Inpatient Rotation

Rotation Description & Overall Goals:

The subspecialty resident will spend a total of nine four-week rotations during the three years managing patients on the pediatrics floors, newborn nursery, neonatal intensive care unit, and intensive care unit with supervision of the ward attending.  The fellow’s role and responsibilities will progressively become greater through the course of the fellowship as their knowledge, skill, and experience increases.  The duties that the fellow is to perform will include directing inpatient rounds, providing follow-up for consultations, managing acutely ill patients, coordinating admissions and transfers, delivering informed consent for procedures and chemotherapy, participating in the management of patients receiving chemotherapy, and providing teaching to the students and residents. One week, generally the third week of the rotation, will focus on the coordination and delivery of chemotherapy in conjunction with an Advance Practice Practitioner.

PRG-1 Objectives:

Medical Knowledge

Under direct supervision followed later by indirect supervision, the fellow:

  • Actively participates in fellowship core conferences and other conferences designed to provide medical knowledge specific to the discipline.
  • Applies knowledge and evidence-based medicine literature searches to generate differential diagnoses and treatment plans for patients with hematologic and malignant diseases.
  • Appropriately applies surgical and radiation therapy in management of patients with malignant disease.
  • Demonstrates knowledge of indications for blood products.
  • Reviews and interprets peripheral smears performed on patients with hematological and oncologic disorders.
  • Appropriately selects methods for providing patient nutrition.
  • Applies evidence-based medicine skills.
  • Effectively uses knowledge and the literature to generate differential diagnoses and treatment plans for patients with hematologic and malignant diseases.
  • Efficiently searches data bases such as PubMed, the Cochran Data Base, and Curesearch Website to develop evidence-based treatment plans for patients.

Patient Care

Under direct supervision followed later by indirect supervision, the fellow:

  • Recognizes septic shock and other medical emergencies
  • Recognizes complications of chemotherapy
  • Accurately develops and appropriately carries out management plans, including
    • inpatient hematology and oncology problems.
    • inpatient chemotherapy.
    • the complications of phlebotomy and blood transfusions.
    • sickle cell disease, particularly as it pertains to acute crisis such as fevers, pain, sequestration, and strokes.
    • hemophilia, particularly in terms of acute and life-threatening bleeds and surgical procedures.
    • other benign hematologic problems such as neutropenia, thrombocytopenia, and anemia.
    • septic shock and other medical emergencies.
    • complications of chemotherapy.
  • Appropriately uses blood products.
  • Effectively controls patient nausea/vomiting.
  • Effectively and appropriately applies pain management methods.
  • Provides appropriate patient care role modeling and supervision.
  • Appropriately triages patients and provides phone advice while on call.
  • Provides seamless transitions of care.
  • Effectively educates families and children about their diagnosis, treatment, and prognosis.
  • Effectively counsels and discusses palliative care and prognosis with patients and families.

PRG-2 and PRG-3 Objectives:

Medical Knowledge

With oversight, the fellow:

  • Actively participates in fellowship core conferences and other conferences designed to provide medical knowledge specific to the discipline.
  • Applies knowledge and evidence-based medicine literature searches to generate differential diagnoses and treatment plans for patients with hematologic and malignant diseases.
  • Appropriately applies surgical and radiation therapy in management of patients with malignant disease.
  • Demonstrates knowledge of indications for blood products.
  • Reviews and interprets peripheral smears performed on patients with hematological and oncologic disorders.
  • Appropriately selects methods for providing patient nutrition.
  • Applies evidence-based medicine skills.
  • Effectively uses knowledge and the literature to generate differential diagnoses and treatment plans for patients with hematologic and malignant diseases.
  • Efficiently searches data bases such as PubMed, the Cochran Data Base, and Curesearch Website to develop evidence-based treatment plans for patients.

Patient Care

With oversight, the fellow:

  • Recognizes septic shock and other medical emergencies
  • Recognizes complications of chemotherapy
  • Accurately develops and appropriately carries out management plans, including
    • inpatient hematology and oncology problems.
    • inpatient chemotherapy
    • the complications of phlebotomy and blood transfusions.
    • sickle cell disease, particularly as it pertains to acute crisis such as fevers, pain, sequestration, and strokes.
    • hemophilia, particularly as it pertains to acute and life-threatening bleeds and surgical procedures.
    • other benign hematologic problems such as neutropenia, thrombocytopenia, and anemia.
    • septic shock and other medical emergencies.
    • complications of chemotherapy.
  • Appropriately uses blood products.
  • Effectively controls patient nausea/vomiting.
  • Effectively and appropriately applies pain management methods.
  • Provides appropriate patient care role modeling and supervision.
  • Appropriately triages patients and provides phone advice while on call.
  • Provides seamless transitions of care.
  • Effectively educates families and children about their diagnosis, treatment, and prognosis.
  • Effectively counsels and discusses palliative care and prognosis with patients and families.

PRG-1/2/3 (Objectives are for all levels unless indicated)

  • Practice-Based Learning and Improvement
    1. Identify and acknowledge gaps in personal knowledge and skills in the care of patients with critical medical and neurological illness.
    2. Develop real-time strategies for filling knowledge gaps that will benefit patients.
    3. Self-evaluate performance based on faculty, peer and patient assessments.
    4. Together with the program director, generate an individualized learning plan.
    5. Participate in the education of patients and families.
    6. Teach medical students, residents, peers and other health professionals about hematologic and oncologic problems.
    7. Commit to professional scholarship, including systematic and critical perusal of relevant print and electronic literature, with emphases on evaluation of information in light of the principles of evidence-based medicine.
    8. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.
  • Interpersonal and Communication Skills
    1. Effectively communicate effectively with colleagues, including referring practitioners and consultants, other health professionals and health related agencies.
    1. Effectively interacting with nursing staff.
    2. Effectively and efficiently respond to consultations from the pediatric services, the NICU, and the PICU.
    3. Develop effective, comprehensive and efficient skills in telephone advice, triage, and documentation to assure timely, comprehensive patient care.
    4. Appropriately write inpatient chemotherapy orders
    5. Effectively work as a member of the hematology/oncology team (PRG1)
    6. Effectively lead the hematology/oncology team (PRG2/3)
    7. Communicate effectively with patients and families in a stressful care environment.
  • Professionalism.
    1. Interact professionally toward patients, families, colleagues, and all members of the health care team.
    2. Acceptance of professional responsibility as the physician for patients under his/her care.
    3. Manage clinical and personal responsibilities so that the patients are seen in a timely fashion.
    4. Be responsive to staff and accountable for the care of patients, including following up on laboratory/test results and communication with families.
    5. Develop collegial, constructive relationships with support services.
    6. Effectively use ethics consultants, including knowing when and how to request consultation, and how best to utilize the advice provided.
  • Systems-based Practice
    1. Function as part of multidisciplinary and/or interprofessional teams, including:
      1. Integrating the support of clinical social workers to address issues related to family stress, school, abuse and neglect, and financial issues.
      2. Integrating the support of Child Life services to prepare patients for invasive procedures or other stressful interventions.
      3. Integrating the role of psychology and psychiatry in the support of patients, including the recognition and management of psychosocial stresses and problems.
    2. Work effectively within the hematology/oncology treatment team.
    3. Increase effective provision of comprehensive patient care.
    4. Effectively provide consultations.
    5. Appropriately facilitate new patient referrals and transfers.
    6. Appropriately consult pediatric pathology, hematopathoogy, neuropathology, immunopathology, pediatric radiology, nuclear medicine, pediatric general surgery, neurosurgery, otolaryngology, orthopedics, urology, and transfusion medicine when needed.
    7. Appropriately apply clinical research protocols, including issues related to enrollment, and ethical issues in managing patients on institutional and multi-institutional protocols.
    8. Lead the patient care team in a way that enhances the wellbeing of patients.
    9. Identify and report system errors and implement potential system solutions.
    10. Incorporate considerations of cost awareness and risk-benefit analysis in patient care as appropriate.