Fellowship Program, Pediatric Hematology/Oncology
The following curriculum has been developed to address the six general competencies as they apply to the field of Pediatric Hematology/Oncology.
1.) Patient Care Skills
A. Caring and respectful behaviors
Subspecialty residents will be expected to model caring and respectful behaviors toward their patients and families. Measures of these behaviors will include direct observation and evaluation by faculty, fellow teaching evaluations, and patient surveys.
Subspecialty residents will learn how to take a history with a hematology/oncology focus. The fellow will observe faculty taking histories, and work in close association with faculty members who will assess their history taking skills. Measures of interviewing will include direct observation and faculty evaluations.
C. Informed decision making
D. Develop and carry out patient management plans.
In order to develop a fund of knowledge that will allow the fellow to have informed decision making and develop and carry-out patient management plans, the subspecialty resident will be expected to read daily about his or her patients. In addition, subspecialty residents will participate in a monthly series of didactic lectures that will make up the core curriculum.
Achievement of these objectives will be measured by yearly ACGME in-service exams, patient surveys, direct observation, and faculty evaluation.
E. Counsel and educate patients and families
Fellow’s are expected to develop the knowledge and skills that will allow them to counsel and educate patients and families about their illness. Fellows will observe faculty and support staff counseling patients about various aspects of disease, and will counsel patients themselves during patient care interactions. We expect our subspecialty residents to have reviewed the written materials we give to patients for the various diseases we treat, and to revise, develop, or find written materials for a disease that they are interested in. These handouts will become part of the subspecialty resident’s portfolio. Skills in counseling will be measured by direct observation and evaluation by faculty, residents and patients.
F. Performance of procedures
Fellow’s will learn to perform physical exams and procedures from the faculty and support staff. Measures will include a procedure log, direct observation and evaluation.
G. Work within a team
Fellow’s will be expected to work well within our team. Interpersonal skills will be evaluated by direct observation, and by fellow and faculty surveys.
2.) Medical Knowledge
A. Investigatory and Analytic Thinking
The fellow will be taught how to perform literature searches, how to search the Children’s Oncology Group website, and how to evaluate research papers in order to develop treatment plans for their patients. The fellow will identify a clinical or laboratory based research project. He/she will develop a research proposal that he/she will present to the Academic Oversight Committee at the beginning of year two for review and approval. The fellow will be expected to write research papers and submit a research grant during their fellowship. Fellow’s will present their research progress during quarterly research conferences of the division. Abilities in this area will be measured by direct observation, faculty evaluation, and external review. Research papers and grants will become part of the fellow’s portfolio.
B. Knowledge and Application of Basic Science
The fellow is expected to develop a knowledge base and learn to apply principles of basic science to the care of their patients. Some fellow’s will develop a research project at the end of the first year of fellowship that will be carried out in a basic science laboratory. Other fellow’s will perform clinical research projects that use basic science concepts to improve patient care. Abilities in this area will be measured by direct observation, faculty evaluation, and external review. Research papers and grants will become part of the fellow’s portfolio.
3.) Practice-based Learning and Improvement
A. Analyze own practice for needed improvements
The fellow will be expected to critically evaluate his clinical practice and make a formally propose a solution to an identified problem. This evaluation will be presented at one of our monthly clinical care conferences. A written outline of this problem and proposed solution will become part of the fellow’s portfolio. Fellow’s will organize and participate in quarterly divisional Morbidity and Mortality conferences. They will also participate in monthly Clinical Care Conferences where we will discuss and develop clinical pathways.
B. Use of evidence from scientific studies
The fellow will learn to critically read scientific studies and how to apply scientific findings to clinical practice. Fellow’s will participate in the College of Medicine’s yearly fellowship conference which includes lectures on how to read scientific articles. The fellow will choose a particular clinical problem, and develop a clinical pathway for treating this problem using a scientific review of the literature. Skills in this area will be assessed by written evaluation by the faculty. The clinical pathway will be part of the fellow’s portfolio.
C. Application of research and statistical methods
The fellow will participate in monthly journal club where they will read and evaluate an article for the faculty. Article summaries from journal club and will become part of the fellow’s portfolio.
D. Use of information technology
The fellow will be expected to be competent in using the latest information technology and apply these tools to his or her practice. These tools will be used on a daily basis in patient care and research. This objective will be measured by direct observation and written evaluation.
E. Facilitate the learning of others
The fellow will participate in divisional journal clubs, teaching rounds and conferences. The fellow will be expected to lead teaching rounds. By the third year, the fellow will develop a formal talk for the fellow’s that will be presented at their core curriculum. This objective will be measured by direct observation and written evaluation by the faculty and fellow’s.
4.) Interpersonal and Communication Skills
A. Creation of therapeutic relationship with patient
Fellow’s will learn and be evaluated on their ability to create therapeutic relationships with their patients through observation of faculty. Fellow’s will interact with divisional social workers and support staff and develop strategies to improve relationships when problems arise. This objective will be measured by direct observation and by written evaluations by faculty, nurses, pediatric residents, medical students and patients.
B. Listening skills
Fellow’s will be expected to listen to and understand the concerns of their patients and coworkers. Fellow’s will be evaluated in this area by direct observation and by written evaluation by faculty and patients.
A. Respectful, altruistic
Our fellow’s are expected to treat their patients, families, and colleagues with respect. Our fellow’s are expected to be altruistic. Fellow’s will be evaluated in this area by direct observation and written evaluation by faculty, subspecialty residents, and patients.
B. Ethically sound practice
Our fellow’s are expected to conduct themselves and practice medicine ethically. Ethical concerns related to patient care will be discussed with faculty members and in some cases referred to ethics committee for formal review. Once during the three years, during our monthly clinical care conference, the fellow will present an ethical dilemma and possible approaches to it and an outline of this talk will become part of the fellow’s portfolio. Fellow’s will be evaluated by direct observation and written evaluation by faculty, fellow’s and patients.
C. Sensitive to cultural, age, gender, and disability issues
The fellow is expected to be sensitive to issues related to culture, age, gender and disability, and will not discriminate against patients, their families, or members of the team based on these or other issues. Fellow’s will be evaluated by direct observation and written evaluation by faculty, subspecialty residents, nurses and patients.
6.) System-Based Practice
A. Understand the interaction of our practice within the larger system
The fellow’s will develop an understanding of our practice within the larger system. They will do this by responding to consultations, receive instruction in billing and compliance issues (though they will not be involved in generating bills), and be encouraged to be involved in the decision making structures of the department. Fellow’s will be evaluated on this objective by direct observation and written evaluation by faculty.
B. Develop knowledge of practice and delivery systems
The fellow’s will develop knowledge of practice and delivery systems through patient transfers and interactions with physicians from other institutions. Fellow’s will be evaluated by direct observation and formal faculty evaluation.
C. Practice cost-effective care
Fellow’s will learn the costs of our treatments through participation in our clinical care conferences. As described above, fellow’s will develop a clinical pathway for a clinical problem of their choice, and will include a cost-analysis of the various treatment options within the pathway. This analysis will become part of the fellow’s portfolio. In addition, fellow’s will participate in our monthly clinical care conferences, where we discuss common clinical problems and come up with cost-effective solutions. Fellow’s will be evaluated by direct observation and formal faculty evaluation.
D. Advocate for patients within the health care system
Fellow’s will be expected to advocate for their patients as they undergo their treatments. Fellow’s will follow a group of patients in clinic and serve as their primary hematologist/oncologist through their fellowship. Fellow’s will be expected to help their patients manage issues related to disability, school, home life, depression, as they relate to the treatment. Achievement of this objective will be determined by direct observation and evaluation by faculty as well as patient evaluations.