This rotation is primarily focused on the care of in patients with cancer or blood disorders.
A. Fellows are responsible for assuming primary responsibility for the care of patients on the hematology-oncology service and rounding daily on those patients. Communication with other members of the multi-disciplinary team is crucial and expected to occur at regular intervals (e.g. dialy with APRNs, patient nurses, social worker, case manager, nutritionist, residents/students).
B. All orders for chemotherapy must be approved and countersigned by the attending.
C. Fellows are responsible for seeing or assigning to residents /students on the service all new hematology-oncology consults and presenting the case to the responsible faculty member. Fellows are responsible to follow consults in the hospital as appropriate.
D. The fellow will see patients for emergent care in the ER or Cancer Center as time allows.
Goals and Objectives: The fellow will demonstrate competency in the care of hospitalized patients with cancer and blood disorders with: a) adequate patient assessment and management plans; b) ongoing self assessment; c) integration of a multidisciplinary and systems based approach to patient care; d) excellent communication with patients, families and staff; and e) a professional demeanor.
1. Patient Care:
a. Develop accurate history taking, particularly as it pertains to acutely ill hematology and oncology patients;
b. Develop physical examination skills necessary to follow treatment effects, diagnose diseases in this sub-specialty and identify toxicities of therapy;
c. Construct a reasonable differential diagnosis;
d. Utilize efficient and cost-effective laboratory evaluation to substantiate a diagnosis;
e. Formulate a management plan including administration of chemotherapy, pain control, immunosuppressive therapy, anticoagulation therapy and transfusion management;
f. Care for patients at end of life;
g. Manage complicated chemotherapy regimens including the ability to write and review complex in patient chemotherapy orders.
2. Medical Knowledge:
a. Develop of an appropriate knowledge base for this subspecialty (see ASH and ASCO curricula);
b. Develop the ability to understand and manage complex hematologic and oncologic diseases usually cared for in hospital such as acute leukemia, sickle cell disease, patients receiving complex chemotherapy, and problems associated with complications of therapy such as neutropenic fever, mucositis, diarrhea, dehydration;
d. Understand the principles behind acute pain management and end of life issues (palliative care).
3. Practice based learning and improvement:
a. Assess and improve ones skills; recognizes needs for guidance and supervision;
b. Develop the ability to access and use advances in new technology related to medicine and molecular diagnostics and therapeutics;
c. Maintain timely, legible and functional medical records;
d. Become fluent with electronic medical record reporting and review;
e. Become fluent with computerized literature searches and the major electronic resources for hematology and oncology.
4. Interpersonal and Communications Skills:
a. Develop the ability to build a trusting relationship between patient and family especially in the setting of acute illness, complications of treatment and near end of life;
b. Develop a model of shared decision making with the patient and appropriate family members/significant others;
c. Develop an appropriate doctor-patient encounter by allowing the patient to complete an opening statement, eliciting a full set of patient concerns, and establishing and maintaining a personal connection;
d. Gather appropriate information by the use of open-ended and closed-ended questions, structuring, clarifying and summarizing information, and actively listening using verbal and non-verbal techniques;
e. Understanding the patient’s perspective on serious illness;
f. Share information with the patient by ussing language the patient can understand, checking for the patient’s understanding, and encouraging questions;
g. Reach agreement about the patient’s problems and the doctor’s plans by encouraging patient participation in decisions, checking patient willingness to follow plans, and identifying resources and supports.
h. Develop appropriate time management in an in patient clinical encounter;
i. Provide appropriate closure to the clinical encounter by asking if there are other questions or concerns, discuss plans for follow up and summarizing the plan.
5. Professionalism:
a. Be truthful with patients and peers;
b. Be accountable to patients and colleagues;
c. Treat people with respect and compassion;
d. Adhere to best interests of the patient;
e. Work cooperatively and communicates effectively with other in hospital staff (APRNs, nurses, social workers, medical assistants, nutritionists, physical therapists, etc) to achieve common patient care interests.
6. Systems based Practice:
a. Efficiently access and utilize resources to provide comprehensive and effective care for patients. Resources include consultants, nutritionists, social workers, pastoral care workers, hospice care-givers, nurses, and others;
b. Participation in the reduction of errors in hospitalized patients and the development of patient safety guidelines.
c. Understand the utility of patient order sets, electronic medical record, etc
