Hematology & Oncology Inpatient Service

Educational Purpose:

In view of the one-month time limitation, the Hematology and Oncology sub specialty curriculum for Internal Medicine trainees rotating through a Division service is necessarily far more limited than the curriculum presented to fellow trainees and focuses on (a.) the most common problems encountered by the hematologist/oncologist and (b.) broad principles of hematology and oncology (as opposed to the practice of sub specialty hematology and oncology).

Internal Medicine trainees (PGY 1 through PGY 3) currently have the opportunity to rotate through the Hematology Service, the Oncology Service, and the MUH/ART Consult Service. Though the IM trainee’s scope of responsibilities is obviously varied amongst these services, the basic curriculum presented by Division faculty is the same.

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:

PGY 1

1. Understand and identify Anemia and Erythrocytosis, Thrombocytopenia and Thrombocytosis, Leukopenia and Leukocytosis, coagulaopathies and anticoagulant therapy.
2. Learn the principles of transfusion, cardinogenesis and broad principles of Cancer diagnosis and treatment and Cancer prevention.

PGY 2 and 3

1. Understand and identify Anemia and Erythrocytosis, Thrombocytopenia and Thrombocytosis, Leukopenia and Leukocytosis, coagulaopathies and anticoagulant therapy.
2. Learn the principles of transfusion, cardinogenesis and broad principles of Cancer diagnosis and treatment and Cancer prevention.

Medical Knowledge Goals and Objectives:

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:

PGY 1

1. Understand and identify various types of cancers.
2. Interpret blood counts, peripheral blood smears, bone marrow aspirate smears, bone marrow biopsy sections, and bone marrow biopsy touch preps.
3. Identify soft tissue and bone sarcomas.

PGY 2 and 3

1. Understand and identify various types of cancers.
2. Interpret blood counts, peripheral blood smears, bone marrow aspirate smears, bone marrow biopsy sections, and bone marrow biopsy touch preps.
3. Identify soft tissue and bone sarcomas.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: 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:

PGY 1

1. Identify, obtain, and review medical literature relevant to the hematologic and/or oncologic problems of patients they encounter.
2. Demonstrate understanding of the literature by providing critical summaries to the faculty and other trainees on the service at hand.

PGY 2 and 3

1. Identify, obtain, and review medical literature relevant to the hematologic and/or oncologic problems of patients they encounter.
2. Demonstrate understanding of the literature by providing critical summaries to the faculty and other trainees on the service at hand.

Systems Based Practice Goals and Objectives:

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:

PGY 1

PGY 2 and 3

1. Supervise and facilitate education of interns and medical students rotating on the service.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: 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:

PGY 1

PGY 2 and 3

Teaching Methods:

Trainee rotation through the Hematology Service, the Oncology Service, or the MUH Consult Service (trainees on the Consult Service participate in the weekly VA clinic). A paper-based or electronic training program syllabus is distributed as well as reference material. There are discussions in daily didactic 30 to 60 minute sessions. Regular provision of constructive criticism by faculty to trainees regarding their techniques of knowledge and skill acquisition, delivery of care, and documentation of delivery of care. Trainees are welcome to participate in all conferences described for fellow trainees. They are also required to attend Department of Internal Medicine Grand Rounds and Friday afternoon Hollings Cancer Center Seminar Series lectures. There is a structured orientation of new trainees to the curriculum, clinical and academic schedules, clinical and academic responsibilities, and a review of institutional clinical and academic resources available for their use.

Mix of Diseases and Pathological Material:

Please see Department for list of comprehensive mix of diseases and pathological material.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. Patients typically have multiple co-morbidities which are either pre-existing or related to complications of their primary Hematologic/Oncologic disease or its treatment.

Types of Clinical Encounters:

Residents rotate on both the Hematology and Oncology inpatient service which each consist of a PGY-1 intern and a PGY-2 or 3 upper level resident. The Hematology service is also comprised of a Bone Marrow Transplant unit which rounded on by residents but primarily cared for by a Nurse Practitioner as well as a fellow. Residents provide initial evaluation, workup, and management of patients either through and Emergency Room setting, directly admitted from clinic, or in transfer from an outside facility.

Procedures and Services:

Bone marrow aspiration and biopsy from the anterior and posterior superior iliac crests, both with and without conscious sedation. Residents also participate in lumbar puncture as well as occasional placement of central venous catheters.

Supervision:

Faculty directly supervise delivery of trainees’ care in all outpatient, inpatient, and consultative settings. Faculty review (and annotation, as appropriate) of all delivery-of-care documentation by trainees. Due to the brevity of their rotation, Internal Medicine trainees are directly supervised in the performance of all tasks. Division fellows participate in the supervision and teaching of Internal Medicine trainees.  More specific information listed under “Responsibility and Professional Relationships.”

Educational Resources to be Used and Reading Lists:

Internal Medicine trainees are allowed to participate in the care of patients enrolled in clinical trials and gain insight and appreciation for the principles and practice of clinical research. With faculty guidance, Internal Medicine trainees are required to identify, obtain, and review medical literature relevant to the hematologic and/or oncologic problems of patients they encounter. Trainees are expected to demonstrate their understanding of the literature by providing critical summaries to the faculty and other trainees on the service at hand (this is also listed underneath our goals and objectives).

Method of Evaluation of Resident Competence:

The Division requires regular evaluation both of the Internal Medicine trainees (by their Division faculty supervisors) and by the Internal Medicine trainees (of their Division faculty supervisors and the specific rotation taken). All personal evaluations are done in accordance with American Board of Internal Medicine standards for such. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in the inpatient setting. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. The residents evaluate the rotation and the attending physician through the E*Value system. The consult attendings review the rotation evaluations and each attending anonymously receives his or her evaluations. Supervisors are required to discuss their evaluations with the Internal Medicine trainees; trainees may discuss their evaluations with their Division faculty supervisors and/or with the Fellowship Training Program Director as appropriate.