Pediatric Hematology/ Oncology Fellow Handbook For 2007 - 2008

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Pediatric Hematology/ Oncology Fellow Handbook For 2007 - 2008

  1. 1. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 1 Pediatric Hematology/ Oncology Fellow Handbook For 2007 - 2008
  2. 2. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 2 Table of Contents Program Statement Program Requirements Program Description General Description Accreditation Certification Components of the Program Clinical Research Program Features Faculty Facilities and Resources General Curriculum General Program Content Knowledge and Clinical Experience Skills – Clinical, Technical and Procedural Scholarship Research Standard of Conduct Humanistic and Ethical Behavior Summary of Curriculum Goals and Objectives Goals of the Fellowship Continuity Clinic Inpatient Rotation Pathology/Hematopathology/Coagulation Bone Marrow Transplant Adult Hematology Radiation Oncology Transfusion Medicine Conferences
  3. 3. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 3 Other Educational Activities Evaluation Procedures First Year Evaluation Second and Subsequent Years Evaluation Evaluation of Fellow Performance Fellow Evaluation of Rotation Fellow Evaluation of Faculty Promotion, Probation, Suspension and Dismissal Important Policies for 2007 – 2008 Supervision Eligibility and Selection Vacation and Leave Moonlighting Work Hours Call Responsibilities Standards of Performance Due Process Evaluation Appendix Form for Fellows to Evaluate Rotations Form for Attendings to Evaluate Fellows Program Director Meeting Form
  4. 4. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 4 Program Statement Hematology/Oncology as a Subspecialty of Pediatrics Satisfactory completion of an accredited program in Pediatrics is a requirement for entry into this subspecialty training program. Subspecialty training in Pediatric Hematology/Oncology is a voluntary component of education in Pediatrics. Requirements of the Fellowship Program The primary requirements of the Fellowship program include: Appropriate progress in achieving clinical competence as specified below. Successful completion of all clinically related tasks required on each specific rotation. These include attendance at clinics, performance of consultative history and physical examinations, daily (or more frequent as medically indicated) follow-up of inpatients, and performance of all requested emergency and inpatient consultations. Maintenance of all medical records pertaining to patient care in an accurate and timely fashion. Hospital and Pediatric Hematology/Oncology Division records need to be complete and accurate, legible, and appropriately detailed. Dictations need to be done within 24 hours of the clinic visit and consultation notes placed on the hospital chart within 24 hours of providing the consultation. Regular attendance at all educational activities (journal club, tumor board, clinical and research conferences) of the division. Subspecialty conferences and meetings are mandatory for the Fellow(s) assigned to the specific rotation, and optional for all other Fellows in the program. Familiarity with and comprehension of Pediatric Hematology/Oncology literature. The Fellow is expected to read widely on topics pertaining to patients in whose care the Fellow is currently involved. Fellows will be asked to take part in and present at a number of conferences throughout their training. It is expected that their efforts will reflect an appropriate amount of thought and work in developing the topics. Annually, the Fellow is expected to do at least one 1-hour special conference presentation. The Fellows in the first year will be expected to do a literature search and a presentation of the subject, while in the second and third years will present results of either clinical or basic science research. The Fellows’ presentations will be evaluated and critiqued by the staff, and it is expected that these presentations will be worthy of presentation at a regional or national meeting and comparable to such presentations in terms of scientific quality and use of audiovisual materials.
  5. 5. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 5 Fellows are expected to maintain a log of procedures performed during their training, including bone marrow aspirates and biopsies, lumbar punctures, paracentesis, thoracentesis, etc.
  6. 6. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 6 Program Description General Program Description Program Accreditation Certification in Pediatric Hematology/Oncology
  7. 7. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 7 General Program Description The University of Utah is the major teaching and research institution in the intermountain west. The University of Utah School of Medicine uses Primary Children's Medical Center (PCMC) as its primary training site for Pediatrics. The University of Utah Health Sciences Center (UUHSC) is also used as a part of Pediatric Hematology/Oncology training program. Major clinical care and clinical and basic research programs are a part of all specialty programs including Pediatrics and Pediatric Hematology/Oncology. The Pediatric Hematology/Oncology Division staff at PCMC and UUHSC is made up of full-time academic faculty members in the University of Utah Department of Pediatrics (see faculty list and appendix for detailed faculty information). Program Accreditation and Relationship to Pediatrics The Hematology/Oncology subspecialty training program at the University of Utah is an integral part of the residency program in Pediatrics, which are together accredited by the Accreditation Council for Graduate Medical Education (ACGME). The Pediatric and subspecialty training programs in the department of Pediatrics are all ACGME accredited programs in the University of Utah’s School of Medicine. These programs include complete and in-depth training in all aspects of Pediatrics, its subspecialties, and in clinical and basic research. The Pediatric Hematology/Oncology training program is offered as a three-year Fellowship. Certification in the Subspecialty of Hematology/Oncology The American Board of Pediatrics offers certification in the subspecialty of Pediatric Hematology/Oncology upon successful completion of the certification examination given by the Board. Specific requirements for certification are given later in this packet.
  8. 8. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 8 Components of the Program Clinical Research
  9. 9. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 9 Components of the Program Clinical Component The Pediatric Hematology/Oncology training program includes 1-6 Fellows who interact on a daily basis with faculty, with each other, and with the general and subspecialty clinical services from Pediatrics and allied medical and surgical specialties. The program consists of structured educational activities including inpatient and outpatient experiences, consultative rotations, technical training, conferences, didactic lectures, teaching experiences, assigned readings, review sessions, and research training. All of these are designed with specific goals, implementation methods, and evaluations so that the Fellow can acquire all of the knowledge, cognitive, technical, interpersonal, humanistic, research, professional and judgment skills necessary to be an academic Pediatric Hematologist/Oncologist and a responsible and contributing part of the medical community and society. The first year of the Fellowship is a clinical year with 5- 6 months of inpatient service and 5-6 months of rotations including Outpatient Clinic and Consultations, BMT (1 month), Pathology and Laboratory Medicine (1 month), Adult Hematology (1 month), Radiation Oncology (I month), and 3 weeks of vacation. Each of the specific educational components is detailed later. Research Component The second and third years of the Fellowship are dedicated to basic science research training. A broad range of research resources and opportunities are available in the division, the department, and the institution. There are tremendous research opportunities available through the University of Utah and the Huntsman Cancer Institute. We recognize that successful research training may not be completed in two years, and are committed to facilitating additional training as appropriate to meet the needs of the Fellow.
  10. 10. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 10 Program Features Faculty Facilities and Resources
  11. 11. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 11 General Features of Training in Pediatric Hematology/Oncology Subspecialty training in Pediatric Hematology/Oncology at the University of Utah provides advanced training to allow the Pediatric Hematology/Oncology Fellow to acquire consultative expertise. All major dimensions of the curriculum (described later) are structured educational experiences with specified goals and objectives, a defined methodology for teaching/learning, and an explicit method for evaluation. The curriculum assures that Fellows will have the opportunity to achieve the cognitive knowledge, psychomotor skills, interpersonal skills, professional attitudes, and practical experience required of a sub-specialist in Pediatric Hematology/Oncology. In addition, Fellows will be expected to maintain in-depth knowledge of Pediatrics, as Hematologist/Oncologists are often called upon to provide primary care to patients. The program at the University of Utah emphasizes scholarship, self-instruction, development of critical analysis of clinical problems, and the ability to make appropriate decisions. The program provides appropriate opportunity for the Fellow to acquire skills in the performance of the techniques required for the practice of the subspecialty. Appropriate supervision is provided during all educational experiences. Faculty The training program is a joint effort between both the Pediatric Hematology and Oncology Divisions of the Department of Pediatrics. Clinical and research faculty is as follows: Division of Pediatric Hematology/Oncology Richard Lemons, MD, PhD Professor of Pediatrics Division Chief, Pediatric Hematology/Oncology Primary Children's Medical Center Phone: 801-662-4733 Pager: 801 914-6360 David Virshup, MD Program Director Willard Snow Hansen Presidential Professor of Cancer Research Professor of Pediatrics Adjunct Professor of Oncological Sciences Investigator, Huntsman Cancer Institute HCI 3245 Phone: 801-585-3408 Pager: 801-914-6512
  12. 12. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 12 Carol Bruggers, MD Professor of Pediatrics PCMC Phone: 801-662-4735 Pager: 801-914-6856 Hassan Yaish, MD Associate Professor of Pediatrics PCMC Phone: 801-662-4701 Pager: 801-914-6993 Zenaib Afify, MD Assistant Professor of Pediatrics PCMC Phone: 801-662-4731 Stephen Lessnick, MD, PhD Assistant Professor of Pediatrics Investigator, Huntsman Cancer Institute Adjunct Assistant Professor of Oncological Sciences HCI 4242 Phone: 801-585-9268 Pager: 801-914-8478 Nikolaus Trede, MD, PhD Assistant Professor of Pediatrics Investigator, Huntsman Cancer Institute HCI 4265 Phone: 801-585-0199 Pager: 801-914-8671 Phillip Barnette, MD, DVM Instructor, Assistant Professor of Pediatrics PCMC Phone: 801-662-4730 J. Kimble Frazer, MD, PhD Instructor, Department of Pediatrics HCI 4263 Phone: 801-587-5599
  13. 13. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 13 Additional Key Faculty Michael Pulsipher, MD Acting Director, Utah Blood and Marrow Transplant Program Assistant Professor of Pediatrics Adjunct Assistant Professor of Medicine PCMC Hem/Onc/BMT Division 5C402 SOM Phone: 801-213-2079 Pager: 801-914-6838 Michael Boyer, MD Assistant Professor Bone Marrow Transplantation Phone: 801-662-4729 John H. Ward, MD Professor of Medicine Division Chief, Oncology Medical Director, Huntsman Cancer Institute 2141 HCI Bldg. Phone: 801-585-0255 Pager: 801-339-5214 George M. Rodgers, MD, PhD Professor of Medicine Adjunct Professor of Pathology (Clinical) 2C110 SOM Phone: 801-585-3229 Pager: 801-339-5208 Robert Blaylock, MD Associate Professor of Pathology Blood Bank Director 5C124 SOM Phone: 801-585-3369 Sherrie Perkins, MD, PhD Associate Professor of Pathology Director, Hematopathology 5C124 SOM Phone: 801-581-5854
  14. 14. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 14 Cheryl Coffin, MD Professor of Pathology Division Head, Pediatric Pathology, PCMC Medical Director, Vice President, Pediatric Pathology ARUP Laboratories Associate Chair, Pathology, University of Utah PCMC, 2nd Floor, Northeast Phone: 801-662-2155 Pager: 801-914-6464 John Thomson, MD Radiation Oncology LDS Hospital Phone: 801-408-1146 Dennis Shrieve, MD Radiation Oncology University of Utah Phone: 801-581-8793 Lynn Smith, MD Radiation Oncology Huntsman Cancer Institute Phone: 801-581-2396 Pager: 801-581-2396 R. Lor Randall, MD, FACS Director, Sarcoma Service Huntsman Cancer Institute HCI 4262 Phone: 801-585-0300 Pager: 888-332-1246 Facilities and Resources The training facilities used by the Hematology/Oncology Fellowship program include inpatient wards and outpatient facilities at PCMC, the UU Health Science Center and the Huntsman Cancer Institute. There are a number of full-time University of Utah faculty members, who provide teaching and direction for the program. The University of Utah, PCMC and Huntsman Cancer Institute are fully accredited and active members of the Children's Oncology Group (COG). COG is a multi-center national clinical investigation cooperative group involved in developing Phase I through Phase III clinical trials for national patient enrollment. Fellows will be expected to take an active role in the recruitment of patients to these trials. Primary Children's Medical Center
  15. 15. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 15 PCMC is a pediatric referral center serving five states in the Intermountain West. This 232-bed facility is equipped and staffed to treat children with complex illness and injury. PCMC offers specialized care services including surgery, pathology, laboratory medicine, rehabilitation medicine, diagnostic and interventional radiology, and nuclear medicine. In addition to the general service wards, there are pediatric intensive care, newborn intensive care, and bone marrow transplant units. There is a close working relationship between the Divisions of Hematology and Oncology and the surgical, pediatric, radiology, and pathology staffs. This relationship includes patient care, lectures, and multi-disciplinary conferences. PCMC is part of Intermountain Health Care, a non-profit organization, and is affiliated with the Department of Pediatrics at the University of Utah. There are over 10,000 inpatient admissions and over 130,000 outpatient visits annually (Approximately 7% of these visits are to the Pediatric Hematology/Oncology service.) There is an air transport service that transports over 500 critically ill to PCMC annually. A fully equipped and well-staffed Pediatric Emergency Department at PCMC provides care for nearly 30,000 patients annually. The Pediatric Hematology/Oncology patients are admitted to a newly renovated (as of January, 2004) dedicated medical unit staffed with nurses specifically trained in issues related to Pediatric Hematology/Oncology and bone marrow transplantation. Also, there is a new (as of July 2006) dedicated Pediatric Hematology/Oncology outpatient clinic within PCMC with 10 exam rooms, with an integrated infusion therapy center and multi-bed procedure center. The PCMC inpatient and outpatient experience includes a full consultative Hematology/Oncology service for Pediatrics and Pediatric Surgery, and all their subspecialties. Fellows will rotate through the inpatient service at PCMC, spending 6 months on it during their first year. The vast majority of clinical care for Pediatric Hematology/Oncology patients occurs at PCMC. University of Utah Health Sciences Center The University Hospital is a 365-bed acute care facility offering primary to quaternary care in all specialties of medicine, surgery, pathology, laboratory medicine, family medicine, obstetrics and gynecology (including gynecologic oncology), rehabilitation medicine, diagnostic and interventional radiology, and nuclear medicine. In addition to the general service wards, there are medical, pulmonary and cardiac, surgical, neurological, and newborn intensive care units. There is a close working relationship between the Divisions of Hematology and Oncology and the surgical, medical, pediatric, radiology, and pathology staffs. This relationship includes patient care, lectures, and multi-disciplinary conferences. The University Bone Marrow Transplant Unit, part of the Hematology Division, evaluated 129 new patients in 1998, and performed 55 autologous transplants and 31 allogeneic transplants that year.
  16. 16. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 16 Fellows will do consults, Adult Hematology and Laboratory Medicine rotations, and parts of their BMT and Pathology rotations at the UUHSC.
  17. 17. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 17 Huntsman Cancer Institute The Huntsman Cancer Institute (HCI) is affiliated with the University of Utah. Situated east of the main hospital building, the Huntsman Cancer Institute is mandated to be a center of excellence for cancer research. Basic science researchers with the Institute study the molecular and biochemical mechanisms underlying malignant transformation, identify malignant gene rearrangements for use as markers predicting inheritance or targets for gene therapy, and develop new therapeutic agents for the treatment of malignancy. Clinical research staff study patterns of disease inheritance, enroll adult patients in clinical trials to evaluate new therapeutic or preventive agents, and work closely with the basic science researchers in translational research. Pediatric Hematology/Oncology Fellows will spend some part of their Fellowship in this facility attending lectures and providing consults if needed. In addition, a substantial number of Fellows elect to do research with laboratory and clinical researchers housed in HCI.
  18. 18. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 18 General Curriculum General Program Content Knowledge and Clinical Experience Skills – Clinical, Technical, And Procedural Scholarship Research Judgment Standards of Conduct Humanistic and Ethical Behavior Summary of Curriculum
  19. 19. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 19 General Program Content and Curriculum The Pediatric Hematology/Oncology clinical training program is a structured educational experience combining inpatient and ambulatory clinical rotations with interactive conferences and didactic teaching sessions. Fellows will participate in a continuity of care clinic for one day per week for the duration of their Fellowship training. An Attending Physician supervises all clinical activities. Inpatient clinical rotations combine extensive interaction with pediatric residents, as well as Fellows from other specialties with reporting to and instruction from the Attending Physician. All procedural training is supervised by on site Attending Physicians. It should be noted that the educational activities are not only structured to meet all of the goals of Pediatric Hematology/Oncology training, but also to maintain skills in General Pediatrics. Fellows are to do complete evaluations on all inpatient and outpatient consultations. These are reviewed and discussed with Attending Physicians. Fellows are required to attend divisional conferences (the schedule of these is outlined later) and are invited to attend didactic conferences for the pediatric housestaff. Research training is accomplished through both didactic teaching of research principles and through closely supervised research projects. A scientific mentor supervises all research activities. The Fellowship program research training requirements are detailed later. Overall Objectives of Training in Hematology/Oncology The overall objective of the Pediatric Hematology/Oncology training program is to fully instruct Pediatric Hematology/Oncology Fellows in the science and practice of their chosen subspecialty. In addition, our Fellows will acquire expertise in the critical appraisal of medical literature required to maintain a high standard of competence throughout their practice lifetime. Graduates of our program will become board certified, and be highly competent and competitive for academic positions. Knowledge and Clinical Experience The Fellow will receive formal instruction, clinical experience, and opportunities to acquire comprehensive knowledge in the following areas: • Morphology, physiology, and biochemistry of blood, marrow, lymphatic tissue, and the spleen. • Basic molecular and pathophysiologic mechanisms, diagnosis, and therapy of diseases of the blood, including anemias, diseases of white cells, and disorders of hemostasis and thrombosis. • Etiology, epidemiology, natural history, diagnosis, pathology, staging, and management of neoplastic disorders. • Measurement of the complete blood count, including platelets and white cell differential, using automated or manual techniques with appropriate quality control.
  20. 20. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 20 • Immune markers, immunophenotyping, cytochemical studies, and cytogenetic and DNA analysis of neoplastic disorders. • Molecular mechanisms of neoplasia, including the nature of oncogenes and their products. • Systemic chemotherapeutic drugs, biological and immunological response modifiers, and growth factors and their mechanisms of action, pharmacokinetics, clinical indications, routes of administration, and limitations, including their effects, toxicity, and interactions. • The use of multiagent chemotherapy protocols and combined modality therapy in the treatment of neoplastic disorders. • Management and care of indwelling venous access catheters. • Principles and application of surgery and radiation therapy in the treatment of neoplastic disorders. In particular, a basic understanding of the physics involved in the administration of radiation therapy and the complications arising from its use, as well as a comprehensive understanding of potential interactions between systemic therapy and radiation therapy. • Management of the neutropenic and/or the immunocompromised patient. • Rapid identification and treatment of hematologic and oncologic emergencies, including spinal cord compression, hypercalcemia, disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenia purpura (TTP), & heparin induced thrombocytopenia (HIT). • Effects of systemic disorder, infections, solid tumors, and drugs on the blood, blood-forming organs, and lymphatic tissues. • Allogeneic and autologous bone marrow transplantation and the nature and management of post-transplant complications. • Indications and application of imaging techniques inpatients with blood and neoplastic disorders. • Pathophysiology and patterns of solid tumor metastases. • Pain management in the cancer patient. • Nutrition management for the cancer patient. • Rehabilitation and psycho-social management of patients with hematologic and neoplastic disorders. • Hospice and home care for the cancer patient. • Recognition and management of paraneoplastic disorders. • The etiology of cancer, including predisposing causal factors leading to neoplasia. • Current cancer prevention and screening recommendations, including competency in genetic testing and counseling as they relate to hereditary cancers and hematologic disorders for high- risk individuals. • Participation in a tumor board. • Tests of hemostasis and thrombosis for both congenital and acquired disorders and regulation of anti-thrombotic therapy. • Treatment of patients with disorders of hemostasis and the biochemistry and pharmacology of coagulation factor replacement.
  21. 21. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 21 • Transfusion medicine, including the evaluation of antibodies, blood compatibility, and the use of blood component therapy and apheresis procedures. • Understand the late effects of cancer therapy. The Fellow will achieve a high level of cognitive knowledge of the following specific disorders, including their risk factors, molecular basis, appropriate treatment options, and prevention strategies, where applicable: • Leukemias, both acute and chronic • Solid tumors of organs, soft tissue, bone, and central nervous system • Lymphomas • Bone marrow failure • Hemoglobinopathies, including the thalassemia syndromes • Inherited and acquired disorders of the red-cell membrane and of red-cell metabolism • Autoimmune hemolytic anemia • Nutritional anemia • Inherited and acquired disorders of white blood cells • Platelet disorders, including ITP and acquired and inherited platelet function defects • Hemophilia, von Willebrand's disease, and other inherited and acquired coagulopathies • Hematologic disorders of the newborn • Transfusion medicine and use of blood products • Congenital and acquired immunodeficiencies In addition to specific hematologic and malignant disorders, the Fellow must develop competency in all aspects of chemotherapy, including treatment protocols and management of complications, diagnosis and treatment of infections in the compromised host, appropriate use of transfusion of blood products, plasma pheresis and bone marrow transplantation. The Fellow is also expected to learn methods of physiologic support of the cancer patient including parenteral nutrition, control of nausea and pain, staging and classifications of tumors, complete knowledge and application of multi-modality therapy, learning to function as a member of an oncology team, and learning the epidemiology of childhood cancer. Skills - Clinical, Technical, and Procedural Fellows will develop the skills needed of a subspecialty consultant in Pediatric Hematology/Oncology. The Fellow will learn the skills of history taking, physical examination, data interpretation, problem synthesis, and proper use of diagnostic and therapeutic procedures. The full spectrum of procedures applicable to the practice of Pediatric Hematology/Oncology will be learned by the Fellow, and will include training in the technical and psychomotor skills required.
  22. 22. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 22 Clinical Skills: Fellows will be expected to be proficient in the following clinical skills: 1. The performance of a directed but thorough history and physical examination. 2. The ability to serially measure palpable tumor masses. 3. The ability to interpret clinical data, including laboratory data, imaging studies, pathologic specimens, and the microscopic interpretation of blood smears and marrow aspirates and biopsies. 4. The ability to formulate an appropriate differential diagnosis and diagnostic plan based upon the clinical, laboratory, and radiological findings. 5. The ability to communicate clinical data in an organized, succinct, and intelligible fashion. 6. The ability to select appropriate, safe, and cost-effective laboratory and diagnostic studies. 7. The ability to formulate and carry out an appropriate therapeutic plan for Pediatric Hematology/Oncology disorders. 8. The ability to work effectively as part of a multi-disciplinary team. 9. The ability to provide appropriate humanistic, ethical, and conscientious care to the patient. Technical and Procedural Skills: The Fellow will know the indications, contraindications, complications, potential benefits, alternatives, and limitations of the following diagnostic and therapeutic techniques and procedures. The Fellow will be able to appropriately, safely and expeditiously perform or recommend and, where applicable, interpret these procedures based upon knowledge of the history and clinical findings. The Fellow will receive training in each of these areas to accomplish this goal. • Accurately calculate doses, order, administer or supervise the administration of cytotoxic chemotherapeutic agents and biologic response modifiers. Specifically, instruction in the careful, concise, and accurate ordering of these agents will be emphasized. • Ordering and administration of blood products, including factor replacement. This will include instruction in the indications for specific preparation of blood products—filtered, irradiated, and washed. • Recommend and assess tumor imaging studies, including plain films, CT scans, ultrasound (dynamic or static), MRI, and metabolic scanning. • Recommend surgical procedures. • Recommend appropriate insertion of central venous access, including PICC lines, broviac or portacath catheters. • Perform bone marrow aspiration and biopsy, including preparation, staining, examination, and interpretation of blood smears, bone marrow aspirates, and touch preparations. The Fellow will be able to perform the bone marrow aspirate/biopsy by the posterior, and anterior approach. • Recommend apheresis procedures, including therapeutic plasmapheresis or peripheral stem cell harvest for transplantation.
  23. 23. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 23 • Perform and interpret partial thromboplastin time, prothrombin time, platelet aggregation, bleeding time and other standard coagulation assays. • Perform diagnostic or therapeutic thoracentesis and paracentesis. • Perform lumbar puncture or access Ommaya reservoirs, and, where applicable, instill chemotherapeutic agents directly into the CSF. • Administer sedation for patients undergoing procedures such as bone marrow biopsy. The Fellow will be expected to be able to concisely outline the nature and utility of each procedure, along with its potential complications and benefits, to the patient for the purpose of obtaining informed consent. The Fellow will appropriately document the indications, performance and results of all procedures in the patient chart. In addition, the Fellow will document all procedures in the ABP-approved procedure logbook, and have the supervising Attending Physician sign off on them. The Fellow will be expected to learn to identify his/her own limitations, and identify when to terminate procedures or seek assistance. Scholarship A scholarly approach to learning, practice, research, and teaching will be developed. Pediatric Hematology/Oncology Fellows will utilize educational offerings to their fullest extent. Fellows will also be expected to become independent learners and develop lifelong habits of reading and literature research. They will learn the principles of evidence-based medicine, critical literature review, and clinical application of new knowledge to the clinical and research settings. They will be encouraged to remain active in research throughout their practice careers, in the laboratory setting, in the clinical setting, or both. Pediatric Hematology/Oncology research is required not only for the purpose of learning necessary skills for a possible academic career, but also to gain first-hand experience in the generation of medical knowledge. Like learning, teaching is an integral part of scholarship. As such, the Fellow will be involved in teaching throughout the program. The Division is responsible for teaching medical students about Pediatric Hematology and Oncology. Fellows will participate by directing small groups of medical students in sessions covering topics outlined in the formal lectures. In addition, Fellows will regularly present and discuss patients and therapeutics at multi-disciplinary conferences, give didactic lectures at Friday conferences, present regularly at journal club, and instruct interns and residents from all disciplines during inpatient and consult service rounds.
  24. 24. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 24 Research Basic science and clinical research are of critical importance to the field of Pediatrics, and to Pediatric Hematology/Oncology in particular. All advances in medical practice are the result of research. Abundant research opportunities exist for our Fellows and include basic laboratory research, translational and clinical research projects. These can be coordinated within the Divisions, the Department of Pediatrics, or any other Department within the University. The HCI investigators and those in the Department of Oncologic Sciences represent a unique opportunity for the development and pursuit of research interests. Fellows in Pediatric Hematology/Oncology will receive instruction in the principles and techniques involved in basic science and clinical research, and will be expected to participate in a research project during their program. Fellows will spend at least two years involved in a research project. By Spring of their first year, Fellows will be expected to have identified a scientific mentor and an area of research interest, and communicate this to the Program Director. Fellows will be encouraged to seek the advice of Faculty members when deciding on a potential research project, and will receive whatever assistance they require. It is hoped that the exposure our Fellows receive to research during their program will foster an interest that will last throughout their career. Judgment The Fellow will develop appropriate clinical judgment in all aspects of the practice of Pediatric Hematology/Oncology. This includes the ability to integrate medical facts and clinical data, weigh alternatives, understand the limitations of knowledge, critically analyze and integrate complex information, develop most appropriate evaluation and management strategies, make appropriate decisions, and incorporate considerations of risks and benefits.
  25. 25. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 25 Standard of Conduct Fellows will be expected to develop a high degree of standard of conduct. A Fellow must be responsive, reliable, committed, cooperative, and respectful. The Fellow must demonstrate appropriate regard for the opinions and skills of colleagues. Records should be legible, timely, and responsive to the referring physician’s needs and questions. Information should be validated through a personal review of clinical findings, laboratory and radiographic data, and pathology specimens. Communication should be effective and non-judgmental. Interpersonal skills should be highly developed in order to achieve effective, positive, and efficient communication with patients, colleagues, and staff. Standard of conduct includes placing the needs of one’s patients, colleagues and staff ahead of one’s own self-interest, being responsive to the needs of society, having a continuing commitment to scholarship and research, and enhancing the ability of all colleagues in the health professions to discharge their responsibilities optimally. Proper standard of conduct also includes the proper application of judgment, the “art” of medicine, and the values learned from mentors and role-model clinicians. The importance of giving time for teaching, institutional committee work, and community service is a part of the standard of conduct, as is the proper application of the principles of quality assessment, quality improvement, risk management, and cost-effective practice. Humanistic and Ethical Behavior Fellows must exhibit the highest standards of humanistic and ethical behavior. The character traits of integrity, respect, compassion, and empathy should always be demonstrated towards both patients and colleagues. Fellows should establish relationships with patients and all other members of the health care team based on mutual trust and understanding. There should be a primary concern for the welfare of the patient. The Fellow should maintain credibility, rapport with patients and families, and respect the patient’s need for information. The Fellow should always be non- judgmental. There should be appropriate attention to confidentiality, informed consent (both in the clinical and research setting), and to social, cultural, and language barriers. Summary of Training Program Curriculum The overall goals and objectives of the program will be accomplished through the following educational offerings. The objectives, value, teaching methods, educational content, mix of diseases, patient characteristics, types of clinical encounters, procedures and services, educational materials, methods of evaluation, and strengths and weaknesses of these educational offerings are outlined under the section “Details of Each Educational Offering” below.
  26. 26. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 26 Goals And Objectives Goals of the Fellowship Continuity Clinic Inpatient Rotation Pathology/Hematopathology/Coagulation Bone Marrow Transplant Adult Hematology Radiation Oncology Transfusion Medicine Conferences Other Educational Activities
  27. 27. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 27 Goals of the Fellowship It is the intent of this training program to develop physicians clinically competent in the field of Pediatric Hematology/Oncology and also with sufficient knowledge, thought processes and laboratory skills necessary for a potential career as an independent investigator. Physicians completing this training program will be eligible for certification in Pediatric Hematology/Oncology. Clinical competence requires: (1) A solid fund of basic and clinical knowledge, (2) The ability to perform a thorough history and physical examination, (3) The ability to appropriately order and interpret diagnostic tests, (4) Adequate technical skills to carry out selected diagnostic procedures, (5) Clinical judgment to critically apply the above data to individual patients, (6) Attitudes conducive to the practice of Pediatric Hematology/Oncology, including appropriate interpersonal interactions with patients, professional colleagues and supervisory faculty, and all paramedical personnel. These humanistic aspects of medicine are of critical importance, (7) Personal integrity, which includes strict avoidance of substance abuse, theft, and unexcused absences, and (8) Regular, timely attendance at education activities of the Department of Pediatrics and the Division of Pediatric Hematology/Oncology. During the initial year of the training program, each of the above elements of clinical competence will be assessed in writing after every completed rotation (see below) by direct faculty supervisors with at least semi-annual reviews by the Program Director. During subsequent years of the training program, evaluations of clinical competence and acquisition of research skills will be evaluated every six months by the faculty supervisors directly involved with the Fellow. Reappointment and promotion to subsequent years of training will require satisfactory ratings. The Program Director will immediately counsel Fellows concerning any unsatisfactory evaluations and what deficiencies must be corrected. Fellows receiving more than one unsatisfactory evaluation during the year will be subject to specific recommendations by the Program Director and/or the Division Chief, which might include the following: (1) Specific corrective actions required (2) The need to repeat a rotation (3) The need to participate in a special program (4) The need to go into official academic probation for a period of time (5) The need for termination, if prior corrective actions and/or probation have been unsuccessful.
  28. 28. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 28 Continuity of Care Clinic (1 day/week) On most clinical rotations, Fellows will see new patient consults either in the outpatient or inpatient setting, allowing each Fellow to follow a cohort of patients. Throughout their Fellowship program, each Pediatric Hematology/Oncology Fellow will be assigned a clinic day in the PCMC outpatient clinic. The Fellow will attend this clinic for the duration of the program. The Attending staff are assigned specific clinic days, enabling each Fellow to develop a close rapport with the Attending Physicians who share that clinic day. In addition, throughout the program, the Fellow will become familiar with a cohort of patients who are regularly seen on that day. This will provide the Fellow with valuable continuity of care experience. InPatient Rotation—(5-6 months) Rationale/Value The Inpatient Rotation is one of the core components of the Fellowship Program, providing the opportunity to gain experience managing the complications of malignant diseases that require hospital admission, including oncologic emergencies and complications of therapy. This is also the primary opportunity for the Fellow to diagnose, treat and manage a broad spectrum of pediatric malignancies and hematologic disorders. Principal Teaching Method The Fellow and the on-service Attending work closely together to care for the inpatient hematology/oncology service. Therefore, most teaching occurs via this interaction. Experience: The full range of malignant diseases is seen and cared for on the Hem/Onc inpatient service. As PCMC represents the tertiary referral service for Utah and several surrounding states, the Fellow will encounter many unusual presentations and unusual diseases as well as the more common pediatric diseases. Patients with solid tumors typically are admitted for care of diagnostic evaluations and oncological emergencies (such as spinal cord compression, superior vena cava syndrome and hypercalcemia). The most common malignancy encountered is acute leukemia. Other admissions include those for neutropenic fever, pain control and occasionally end-of-life care. Patient Characteristics: Most patients are from Utah or the surrounding states of Wyoming, Idaho, Nevada and Montana. The population of these states is majority Western European descent, although African-American, Native American, Pacific- islander and Hispanic communities are represented in our patient population as well. Ages of the patients range from newborns to young adult. Types of Clinical Encounters: Fellows participate in the care of all patients on the Hematology/Oncology inpatient service and see inpatient consultations on other services.
  29. 29. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 29 Procedures: Fellows perform bone marrow aspirations and biopsies, lumbar punctures, Ommaya taps and instillation of intrathecal chemotherapy, paracentesis, and thoracentesis. Ordering and coordination of chemotherapy administration is emphasized, especially of high dose, inpatient chemotherapy. Services: The Fellow provides three general types of service during this rotation; care of the hematology/oncology inpatients, consultations for other services and telephone call support. The Fellow works with the on-service Attending and resident team to care for about 10- 20 pediatric hematology/oncology patients on a separate ward of the PCMC. Therefore, the Fellow supervises and teaches medical students, interns and residents on rounds and throughout the day as questions arise. He/she is usually the initial person contacted by the housestaff for questions and for supervision of procedures. The Attending is always present during rounds to provide overall education and supervision of the team, and always available to the Fellow and housestaff as needed. The Fellow also will provide hematology and oncology consultations to other inpatient services of PCMC and the University Hospital. There is on average about 3 new patient consultations per week. Typically, the Fellow sees the patient initially, obtains a history, does the physical exam and collects all relevant data. The Fellow formulates a plan, which is then reviewed by the Attending. The patient is seen and a final diagnostic and therapeutic plan devised. Plans for outpatient follow-up are also made. The Fellow is expected to coordinate our recommendations with the primary treating team, and follow the patient with the Attending for the duration of his/her stay. Reading List: The Pediatric Hematology/Oncology Reading List contains key articles on the subjects covered by this rotation. Pathological Material: All bone marrow aspirations and biopsies obtained on the inpatient service are reviewed by the treating team in consultation with staff hematopathologists. Peripheral smears are also reviewed. Any other biopsies obtained on our patients or consult patients are reviewed by the Fellow and Attending with the pathologists as necessary. Other: The Fellow is expected to actively participate in the Tumor Board conferences, typically presenting cases encountered during the inpatient experience. The Fellow presents the details of the case, and representatives of the Pathology and Radiology Departments review and discuss the pathological and radiological materials. The Fellow is expected to review the literature and synthesize the information to provide a cogent, useful presentation. This is an important learning experience for the Fellow.
  30. 30. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 30 Methods for Evaluating Fellow The Attending Physician provides a written evaluation of the Fellow, describing clinical judgment, clinical skills, medical knowledge, medical care, humanistic qualities, professional attitudes, behavior, and commitment to scholarship. On-going informal feedback is given on a day-to-day basis. Confidential, semi-annual reviews of all the evaluations of each Fellow are provided by the Fellowship Program Director. Methods for Evaluating Program The Fellows provide a written evaluation of the Inpatient Rotation at the end of each month. Fellow’s Responsibilities/Line of Responsibilities As noted previously, the Fellow is part of a team of treating physicians which also includes the on-service Attending, who has ultimate responsibility for the care of the Hematology/Oncology inpatients as well as for the consultations provided for other services. Teaching is another primary responsibility of the Attending Physician. The Fellow is primarily responsible for teaching the housestaff and overseeing the care provided by them, as well as for carefully following patients seen in consultation and ensuring our recommendations are communicated in a timely, understandable manner. The Fellow is also expected to write all chemotherapy orders for inpatients that are not performed by the inpatient nurse practitioner. Pathology/Hematopathology/Coagulation Rotation Rationale/Value The primary focus of this rotation is to: 1) Study the histopathology and pathologic basis of oncologic and hematologic diseases of childhood, 2) Learn diagnostic tools and understand the principles that govern their use, 3) Become proficient in examining bone marrow aspirates and biopsies, 4) Learn the histopathologic classifications of solid tumors, and 5) Gain a working knowledge of hemostatic disorders. Principal Teaching Method The Fellow will learn to prepare peripheral blood and bone marrow specimens and interpret these tests. The Fellow will review teaching file material and discuss didactic cases. Selected readings from “Pediatric Soft Tissue Sarcoma” by Dr. Cheryl Coffin and “Bone Marrow Pathology “ by Dr. Kathryn Foucar are required. A didactic set of clinical cases on hematostatic disorders is covered during the rotation. Rotations through the coagulation laboratory are available for those Fellows desiring to know technical details of hemostasis testing.
  31. 31. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 31 Educational Content Mix of Diseases: Hematopathologic disorders include malignant and non-malignant disorders, including leukemia, lymphoma, myeloma, myeloproliferative disorders, myelodysplastic disorders, anemias, thrombocytopenias, etc., and staging bone marrows. Bone marrows done pre- and post-bone marrow transplant are also evaluated on the Hematopathology service. A broad range of hemostatic disorders are also seen, including patients with inherited and acquired bleeding disorders, to include hemophilia, von Willebrand's disease, disorders of platelet function, disseminated intravascular coagulation, vitamin K deficiency, etc. The Mountain States Hemophilia Center is located in our institution, and attracts referrals from a seven-state area. University Hospital also has an Anticoagulation Clinic that monitors patients on oral anticoagulation. The Fellows learn appropriate patient instruction in this clinic. Our clinic is also a major referral center for patients with inherited thrombotic disorders, and Fellows learn about the laboratory evaluation and management of their disorders. Patient characteristics: Most patients are from Utah or the Intermountain Western states. Approximately 10% of patients are age 25 or younger. Types of Clinical Encounters: Fellows perform and interpret bone marrows on hospital inpatients and outpatients. They should follow solid tumor from resection to histologic diagnosis. Fellows will attend the Coagulopathy clinic run by Dr. George Rodgers. The Fellow will meet with Dr. George Rodgers at least weekly to review the didactic clinical cases and discuss topics related to coagulation. Procedures: Fellows perform bone marrow aspirations and biopsies, stain blood smears and bone marrows, and interpret peripheral blood smears and bone marrows. Services: Fellows provide the following services on this rotation: performance and interpretation of bone marrows. Principal Ancillary Education Materials Reading list: Read appropriate selections from "“Practice and Principles of Pediatric Oncology” by Paplock and Pizzo, "“Pediatric Soft Tissue Sarcoma” by Dr. Cheryl Coffin and “Bone Marrow Pathology “ by Dr. Kathryn Foucar. Pathological material: During an average one-month rotation on hematopathology, the Fellow performs and interprets 30-50 bone marrows. A comprehensive teaching slide set of peripheral blood smears and bone marrows is also available for Fellow self- teaching.
  32. 32. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 32 Methods for Evaluating Fellows Each Fellow is evaluated after each Pathology/Hematopathology/Coagulation rotation (written evaluation). Components of the evaluation include technical skills in performing and interpreting bone marrows, clinical skills in evaluating and managing hematologic disorders, their performance in participating in the didactic case discussions, and their month-by-month improvement in fund of knowledge in hematology from independent study. In addition to the written evaluation above, the Fellows receive feedback throughout each month on how they are progressing. Methods for Evaluating Program The Fellow will provide a written evaluation of the Pathology/Hematopathology/Coagulation rotation at the end of the month. Fellow’s Responsibility/Line of Responsibility There are generally no students or residents on this rotation, just the Attending and the Fellow. The Fellow has the primary responsibility for performing and interpreting bone marrows. The Fellow will provide the pager to the Attending pathologists and request to be paged for any solid tumor biopsy. He/she will follow the processing of samples from the OR to final diagnosis for every pediatric solid tumor during the rotation. The Fellow will review all bone marrows obtained during the rotation and attend Hematopathology sign out rounds. He/She should schedule 1-2 days in the flow cytometry lab to learn immunophenotyping (Dr. Sherrie Perkins), 1-2 days in the cytogenetics lab to learn the procedures involved in cytogenetic analysis (Dr. Art Brothman), and 1-2 days in the Coagulation lab at ARUP. Bone Marrow Transplant Rotation (0.5-2 months) Rationale/Value The Bone Marrow Transplant (BMT) Unit rotation at University Hospital and Primary Children’s Hospital will give the Fellow exposure to adult and pediatric patients with a variety of malignancies being treated with autologous or allogeneic transplant. The role of bone marrow transplant in certain diseases is in a state of flux at present, but there are a number of disease processes that are routinely treated with this modality. Whether or not the Fellow plans to perform BMT when in practice, it is extremely important to have an understanding of the indications for BMT, as well as the methods utilized.
  33. 33. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 33 Principal Teaching Method The Fellow will cover the Pediatric BMT Unit and assist from time to time in covering patients in the Adult BMT unit. The primary teaching method will be by seeing patients in the inpatient or outpatient setting, and discussing those patients with an Attending Physician in detail. In addition, when on the inpatient service, rounds will be done daily in a multi-disciplinary team format, and the Fellow will be expected to participate fully in these. Educational Content The malignant diseases seen on the BMT Unit at University Hospital are both hematologic and solid tumors. The hematologic malignancies seen are primarily leukemias and lymphomas, either in remission or relapsed, as well as occasional patients with myeloma and myelodysplastic syndrome. These diseases may be treated with either myeloablative therapy/stem cell rescue (MAT/SCR) or allogeneic transplant using matched related donors or matched unrelated donors. The most common solid tumor seen is breast cancer, which is generally treated with MAT/SCR. The patients at Primary Children’s Hospital have a wide range of hematologic and solid malignancies, treated either with allogeneic transplant or MAT/SCR. Patient Characteristics: University Hospital and PCMC are the primary BMT referral center for patients in the Intermountain West. Most patients are from Utah, Idaho, Nevada, Montana, or Arizona. The patients seen range from infants to adults; the emphasis in our program is on pediatric transplantation. Types of Clinical Encounters: Patients will be seen in the BMT Unit as inpatients or in the BMT clinic for initial consultation or follow-up evaluation. Procedures: The Fellow will perform supervised lumbar punctures (with and without chemotherapy instillation) and bone marrow aspirates and biopsies. In addition, where indicated, the Fellow will perform skin biopsies on post-BMT patients for evaluation of the presence of graft-vs-host disease (GVHD). Services: The Fellow will generally be assigned to the inpatient BMT service for 0.5-2 months during the first year depending on interest and career goals. The Fellow will be assigned patients from day of admission to date of discharge, and will be responsible for all aspects of day-to-day care, including twice-daily evaluations on stable patients or more frequent evaluations on unstable patients. The Fellow will write all medication and TPN orders, as well as daily progress notes. All patients will be discussed daily in a multi-disciplinary conference, during which the treatment plan for the day will be outlined. The Fellow will be supervised by a BMT Attending Physician, and will work with the physician’s assistants and nurse practitioners assigned to the unit.
  34. 34. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 34 The Fellow will also see patients who are referred for evaluation for possible transplant, and see patients in follow-up who have already undergone transplant. New patients will have a complete history and physical performed, as well as a review of relevant pathology and scans, following which they will be discussed in detail with the Attending on service. Follow-up patients will be assessed for engraftment, signs of infection, and signs of graft-vs-host disease. Immunosuppressive and anti-infective agents will be adjusted as necessary. These follow-up patients will also be discussed with the Attending on service. Principal Ancillary Educational Materials Reading List: The Bone Marrow Transplant service will provide each Fellow with a comprehensive binder of articles pertaining to all aspects of blood and marrow transplantation. Pathology: The Fellow will have the opportunity to review the pathology slides from biopsies, bone marrows, and other operative procedures with the pathologists. Other: The Fellow will be expected to attend the weekly Multi-Disciplinary Tumor Board, as well as the Wednesday morning Journal Club/Basic Science conference and Monday Fellow lunch conference. In addition, the Fellow will have the opportunity to attend separate Bone Marrow Transplant conferences and lectures when these are held. Methods for Evaluating Fellows The Attending Physician will provide a written evaluation of the Fellow to the Program Director at the end of the rotation, describing clinical skills, clinical judgment, medical knowledge, medical care, humanistic qualities, professional attitudes, behavior, and commitment to scholarship. Methods for Evaluating Program The Fellow will provide a written evaluation of the Bone Marrow Transplant unit rotation at the end of the month. In addition, board scores are monitored for pass/fail as well as for strength/weaknesses in specific areas of hematology and oncology. Fellow’s Responsibility/Line of Responsibility The BMT Unit functions primarily with an Attending Physician and a number of staff physician extenders. The Fellow will be a part of the inpatient or clinic team, and will report to the Attending Physician. The Fellow will be responsible for his/her patients, and be expected to know their current clinical situation. The Fellow will interact with the nursing and ancillary staff on the Unit who are involved with his/her patients, and be expected to provide teaching or clarification to them as needed. The Fellow will have Attending back-up for all areas of responsibility.
  35. 35. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 35 Should there be medical students or residents on the rotation, the Fellow is encouraged to participate in teaching them whenever possible. Adult Hematology Rotation Rationale/Value During this rotation, the Fellow spends several days each week seeing new and returning patients with selected senior physicians in Adult Hematology/Oncology and Coagulation. The new patient evaluations are comprehensive and provide the Fellow with the opportunity to devise an initial therapeutic plan and to discuss this in detail with both the patient and Attending. Attendings are selected for the relevance of their patient population to the educational mission of the Fellowship. As the Fellow is working with a different Attending, they are exposed to different disease mixes and treatment styles, which serve to broaden their experience from their one day/week continuity clinic. Principal Teaching Method The Fellow and Attending see and discuss each patient in detail, and diagnostic and therapeutic plans are devised together. Relevant papers are provided, and the Fellow is encouraged to research topics in depth as they come up. Therefore, most teaching occurs during the interaction between the Fellow and Attending. Education Content: Mix of Disease: The full range of malignant diseases is seen and cared for in the Outpatient Department, with an emphasis on hematologic malignancies and non- malignant disorders, coagulation disorders and thrombophilia, hemachromatosis and porphyria. Patient Characteristics: Most patients are from Utah or the surrounding states of Wyoming, Idaho, Nevada and Montana. The population of these states is relatively racially homogeneous of Western European descent, although the Native American and Hispanic communities are represented in the patient population as well. Ages range from 18 to quite elderly, the majority tending to be older as is expected for patients with malignancies. Types of Clinical Encounters: All patients are seen in the Hematology/Oncology Outpatient clinic. Procedures: Fellows perform bone marrow aspirations and biopsies, lumbar punctures, Ommaya taps and instillation of intrathecal chemotherapy. Outpatient chemotherapy is also written by the Fellows if needed.
  36. 36. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 36 Services: The Fellow sees both new patients and those in need of follow-up. The Fellow is expected to obtain a detailed history and performs a physical exam on all new patients. All radiological and pathological materials are reviewed with the Attending, usually with a radiologist and pathologist. A comprehensive, detailed diagnostic work- up and treatment plan is formulated by the Fellow and Attending, and discussed at length by them with the patient and family. The Fellow with the help of the clinic staff coordinates future care. A detailed Initial Visit Note is generated by the Fellow, reviewed with the Fellow by the Attending and provided to the referring physician. The Fellow also sees several follow-up patient visits each day, during which an interval history and physical exam are performed. The Fellow discusses each patient with the Attending, and participates in all decisions, such as initiation or continuation of therapy, and development of diagnostic plans and treatment approaches. All discussions with the patients include the Fellow. The Fellow writes all chemotherapy orders, and the Fellow with Attending supervision typically performs any procedures required in clinic. Principal Ancillary Educational Materials Reading List: The Hematology/Oncology Fellow bibliography contains key articles on the subjects covered by this rotation. Additionally Dr. Rodgers provides hematologic case study problems which require directed reading to decide on appropriate testing, making the diagnoses, and formulating treatment plans. Pathological Material: Pathology slides are usually provided by our new patients for review with our pathologists. This review is done at the time of the initial visit. A similar procedure is followed for review of radiological studies. Most studies obtained for our patients under continuing care are also reviewed the day of clinic. Other: The Fellow is expected to actively participate in the weekly Multi-disciplinary Tumor Board, typically presenting one to two interesting cases encountered during the prior week. The Fellow presents the details of the case, and representatives of the Pathology and Radiology Departments review and discuss the pathological and radiological materials. The Fellow is expected to review the literature and synthesize the information to provide a cogent, useful presentation. This is an important learning experience for the Fellow. The Fellow is also expected to attend weekly Wednesday morning academic conference and Monday Fellow lunch conference. Methods for Evaluating Fellow The Attending Physician provides a written evaluation of the Fellow, describing clinical judgment, clinical skills, medical knowledge, medical care, humanistic qualities, professional attitudes, behavior and commitment to scholarship. On-going informal feedback is given on a day-to-day basis. Confidential, semi-annual reviews of all the evaluations of each Fellow are provided by the Fellowship Director.
  37. 37. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 37 Methods for Evaluating Program The Fellow will provide a written evaluation of the Outpatient Clinic rotation at the end of the month. In addition, board scores are monitored for pass/fail as well as for strength/weaknesses in specific areas of hematology and oncology. Fellow’s Responsibility/Line of Responsibility While medical students and Internal Medicine residents are often present in the clinic, the Fellow works only with the Attending conducting clinic, as well as the clinic staff. Therefore, the Fellow is responsible for the initial work-up of new patients and ongoing patients. As such, he/she is responsible for ensuring that the diagnostic and therapeutic plans devised by the Fellow, Attending and patient are initiated. The Attending has on- going responsibility for the patients in their clinics, and therefore will receive and review test results, etc. The Fellow is encouraged to follow-up on test results, etc., and communicate them to the patients, but the Attending Physician has ultimate responsibility for this. Fellows are expected to complete all documentation in a timely and complete manner. Radiation Oncology Rotation Rationale/Value The Radiation Oncology rotation at the University Hospital will give the Fellow experience in the use of radiation therapy to treat patients with malignancy. Pediatric Oncologists have always worked with Radiation Oncologists in the treatment of cancer, but this relationship has become closer in recent years. There are now an increasing number of malignancies treated using combinations of chemotherapy and radiation therapy, often given concurrently. It is therefore increasingly important for the Pediatric Oncologist to have a good understanding of the rationale, complications, and logistics behind administering Radiation Therapy. Principal Teaching Method The Fellow will see patients referred to the Radiation Therapy Department for consideration of treatment. Most of the emphasis in this rotation will be on seeing new consults. These patients span a broad range of malignancies, including pediatric sarcomas, brain tumors, and other solid tumors. Also adult patients with breast, prostate, lung, GI, CNS, and hematologic malignancies will be seen. Some of these patients will be receiving radiation therapy only, some will have already received chemotherapy, and some will be receiving concurrent chemotherapy. All patients will be fully reviewed with an Attending Radiation Oncologist after being seen. Scans and pathology will be reviewed where necessary, and a treatment plan will be formulated and discussed. The Fellow will be encouraged to follow those patients seen as new consults through the course of their therapy, although, as a rule, a course of radiation therapy will last longer than the 4-week rotation time.
  38. 38. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 38 During the rotation, the Fellow should gain a good understanding of the issues involved in coordinating patient care from the perspective of the Radiation Therapy Department. In addition, the Fellow should become familiar with the common complications arising from radiation therapy, develop a basic understanding of tissue tolerances, and understand the rationale behind dose-fractionation. Educational Content Mix of Disease: The full range of solid tumors are seen and cared for in the Radiation Oncology department at the University Hospital. In addition, there are some hematologic malignancies seen, primarily Hodgkin’s or Non-Hodgkin’s lymphomas. Patient Characteristics: The University Hospital is a major referral center for patients with malignancies in the Intermountain West. Most patients are from Utah, Idaho, Nevada, Montana, or Arizona. The patients seen range in age from pediatric to the very elderly. Types of Clinical Encounters: Patients will be seen in the Radiation Therapy Outpatient Department for consultation. Patients will also be seen on the Medicine or Surgical wards, if inpatient consults are requested. Procedures: The Fellow will as a rule not be performing procedures while on this rotation, aside from history and physical examinations. Services: The service provided on this rotation is as a consultant to outpatients and inpatients. The Fellow will work with an Attending Radiation Oncologist, who will review all histories and physicals on new patients and follow-up patients with the Fellow. The Fellow will have the opportunity to observe patients being treated or prepared for treatment, but will not have a role in the ordering of Radiation Therapy or determination of doses. Principal Ancillary Educational Materials Reading List: The Fellow bibliography contains some key articles on the subjects covered by this rotation. In addition, the Radiation Oncologists will provide key references pertaining to patients seen while on rotation. Pathology: The Fellow will have the opportunity to review the pathology slides from operative procedures with the pathologists. Conferences: The Fellow will be expected to attend the weekly Adult Multi-Disciplinary Tumor Board. In addition, the Fellow will have the opportunity to attend the separate Radiation Therapy Resident conferences.
  39. 39. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 39 Methods for Evaluating Fellows The Attending Physician will provide a written evaluation of the Fellow to the Program Director at the end of the rotation, describing clinical skills, clinical judgment, medical knowledge, medical care, humanistic qualities, professional attitudes, behavior, and commitment to scholarship. Methods for Evaluating Program The Fellow will provide a written evaluation of the Radiation Oncology Rotation at the end of the 4 weeks. Fellow Responsibility/Lines of Responsibility While on this rotation, the Fellow will see patients in the Radiation Oncology outpatient department, and occasionally inpatient consults on the wards. The Fellow will be under the supervision of an Attending Radiation Oncologist, who will assume ultimate responsibility for the patients. All histories, physicals, and laboratory or radiographic findings will be discussed with the Attending. All radiation orders will be written by the Attending. The Fellow will have the opportunity to observe simulation techniques and discuss cases with the physicists, but this is not a primary responsibility on the rotation. Transfusion Medicine Rotation (in combination with Pathology rotation) Rationale/Value The Lab Medicine rotation at University Hospital will give the Fellow exposure to the methods utilized in cross-matching blood, and instruction in the management of patients with multiple antibodies, transfusion reactions, or immune-mediated hemolytic processes. Physicians practicing Pediatric Hematology/Oncology frequently utilize blood products. It is therefore extremely important for the Fellow to be aware of issues relating to blood processing and availability, and have a firm understanding of the reasons for using different types of blood products. Principal Teaching Method The primary teaching method on this rotation is by daily lecture. Each lecture discusses a different area of transfusion medicine. In addition, there will be time set aside for hands-on bench-work, during which the Fellow will learn to type blood, and perform antibody screening. The Fellow will have the option of seeing patients on the wards who have multiple antibodies or transfusion reactions, and will also visit the donor center to see patients.
  40. 40. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 40 Educational Content Mix of Disease: The majority of the patients dealt with on this rotation have autoantibodies, single or multiple alloantibodies, or have had transfusion reactions in the past. There are also occasionally patients with TTP requiring plasmapheresis treatment. All services are represented on this rotation, although the most contact comes from the surgical, obstetrical, and oncology/marrow transplant services. Patient Characteristics: Most patients are from Utah or the surrounding Intermountain Western States. The Lab Medicine service at University Hospital also covers the adjacent Primary Children’s Hospital, so the age range of patients seen is from newborn to the very elderly. Types of Clinical Encounters: Clinical encounters are generally as a consultant to inpatient services. Procedures: The Fellow will be given hands-on teaching in cross-match and antibody screening techniques. These will be performed on teaching samples only, as Fellows are not certified or authorized to perform tests giving official results. Services: The service provided on this rotation is generally as a consultant to inpatients, or as a telephone consultant. There is generally a Pathology resident on the Lab Medicine service who performs most of the consults, and there is a qualified Hematopathologist specializing in blood transfusion medicine on call at all times. Principal Ancillary Educational Materials Reading List: Key articles on the subjects covered by this rotation will be provided. Conferences: The Fellow will attend the blood bank service weekly conference in which difficult cases are presented. Other: There is a folder of practice cases involving antibody screening results. The Fellow is encouraged to complete these. There are generally a number of such cases on the Hematology board examination. Methods for Evaluating Fellows The Attending Physician will provide a written evaluation of the Fellow to the program director at the end of the rotation, describing clinical skills, clinical judgment, medical knowledge, medical care, humanistic qualities, professional attitudes, behavior, and commitment to scholarship.
  41. 41. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 41 Methods for Evaluating Program The Fellows provide a written evaluation of the Blood Bank Rotation at the end of the month. The subspecialty board scores of the Fellows are monitored, as are the specific strengths and weaknesses as assessed by those tests. Fellow Responsibility/Lines of Responsibility While on this rotation, the Fellow will be expected to attend the didactic lectures, and will have the opportunity to be involved in ward consults. However, since the Blood Bank is under the aegis of Pathology, the Blood Bank attending will have the ultimate responsibility for patient care. There is generally a Pathology resident on the service, who is responsible for doing the consults and deciding patient management in conjunction with the Attending. The Pediatric Hematology/Oncology Fellow will therefore have no order writing responsibility on this service. Conferences Goals and Objectives - Assist the transition from resident to Fellow - Develop teaching, leading and communication skills - Introduce and explore concepts that are essential to the practice of Pediatric Hematology/Oncology • Communication skills and styles • Patient compliance • Difficult situations • Patient experiences • Variations in decision making • Comfort with uncertainty - Increase knowledge of parental and patient resources - Increase knowledge of the six RRC core competencies • Patient Care • Medical Knowledge • Practice-based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-based Practice - Increase fund of knowledge regarding Pediatric medicine and Pediatric Hematology/Oncology Methods - Case-based discussions - Fellow driven
  42. 42. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 42 Monthly Solid Tumor Board (First Friday every Month) This conference is held on a monthly basis year-round, and regular attendance is compulsory for Pediatric Hematology/Oncology Fellows. Staff, Fellows, and residents from Hematology/Oncology, Radiation Oncology, Radiology, Pathology, and various Surgical services attend this conference. Challenging or unique cases of pediatric solid tumors are presented at this conference for the purpose of obtaining opinions on appropriate treatment strategies. Pediatric Hematology/Oncology Fellows are expected to present patients at this conference on a regular basis. This will provide the Fellows with valuable experience in proper medical subspecialty patient case presentation, including case preparation, review of the relevant literature, interaction with a multi- disciplinary audience, and public presentation skills. Monthly Hematopathology Tumor Board (Second Friday every Month) This conference is held on a monthly basis year-round, and regular attendance is compulsory for Pediatric Hematology/Oncology Fellows. This conference is attended by staff, Fellows, and residents from Hematology/Oncology and Hematopathology. Challenging or unique cases of pediatric hematology and hematopoietic malignancies are presented at this conference to review the pathology and for the purpose of obtaining opinions on appropriate treatment strategies. The Fellows are expected to present patients at this conference on a regular basis. This will provide Pediatric Hematology/Oncology Fellows with valuable experience in proper medical subspecialty patient case presentation, including case preparation, review of the relevant literature, interaction with a multi-disciplinary audience, and public presentation skills. Brain Tumor Board. (Third Friday every Month) This conference is held on a monthly basis year-round, and regular attendance is compulsory for Pediatric Hematology/Oncology Fellows. This conference is attended by staff, Fellows, and residents from Hematology/Oncology, Radiation Oncology, Radiology, Pathology, and Neurosurgery. Challenging or unique cases of pediatric brain tumors are presented at this conference to review the pathology and for the purpose of obtaining opinions on appropriate treatment strategies. The Fellows are expected to present patients at this conference on a regular basis. This will provide Pediatric Hematology/Oncology Fellows with valuable experience in proper medical subspecialty patient case presentation, including case preparation, review of the relevant literature, interaction with a multi-disciplinary audience, and public presentation skills.
  43. 43. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 43 Journal Club/Interesting Case Conference (Fourth Friday every Month) The fourth Friday of each month is the program’s journal club. Each month, a Fellow and an Attending Physician will be assigned to each present one or more recent journal articles that are felt to merit discussion. The choice of the Fellow’s article will be left to the individual Fellow. However, the Attending Physician assigned for that month will be available to act as a resource person. This is particularly important for junior Fellows, who may still be learning the art of critical literature appraisal, and may need some guidance in choosing an appropriate article. Journal club is a valuable experience for Hematology/Oncology Fellows, as it provides important training in critical literature appraisal, and also encourages continuous review of current literature. Other Friday Conferences This conference is held on Fridays when there is not tumor board or journal club and regular attendance is compulsory for Pediatric Hematology/Oncology Fellows. This conference is attended only by Hematology/Oncology Fellows, and is presided over by an Attending from the Hematology/Oncology service. Different topics pertaining to the practice of Pediatric Hematology/Oncology are discussed - management of specific diseases, pain management, ethical, legal and cultural issues are examples. This conference is held in a very informal small group setting, providing an excellent opportunity for the Fellows to benefit from the knowledge and experience of not only the discussion leader but each other as well. Pediatric Research in Progress Conference This conference is held on a weekly basis year round and organized by the Department of Pediatrics. Attendance is not compulsory for Fellows, but they are encouraged to attend whenever time permits. At this conference, all clinical-based and research- based members of the Department of Pediatrics have the opportunity to discuss research projects they are involved in, and what progress has been made in the area being investigated. At this conference, therefore, Pediatric Hematology/Oncology Fellows will be able to learn of different research projects underway in the Department and in associated specialties. This knowledge may help the Fellows decide what area of research they would like to participate. Pediatric Grand Rounds This conference is held on a weekly basis year round and organized by the Department of Pediatrics. Attendance is not compulsory for Pediatric Hematology/Oncology Fellows, but they are encouraged to attend whenever time permits or the topic is of particular interest to the practice of Pediatric Hematology/Oncology. The conference is hosted by the Department of Pediatrics, and features a different speaker and topic each week. All aspects of the practice of Pediatrics and its subspecialties are discussed throughout the year. This conference is an important forum for continuing medical education for the Fellow, and an ancillary to regular review of the medical literature. New therapies and treatment guidelines in other sub-specialties are often discussed, many of which are relevant to the practice of Pediatric Hematology/Oncology.
  44. 44. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 44 Other Educational Activities Pediatric Fellows Conference This course is mandatory. The course provides instruction on lecture presentation, scientific writing, biostatistics and medical ethics. Fellows from all pediatric disciplines meet on a weekly basis between September and February. National Meetings Attendance at national meetings (ASPHO, AACR, ASCO or ASH) is an important component of subspecialty training. At these meetings, Pediatric Hematology/Oncology Fellows have an opportunity to meet Fellows from other programs and clinical and research experts from all over the world, and to hear presentations on a variety of topics. Frequently, data presented at these meetings result in changes in practice patterns, some of which are profound. Hematology/Oncology Fellows will be given the opportunity to attend one major conference in each year of their Fellowship program. Time off from regular clinical duties is allocated for this (see the Educational Leave section of the Fellow Vacation and Leave Policy segment of this curriculum). Whenever possible, Pediatric Hematology/Oncology Fellows are encouraged to present topics or posters at these meetings. Grant Writing Workshop The Department of Pediatrics offers a semi-annual weekend workshop on grant-writing skills. Fellows are strongly urged to avail themselves of this excellent opportunity. Participants bring the Specific Aims for a small grant, and these are reviewed by senior faculty. In addition, a number of formal didactic sessions review the essential elements of successful grant writing.
  45. 45. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 45 Evaluation Procedures First Year Evaluation Second and Subsequent Years Evaluations Evaluation of Fellows Performance Fellows Evaluation of Rotations Fellows Evaluation of Faculty Promotion, Probation, Suspension and Dismissal
  46. 46. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 46 Evaluation Procedures Assessment of Competence During the First Year of Training During the first year of training in Pediatric Hematology/Oncology, the Fellow will be assessed by the supervisory faculty at least every six months. This information will be stored in the specific Fellow’s file in the Program Director’s office. That assessment will include the following: Fundamentals of clinical diagnosis with special emphasis on history taking and physical examination including the evaluation and management of both inpatients and outpatients who have hematologic and oncologic disorders including: • Leukemias, both acute and chronic • Solid tumors of organs, soft tissue, bone, and central nervous system • Lymphomas • Inherited and acquired bone marrow failure syndromes • Hemoglobinopathies, including sickle cell and thalassemia syndromes • Inherited and acquired disorders of the red cell membrane and of red cell metabolism • Autoimmune hemolytic anemia • Nutritional anemia • Inherited and acquired disorders of white blood cells • Platelet disorders, including ITP and acquired and inherited platelet function defects • Hemophilia, von Willebrand disease, and other inherited and acquired coagulopathies • Hematologic disorders of the newborn • Transfusion medicine and use of blood products • Congenital and acquired immunodeficiencies
  47. 47. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 47 In addition to specific hematologic and malignant disorders, the Fellow must develop competency in all aspects of chemotherapy, including treatment protocols and management of complications; diagnosis and treatment of infections in the compromised host; appropriate use of transfusion of blood products, plasmapheresis and bone marrow transplantation. The Fellow is also expected to learn methods of physiologic support of the cancer patient including parenteral nutrition, control of nausea and pain, staging and classifications of tumors, complete knowledge and application of multi-modality therapy, learning to function as a member of a multidisciplinary oncology team, and learning the epidemiology of childhood cancer. Making good observations and keeping accurate patient data are vital aspects of Pediatric Hematology/Oncology and it is expected that the Fellow will acquire these during the first year of this training program. The Fellow is expected also to acquire the necessary skills for the interpretation and performance of procedures and laboratory tests common to the practice of Pediatric Hematology/Oncology. He/she is expected to become skilled in the performance and interpretation of bone marrow aspirations and biopsies, venipunctures, lumbar puncture, clinical microscopy, and interpretation of peripheral blood smears. The Fellow is expected to participate in the entire curriculum for this initial year of training in order to acquire the above detailed skills. That curriculum includes six months on the inpatient Hematology/Oncology service and the attendance of at least one full day’s outpatient clinic per week. In the outpatient clinic, the Fellow will follow a population of patients in continuity during the first and also subsequent years of training. First year Fellows in Pediatric Hematology/Oncology are expected to participate in the conference and lecture schedule of the division which includes weekly patient management conferences, Pediatric Grand Rounds and Pediatric Research in Progress, as well as twice-monthly tumor boards and monthly division journal club. The Fellow is also expected to participate in the Department of Pediatric Fellowship course as offered, which includes the topics of scientific writing and presentations, biostatistics, and medical ethics. Finally the Fellow is expected to participate in the teaching activities of the division including the organization of educational conferences and also the development of skills in medical writing. The first year Fellow is also expected to take home call approximately one out of every 4 weeks.
  48. 48. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 48 Assessment of Competence During the Second and Subsequent Years of Training The second and subsequent years of training are focused mainly on the development of research skills and experience. Clinical responsibilities are limited to one day in clinic each week, home call approximately only one out of every 5-6 weeks, and the attendance of regular educational conferences of the Division of Pediatric Hematology/Oncology. Under the guidance of a specific mentor, Fellows in the second year of training embark on a structured program of research education designed to develop the knowledge, thought processes and laboratory skills needed for a career as an independent investigator. The specific laboratory work is supplemented by courses within the School of Medicine involving basic science and research methodology important to the development of an investigative career. Trainees in the second and third years of fellowship are required to have a Scholarship Oversight Committee (SOC). This committee should consist of the research mentor and at least two other faculty members who can contribute to the Fellow’s intellectual and career development. This SOC should meet at least semi-annually. During the second and subsequent years of training, the Fellow will meet on a monthly basis with his/her research supervisor and mentor to evaluate progress and receive specific feedback and recommendations. Formal written assessment of performance will be required at six-month intervals by both the research mentor and the other faculty members who have contact with the Fellow in either the clinical or laboratory settings. It is expected during these years that the Fellow will continue to work towards improving his/her teaching and medical writing skills. This can be accomplished by the presentation of lectures within the institution and abstracts of research performed at national meetings, as well as the preparation of manuscripts reporting that research. Fellows are expected to prepare posters, abstracts, manuscripts and/or grant applications with the guidance of their primary research mentor. Members of the Fellow’s Scholarship Oversight Committee are also available to critique and guide the fellow in this process.
  49. 49. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 49 Evaluation of Fellow Performance The overall performance of each Fellow will be evaluated as follows: 1) The elements of clinical competence described above will be assessed and recorded by the faculty on the Fellow Evaluation Form at the conclusion of every rotation. It is imperative that faculty members responsible for filling out the evaluation form do so critically, utilizing the entire scale from unsatisfactory to outstanding. There should be no hesitation in labeling an unsatisfactory performance as such, since it is crucial that problems be identified as early as possible in a Fellow’s career. Borderline performance that is rated satisfactory is the main reason for Fellows not being placed on probation until their senior years. This evaluation is submitted to the Program Director, who reviews the evaluations quarterly and makes recommendations to the Division Chief, who will review these evaluations with the Fellow annually, at a minimum. If there are substantial deficiencies in the Fellow’s performance (as judged by the Program Director and the Division Chief in consultation with the Division faculty), reviews will be carried out with the Fellow on a more frequent basis. 2) The Program Director, Division Chief and the Division faculty will meet annually to discuss the academic and clinical progress of all the Fellows in the program. Any problems that are identified at this meeting will be reviewed in a meeting between the Division Chief and the Fellow within two weeks of this meeting. Procedure for Fellow Evaluation of Rotations Each Fellow will complete an evaluation form following the completion of each rotation service. Forms will be gathered and reviewed by the Program Director. Possible areas of concern will require review with Division Chief and the Division faculty. Additional information will be gathered and recommendations will be made to the Program Director. A sample of the Fellow Evaluation of Rotation form is included in the Appendix. Procedure for Fellow Evaluation of Faculty Each Fellow will evaluate the faculty members involved in each rotation at the end of each month by filling out the Fellow Evaluation of Rotation Form. In addition, at the end of each year, each Fellow will be given a Faculty Evaluation Form to fill out for each member of the teaching staff. However, the annual Faculty Evaluation Forms will be confidential. The forms will be submitted to the Program Director for review, and then submitted to the Division Chief. The promotion and tenure review committee will use the information obtained from the forms to help guide their decisions.
  50. 50. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 50 Promotion, Probation, Suspension and Dismissal At the conclusion of each academic year, each Fellow will be promoted to the next year of the Fellowship, provided that he or she has successfully fulfilled the requirements of the program and has received satisfactory (or better) evaluations by each of the two methods described above. Following the successful conclusion of the third year in the program, the Fellow will graduate and will be eligible to sit for the Pediatric Hematology/Oncology certifying examination. Faculty are expected to notify the Division Chief/Program Director of any unsatisfactory performance immediately upon occurrence. The Division Chief will promptly review such situations. If the review confirms that performance is unsatisfactory, the Division Chief will meet with the Fellow to discuss the situation and decide if corrective action is necessary. Unless circumstances are exceptional, the Fellow will have an opportunity to remediate an unsatisfactory performance. Corrective actions required of a resident could include remediation (such as repeating a rotation, participation in a special program, etc), academic probation, suspension, or dismissal. 1) Remediation a) When an evaluation is below that expected for the Fellow’s level of training, the Division Chief must decide on a program of remedial training and must arrange such training. b) The Fellow must be informed of this decision in writing, with details regarding the remediation, including the areas in which, and the time within which, improvement is expected, and the possible outcomes of such remediation. c) At the end of the remedial training, the Division Chief shall inform the Fellow in writing that the weakness has either been corrected or has not been corrected. If it has not been corrected, the Chief shall include written notification that the Fellow will have a further period of remedial training with or without probation, or the Fellow will be placed on probation. 2) Probation A Fellow may be placed on probation by the Division Chief, following approval of the Director of Graduate Medical Education, if: Remedial action outlined in Section 1 fails to correct a recognized deficiency. Or The deficiency is of a nature that is not subject to usual remedial measures; for example, attitudinal or ethical problems.
  51. 51. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 51 b) Guidelines for the probationary period must be communicated in writing to the Fellow and must include the specific weakness to be corrected, what must be accomplished to correct the weakness, the time period of probation, and the possible outcomes of probation. c) In general, the probationary period will not extend past the end of the current agreement year, unless the agreement year ends within three months, in which case the program has the option of extending the probationary period into the next agreement year, but that extension shall not exceed three months. d) Any houseofficer agreement which may have been issued by a program for a subsequent year will be considered invalid until the Fellow has fulfilled probationary requirements and been removed from probation. e) At the time that the Fellow is removed from probation, the program has the following options: Full reinstatement. An additional probationary period, with or without remediation. Dismissal from the program either immediately or at the conclusion of the current training year. Houseofficer agreements for a subsequent year may contain a written clause stating conditions under which the agreement may be terminated immediately. Usually that clause will refer to continuing problems of the kind that resulted in the first probationary period. 3) Suspension The Division Chief may suspend a Fellow for non-academic reasons, if he or she is of the opinion that the continued presence of the Fellow in a clinical setting would be detrimental to staff or to patient care. This decision to suspend a Fellow must be followed immediately by an evaluation and either probation or dismissal, subject to appeal. Appeals will follow the due process procedures established by the Graduate Medical Education office. 4) Dismissal In general, a Fellow may be dismissed from the program only after going through the process of evaluation and probation with or without remedial training. There are instances, however, in which the Division Chief may find it necessary to dismiss a Fellow for non-academic reasons that are not subject to remediation or probation.
  52. 52. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 52 The decision to dismiss a Fellow may initially be made by the Division Chief, with the consent of the Program Director and the Division faculty. The Chairman of the Department of Pediatrics and the Dean of the School of Medicine must approve the dismissal. The Fellow must be informed of this decision in writing, which must include the reason(s) for dismissal. Appeals The Fellow may appeal the decision of remedial training, probation, suspension, or dismissal to the School of Medicine. Appeals will follow the due process procedures established by the Graduate Medical Education office.
  53. 53. University of Utah Department of Pediatrics Hematology/Oncology Fellow Handbook Revised January, 2007 Page 53 Pediatric Hematology/ Oncology Policies For 2007 - 2008 Supervision Selection and Eligibility Vacation and Leave Moonlighting Work Hours Call Responsibilities Evaluation Standards of Performance Due Process Evaluation

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