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VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
MCV Hospital Inpatient Hematology
Description of Rotation or Educational Experience
The VCU Hematology-Oncology fellowship program MCV Hospital Inpatient Hematology service are designed to provide the
fellow the opportunity to participate in the care and management of adult patients admitted to the hospital with acute benign
and malignant hematologic medical needs. The fellow operates within the context of a multi-disciplinary team managing such
conditions including though not limited to acute oncologic emergencies, symptoms of advanced malignancy, acute leukemia,
inpatient administered chemotherapy regimens, complications of oncologic therapies, immune-mediated cytopenia, bone
marrow failure states, and hemophilia. Additionally, the rotation affords the opportunity for the fellow to engage directly in
the subspecialty specific oversight and education of internal medicine residents and medical student learners rotating on the
service. All of this occurs under the supervision of the responsible faculty from the Division of Hematology, Oncology, and
Palliative Care ward attending faculty members.
Location:
VCUHS MCV Hospital inpatient nursing units
Length of Experience:
2 week block – days only. The rotation includes weekend day coverage. There is no in-house night coverage.
Educational Goals
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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 benign and
malignant hematologic medical conditions and in providing the necessary support and ancillary services to effectively
meet their medical and psychosocial needs.
Gain experience in the management of end-of-life issues, including advanced directives, resuscitation status,
surrogate decision making, and home/inpatient hospice resource utilization.
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
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YEAR 3
YEAR 2
YEAR 1
Progressive Responsibilities by Fellow Year
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 acute benign and malignant hematologic 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 acute benign and malignant hematologic 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).
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.
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 acute benign and malignant hematologic 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.
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 acute inpatient hospital setting under the supervision of the appropriate subspecialty
faculty member. Fellows will participate in the evaluation, counseling, and management of acutely and chronically ill benign
and malignant hematologic inpatients. This will provide the opportunity to learn the different approaches to inpatient
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 the acute inpatient hospital setting.
Competencies
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 benign and malignant
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hematologic 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
Objectives
Fellows are expected to:
 Develop skills in history/physical examination of the patient with benign and malignant hematologic disorders
 Develop skills as an inpatient subspecialty heath care provider and manager
 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.
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 are expected to:
 Medical knowledge acquisition should focus on the routine diagnosis, natural history, staging, prognosis, and first-line
management of the benign and malignant hematologic 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 benign and malignant hematologic condition.
Second year fellows are expected to:
 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 are expected to:
 Medical knowledge acquisition should focus on mastery of the knowledge obtained as a first and second year fellow
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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 the following core rotation specific objectives outline specific medical knowledge content material that the
fellow is expected to obtain during this rotation:
 Recognize immature cells on a peripheral blood smear
 Demonstrate and understanding of the diagnostic laboratories and ancillary studies utilized in the initial diagnosis of
the acute myeloid and lymphoid leukemias and highly aggressive lymphomas including an understanding of the
interpretation of these pathology ancillary studies as they related to the differentiating between the hematologic
malignancies and between malignant and non-malignant states.
 Demonstrate an understanding of the prognostic implications of age, patient-specific characteristics, co-existing
medical conditions, histologic subtypes, cytogenetics, and genetic and molecular markers detected by FISH/PCR in the
acute leukemias and highly aggressive lymphomas
 Demonstrate an understanding of the use of age, patient-specific characteristics, co-existing medical conditions,
histologic subtypes, cytogenetics, and genetic and molecular markers detected by FISH/PCR in the therapeutic
determinations for the acute leukemias (inclusive of the induction , consolidation, and possible maintenance phases
of treatment) and for the highly aggressive lymphomas
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with extreme
leukocytosis with or without leukostasis, including indications for urgent leukophersis
 Demonstrate and understanding of the salvage options available for the treatment of relapsed or refractory acute
leukemia and highly aggressive lymphomas
 Demonstrate knowledge of the biology, pathophysiology, and molecular pathways involved in the acute leukemias
and highly aggressive lymphomas
 Demonstrate an understanding of the indications for and the therapeutic options available for the prevention and
treatment of tumor lysis syndrome including the ability to discuss the published guidelines
 Demonstrate an understanding of the treatment of febrile neutropenia including the most up-to-date published IDSA
guidelines for the approach to the patient with febrile neutropenia and the institutional guidelines that have been
developed
 Demonstrate and understanding of the indications for and the therapeutic options of the antimicrobial prophylaxis in
the patient with acute leukemia or a highly aggressive lymphoma undergoing immunosuppressive chemotherapy
including the most up-to-date published IDSA guidelines for the approach to the patient with febrile neutropenia
 Discuss the different blood products and their indications in the management of the patient with acute leukemia or
highly aggressive lymphoma. This should include an understanding of the use of leukoreduction, irradiation,
 Understand the indications for the use of CMV negative blood products
 Recognize, distinguish, and manage acute transfusion reactions, including acute hemolytic reaction, TRALI, TACO,
acute febrile reaction.
 Demonstrate a knowledge of the pathophysiologic mechanism leading to malignancy-associated hypercalcemia
 Demonstrate a knowledge of the diagnostic approach to the patient with malignancy-associated hypercalcemia
 Demonstrate a knowledge of the prognostic implications of malignancy-associated hypercalcemia in relationship to
the underlying malignant etiology
 Demonstrate a knowledge of the therapeutic approach to the patient with malignancy-associated hypercalcemia
including the indications, dosing, monitoring, toxicities, and therapeutic benefits of the hydration, bisphosphonates,
calcitonin, glucocorticoids, calcimimetics, and dialysis
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new brain
metastasis in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new cord
compression in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new malignant
leptomeningeal involvement in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the differential diagnosis, diagnostic approach and therapeutic management of the
patient presenting with new superior vena cava syndrome in both the setting of an undiagnosed malignancy and a
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known malignancy
Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with bowel
obstruction in both the setting of an undiagnosed primary malignancy and a known malignancy
Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new malignant
pleural effusion and/or ascites in both the setting of an undiagnosed primary malignancy and a known malignancy
Demonstrate an understanding of the management options of malignancy-related pain including the role of
pharmacologic agents, radiation, surgery, kyphoplasty, and neurologic blocks.
Demonstrate the ability to initiate, titrate, and convert among the various oral and intravenous opioid preparations
Understand the use and calculate a patients performance status using the Eastern Cooperative Group and the
Karnofsky performance scoring systems
Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with severe
immunologic-induced cytopenias requiring inpatient hospitalization, including but not limited to the use of
glucocorticoids, immunosuppressive chemotherapy, monoclonal antibodies, immunoglobulin, thrombopoietin
receptor agonists, transfusions, and splenectomy.
Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with acute bleeding
manifestations suspected/known to be the result of an inherited or acquired disorder of hemostasis.
Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with a
known/suspected marrow failure state, including aplastic anemia, myelodysplasia, and myelofibrosis.
Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with a
suspected/known myeloproliferative neoplasm
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.
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. 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.
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.
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
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.
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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Patient care/clinical experience
Modeling of observed behaviors of attending physicians
Case-based interactive discussions
Didactic sessions
Performance feedback
Self-directed learning
Assessment of Fellow Performance
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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 and supervising attending physicians of a counseling and communication encounter
Semi-annual self-assessment by the fellow
Assessment of Rotation
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End-of-rotation evaluation of the supervising attending physicians by the fellow
Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision
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Indirect supervision with faculty immediately available
Direct supervision by the faculty of select patient, family and professional health staff encounters to assess medical
knowledge as conveyed in the provided counseling and care coordination, system-based practice, professionalism,
and interpersonal communication skills
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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
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
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