resources























Devita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology
Hoffman Hematology: Basic Principles and Practice
UpToDate
ASCO University
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)
The AJCC 7th edition TMN staging of Cancer
Common Toxicity Criteria v4.0 (aka Common Terminology Criteria for Adverse Events)
GAIL model
Claus model
Adjuvant! Online
Apheresis/Blood bank textbooks (available in TM)
ASFA guidelines
FIGO staging guidelines
VCUHS Hospital Palliative Care Unit patient care set algorithms and procedures manual
UNIPAC Self-Study Program
EPERC
Bonica Management of Pain
Bruera Oxford American Handbook of Hospice and Palliative Care
Bruera Textbook of Palliative Medicine and Supportive Care
7