Thomas Jefferson UniversitySidney Kimmel Medical College

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Rotations

1) Hematology Consults

The consult fellow handles Hematology Consults including consults from medical and non-medical services. There are also occasional inpatients who are primarily managed by the fellow and consult attending with a team of internal medicine residents. During this rotation, the fellow will organize and present at the Friday AM Clinico-Pathologic Conference (aka Slide Conference) and at one case management conference during Hematology Grand Rounds (Tuesdays 12:00-1:00 pm).

Educational Purpose: To provide a varied and comprehensive experience in general and consultative hematology.

Principal Teaching Methods: Teaching rounds, bedside presentation and discussion, conferences, direct supervision of bone marrow aspiration and biopsy procedures, literature review, intensive microscopic review of case materials, participation in hematopathology rounds, and experience in the methodologies and interpretation of laboratory-based testing.

It is expected that the fellow will provide brief lectures to the Hematology team, at least weekly, on topics in general hematology (e.g. cytopenias, evaluations of prolonged PT or aPTT, hypercoaguable states, hemolytic anemias).

Educational Content: Exposure to all aspects of adult hematology, including congenital and acquired coagulation disorders, transfusion medicine, the diagnosis and management of cytopenias and elevated blood counts, and the evaluation of patients with gammopathies. Detailed study of peripheral blood and bone marrow morphology, the laboratory evaluation of coagulation disorders, flow cytometry and cytogenetics are all included.

Mix of Diseases: The full range of congenital and acquired adult hematologic disorders.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Bedside consultations.

Procedures: Bone marrow aspiration and biopsies.

Educational Resources: Dedicated fellows' hematology-oncology library, multi-headed teaching microscope and television, American Society of Hematology Slide Collection, as well as the Medical School Library collection.

Supervision: All Consults are supervised by the Hematology Consult Attending.

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2) Hematologic Malignancy Service (HMS)

Fellows will coordinate patient care on this inpatient Hematology/Oncology Unit. The daily schedule consists of morning walk rounds with the attending and residents including discharge planning rounds. The fellow is responsible for diagnostic and therapeutic procedures including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or Ommaya reservoir tap. In addition, the fellow is responsible for obtaining consent for chemotherapy and writing draft chemotherapy orders. Fellows will continue to follow their patients when they are transferred to other units, such as the ICU, Physical Medicine and Rehabilitation, or Surgery.

Finally, the fellow also serves as liaison between hematopathology and the Blue Medicine service, reviewing the new cases with the pathologists and reporting results to the team. The fellow is responsible for dictating discharge summaries for any elective chemotherapy admission patient whose length of stay is greater than 2 days.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic malignancies; to provide experience in the diagnosis and management of oncologic emergencies; to gain expertise in the management of pain control and family-centered terminal care.

Principal Teaching Methods: Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

It is expected that the fellow will provide brief lectures to the Blue Medicine team, at least weekly, on topics in hematologic malignancies (e.g. multiple myeloma, lymphomas, leukemias, tumor lysis syndrome, febrile neutropenia).

Educational Content: Exposure to the pathogenesis and biology of myeloid and lymphoid malignancies and exposure to all aspects of hematologic malignancies requiring hospital-based therapies.

Mix of Diseases: All hematologic malignancies as well as myelodysplastic syndrome and aplastic anemia.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Daily bedside encounters.

Procedures:  Bone marrow aspiration and biopsy, chemotherapy infusion, intrathecal chemotherapy administration.

Educational Resources: As previously described.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the inpatient attending physicians.

Corridor

3) Solid Tumor Oncology Service

On this rotation, the fellows will concentrate on the evaluation and management of patients with new oncologic diagnoses (or patients with unknown diagnoses for whom a malignancy is part of the differential diagnosis) as well as provide support to the oncology inpatients by writing chemotherapy orders on solid tumor oncology inpatients. The aims are for the fellow to gain an understanding of disease processes, the past histories and the choices of chemotherapy regimens. Consults will be staffed by the solid tumor inpatient attendings on-service. (Consults that are requested of and staffed by attendings who are not on service will not be seen by the fellow.)

The fellow will also facilitate transfers to the solid tumor inpatient oncology service from other hospitals or other services at Jefferson, and follow those patients as above.

Workstations

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of oncologic diseases, under the direct supervision of attending physicians.

Principal Teaching Methods: Inpatient patient management, consultation, teaching, clinical conferences and case reviews, literature reviews.

It is expected that the fellow will provide brief lectures to the Blue Medicine team, at least weekly, on topics in oncology (e.g. lung cancer, colon cancer, breast cancer, prostate cancer, cancer screening, management of nausea and emesis).

Educational Content: Exposure to the biology and pathogenesis of a variety of solid tumors and participation in the diagnosis and treatment of a variety of solid tumors and their complications, including breast cancer, aero-digestive cancer, melanoma and sarcoma, lymphomas, brain tumors, and genitourinary cancers.

Mix of Diseases: A wide array of solid tumor oncologic problems, as well as hypercalcemia, workup of new masses or lytic bony lesions.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Interviews and examinations in the inpatient setting.

Procedures: Bone marrow aspiration and biopsies, chemotherapy infusion, intrathecal chemotherapy administration.

Educational Resources: As previously described.

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4) Blood and Marrow Transplant Service (BMT)

Desk Work
A first-year fellow in the BMT unit

The BMT fellow will coordinate patient care on BMT Unit. Each fellow will round with one attending. Patients who have received allogeneic transplants who are admitted to the general floor with post-transplant complications will also be followed by this team of attending and fellow. The daily schedule consists of morning rounds with the attending, residents, BMT pharmacist, BMT nurse practitioner, and nursing staff. This includes discharge planning rounds on a daily basis. The BMT service website provides information regarding BMT studies and guidelines.

The fellow is responsible for diagnostic and therapeutic procedures including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or Ommaya reservoir tap. In addition, the fellow is responsible for obtaining consent for chemotherapy and writing all chemotherapy orders on the unit.

Finally, the fellow also serves as liaison between hematopathology and the BMTU service, reviewing the new cases with the pathologists and reporting results to the team. The fellow is responsible for dictating discharge summaries for any patient whose length of stay is greater than 2 days who is not followed by the internal medicine residents.

Educational Purpose: To provide a sophisticated and comprehensive exposure to the principles and practice of high dose therapies, and autologous and allogeneic hematopoietic stem cell transplantation, including the infectious disease complications and graft-versus-host disease.

Principal Teaching Methods: Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

Educational Content: Explication of the pathogenesis and biology of myeloid and lymphoid malignancies and exposure to all aspects of hematologic malignancies requiring hospital-based therapies.

It is expected that the fellow will provide brief lectures to the BMT service, at least weekly, on topics in hematologic malignancies and transplant (e.g. leukemias, lymphomas, use of high dose therapy, opportunistic infections, febrile neutropenia management of nausea and emesis).

Mix of Diseases: All hematologic malignancies as well as myelodysplastic syndrome and aplastic anemia, autoimmune diseases and sickle cell anemia.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Daily bedside encounters.

Procedures: Bone marrow aspiration and biopsy, chemotherapy infusion, stem cell and bone marrow infusion, intrathecal chemotherapy administration.

Educational Resources: As previously described.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the BMTU attending physician.

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5) Transfusion Medicine

Fellows will become proficient in the evaluation, diagnosis and management of patients in transfusion and apheresis medicine. They will work with the transfusion medicine attendings and fellows to see patients requiring consultation for red cell exchange and apheresis procedures, and to deal with patients with difficult transfusion issues.

Educational Purpose: To provide a sophisticated and comprehensive experience in blood banking including cross matching, use of plasma and cellular product. To provide an experience in the use of aphersis procedures for multiple indications.

Principal Teaching Methods: Rounds with the transfusion medicine team, inpatient consultation, literature review, and teaching conferences.

Educational Content: Exposure to the standard transfusion medicine procedures and to the most current guidelines for transfusion. This will include the risk of transfusion reaction and viral transmission, the use of apheresis, the evaluation and management of patients who are refractory to red cell or platelet products.

Mix of Diseases: All patient who require transfusion support and/or apheresis.

Patient Characteristics: The entire TJUH population including children and adults, male and female.

Types of Clinical Encounters: Occasional inpatient consultation, some evaluation of patients who will be undergoing phlebotomy or apheresis in the TJUH Donor Center.

Procedures: Not applicable

Educational Resources: As previously described.

Supervision: All aspects of the fellow's activities and training are supervised by the Transfusion Medicine attending physicians.

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6) Hemostasis and Thrombosis

The outpatient hemophilia experience provides an exposure to patients with bleeding disorders. This will include patients with inherited Factor 8 and Factor 9 deficiency, but will also include those with von Willebrand disease and acquired factor deficiency.

The fellow will see outpatients with the Hemophilia Center Director or his/her designee, Hemophilia Center nursing staff.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of bleeding disorders and the long term sequelae of these diseases.

Principal Teaching Methods: Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

Educational Content: Explication of the pathogenesis and biology of bleeding disorders.

Mix of Diseases: All bleeding disorders, but with primary focus on Factor 8 and Factor 9 deficiencies.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Outpatient office visits.

Procedures: Not applicable

Educational Resources: As previously described.

Supervision: All aspects of the fellow's clinical activities and training are supervised by the Hemophilia Center Director.

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7) Sickle Cell Program

Educational Purpose: To provide an in-depth experience in the treatment of sickle cell anemia, related hemolytic processes and their long term sequelae.

Principal Teaching Methods: Outpatient office visits, sickle cell day center visits, teaching rounds, bedside presentation and discussion, conferences, inpatient consultation

Educational Content: Exposure to all aspects of the care of patients with sickle cell anemia, SC disease, sickle beta thalassemis and related hemolytic disorders. This includes an in-depth experience looking at the management of pain crisis, renal crisis, neurological sequelae and other end-organ damage related to these entities.

Mix of Diseases: Sickle cell anemia, SC disease, sickle beta thalassemia and related hemolytic disorders

Patient Characteristics: Men and women, adults and adolescents.

Types of Clinical Encounters: This will be mostly an outpatient rotation including the sickle cell day center and outpatient office visits. There will be rounds on the inpatients with sickle cell anemia and inpatient consultations as necessary.

Procedures: Not applicable.

Educational Resources: As previously described.

Supervision: Fellows are supervised by the attending physicians in Hematology and General Internal Medicine who care for patients with these diseases.

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8) Hematopathology

All fellows will spend 2-4 weeks on the hematopathology rotation. This is an in-depth exposure to all aspects of hematopathology and the laboratory medicine related to hematology and hematologic malignancies. The fellow also serves as liaison between hematopathology and clinical teams – hematologic malignancies, BMT and general hematology. There is active participation in hematopathology rounds, and experience in the methodologies and interpretation of laboratory-based testing.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis of hematologic malignancies, including microscopy, flow cytometry and molecular analysis. Fellows will also be given the opportunity to have further experience in the Cardeza Special Hemostasis Laboratory learning about the testing of patients with congenital and acquired bleeding and clotting disorders.

Principal Teaching Methods: Microscopy sessions, half- or full-day sessions in the hematology, flow cytometry and special hemostasis laboratories.

Educational Content: Pathologic review of bone marrow aspirations and biopsies and lymph node biopsies; observation of laboratory analysis of special hemostasis lab tests; observation of flow cytometry and molecular assays with focus on interpretation of results in consultation with attending pathologist/hematologist.

Mix of Diseases: All diseases / evaluations which would include marrow or lymph node biopsies (including hematologic malignancies and general hematology) bleeding and clotting disorders.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Clinical correlation of laboratory findings will usually be done at conferences or via phone consultation.

Procedures: Not applicable

Educational Resources: As previously described.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the attending physicians in Pathology / Hematolopathology.

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9) Albert Einstein Cancer Center (Oncology Rotation)

Tester
Bill Tester, MD - Albert Einstein Cancer Center

On this rotation, second year fellows will spend three consecutive months at the Albert Einstein Cancer Center where they will concentrate on the evaluation and management of patients with new oncologic diagnoses (or patients with unknown diagnoses for whom a malignancy is part of the differential diagnosis) as well as provide support to oncology inpatients and outpatients by writing chemotherapy orders. The aims are for the fellow to gain an understanding of disease processes, the past histories and the choices of chemotherapy regimens.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of oncologic diseases, under the direct supervision of attending physicians.

Principal Teaching Methods: Inpatient patient management, consultation, teaching, clinical conferences and case reviews, literature reviews. Outpatient consultation, chemotherapy and management of side effects and screening for long term sequelae of cancer.

Educational Content: Exposure to the biology and pathogenesis of a variety of solid tumors and participation in the diagnosis and treatment of a variety of solid tumors and their complications, including breast cancer, aero-digestive cancer, melanoma and sarcoma, lymphomas, brain tumors, and genitourinary cancers.

Mix of Diseases: A wide array of solid tumors and related oncologic problems.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Interviews and examinations in the outpatient and inpatient setting.

Procedures: Bone marrow aspiration and biopsies, chemotherapy infusion, intrathecal chemotherapy administration.

Educational Resources: As previously described.

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10) Helen F. Graham Cancer Center (HFGCC) Experience

On this elective rotation, the fellows will spend one month at the Helen F Graham Cancer Center in Newark, DE where they will concentrate on the evaluation and management of patients with new oncologic diagnoses (or patients with unknown diagnoses for whom a malignancy is part of the differential diagnosis) as well as provide support to oncology inpatients and outpatients by writing chemotherapy orders. The aims are for the fellow to gain an understanding of disease processes, the past histories and the choices of chemotherapy regimens.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of oncologic diseases, under the direct supervision of attending physicians.

Principal Teaching Methods: Inpatient patient management, consultation, teaching, clinical conferences and case reviews, literature reviews. Outpatient consultation, chemotherapy and management of side effects and screening for long term sequelae of cancer.

Educational Content: Exposure to the biology and pathogenesis of a variety of solid tumors and participation in the diagnosis and treatment of a variety of solid tumors and their complications, including breast cancer, aero-digestive cancer, melanoma and sarcoma, lymphomas, brain tumors, and genitourinary cancers.

Mix of Diseases: A wide array of solid tumors and related oncologic problems.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Interviews and examinations in the outpatient and inpatient setting.

Procedures: Bone marrow aspiration and biopsies, chemotherapy infusion, intrathecal chemotherapy administration.

Educational Resources: As previously described.

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Dr. O'Hara

Message from
Joanne Filicko-O’Hara, MD

Program Director,
Combined Fellowship in Hematology/Medical Oncology

Ms. Sparano

Kathleen Sparano
Fellowship Coordinator


834 Chestnut Street
Ben Franklin House,
Suite 320
Philadelphia, PA 19107
(215) 955-5822

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