Subspecialty residents at every level are expected to treat all other members of the health care team with respect and with recognition of the value of the contribution of others involved in the care of patients and their families. The highest level of professionalism is expected at all times. It is expected that documentation for the medical record be completed and submit for attending co-signature in a timely manner, generally within 24 hours. Racial, ethnic, or cultural slurs are never acceptable. Subspecialty residents are expected to be prompt to regularly scheduled meetings and to treat others with the respect and consideration they would expect for themselves. Ego and personality conflicts are not conducive to good patient care. Long hours and the stress of practice can precipitate conflict. The subspecialty resident should be aware of the situations where this is likely to happen and try to compensate by not escalating the situation.
The subspecialty resident is expected to develop a personal program of reading. Besides the general reading in the specialty, subspecialty residents should read daily focusing on problems that they encounter in patients care. The subspecialty resident is responsible for reading about procedures prior to performing or assisting in their performance. Subspecialty residents are expected to attend all conferences at the service and program level. The conference program is designed to provide a didactic forum to augment the subspecialty resident’s reading and clinical experience. Conferences will be supplemented with additional educational opportunities including the Resident as Teachers (RAST) curriculum and the course Introduction to Clinical/Translational Research.
Individuals in the PGY 4 year are closely supervised by faculty. Examples of tasks that are expected of PGY 4 physicians in pediatric hematology/oncology include:
- acceptable performance of a hematology/oncology-specific history and physical
- ordering of medication and diagnostic tests
- collecting and analyzing test results and communicating these to the other members of the team and faculty
- obtaining informed consent for procedures
- assisting with non-invasive and invasive procedures relative to the field of pediatric hematology/oncology under the supervision of the faculty or senior subspecialty residents at the discretion of the responsible faculty member.
Fellow’s will be instructed and develop skills in bone marrow aspirates and biopsies and intrathecal administration of chemotherapy under the direct supervision of faculty. Fellow’s at this level will respond to consults and learn the elements of an appropriate response to consultation in conjunction with the faculty member. The fellow will be trained in the interpretation and follow-up of neonatal screening tests for hemoglobinopathies. The fellow is expected to exhibit a dedication to the principles of professional preparation that emphasizes the primacy of the patient as the focus for care. The first year fellow must develop and implement a plan for study, reading, and research of selected topics that promote personal and professional growth and be able to demonstrate successful use of the literature in dealing with patients. The fellow should be able to communicate with patients and families about the disease process and the plan of care as outlined, initially, by the attending and, gradually, as developed by the resident as more experience is gained. At all levels, the fellow is expected to demonstrate an understanding of the socioeconomic, cultural, and managerial factors inherent in providing cost-effective care.
- To be able to provide routine care to uncomplicated patients.
- To be able to treat infections and other complications in patients.
- To be able to identify patients with complications and seek appropriate consultation.
- To be able to understand the principles of informed consent.
- To be able to recognize abnormal laboratory results and obtain appropriate consultations.
- To be able to provide emotional support to patients with life-threatening diseases.
- To be able to provide instructions for newly diagnosed patients.
- To be able to diagnose patients with cancer or blood disease.
- To be able to take proficient patient histories and conduct thorough physical examinations.
- To be able to apply physiologic support of the cancer patient including parenteral nutrition, control of nausea, vomiting, and pain.
- To be able to stage and classify tumors.
- To be able to apply multimodal therapy.
- To be able to function as an integral member of the oncology team.
- To be able to perform telephone consultations with patients who call with problems.
- To be able to maintain patient data.
- To be able to present patients in tumor board.
- To be able to perform and interpret bone marrow aspiration and biopsy.
- To be able to do lumbar punctures with an evaluation of cerebrospinal fluid and injections of intrathecal medications.
- To be able to interpret microscopic peripheral flood films.
- To be able to interpret hematological laboratory diagnostic tests.
- To be able to be familiar with all aspects of chemotherapy, surgical therapy, and radiation therapy.
- To be proficient in the appropriate use of transfusion of all blood components and plasmapheresis.
- To have expertise in bone marrow transplantation.
- To be able to understand the epidemiology and etiology of childhood cancer.
- To be proficient in managing terminal illness.
- To recognize and treat oncologic emergencies.
- To have identified a mentor, designed, and implemented a research plan.
- To present a poster or abstract at a local or national conference.
Individuals in the second subspecialty year are expected to perform more independently the duties learned in the first year, and may supervise the routine activities of the first year fellow (PGY 4) along with faculty supervision. PGY 5 fellows in pediatric hematology/oncology should be able to demonstrate continued sophistication in the acquisition of knowledge and skills and further their ability to function independently in the evaluation of patient problems and developing a plan for patient care. These skills include the ability to perform and interpret bone marrow aspirates, biopsies, and CSF cytospin. They will also be instructed in interpretation of peripheral blood smears and standard laboratory hematology tests including immunophenotyping, coagulation assays and hemoglobin electrophoresis. The subspecialty resident at this level should take a leadership role in teaching pediatric residents (PGY 1-3) and medical students the practical aspects of patient care relating to the subspecialty and be able to explain complex diagnostic and therapeutic procedures to the patient and family. The subspecialty resident should be adept at the interpersonal skills needed to handle difficult situations. The PGY 5 should be able to incorporate ethical concepts into patient care and discuss these with the patient, family, and other members of the health care team. The fellow should have taken the class “Introduction to Clinical/Translational Research” and begun a research project (s) in conjunction with a faculty mentor. At this stage of their training, the fellow will be developing their skills in a chosen research project and will learn how to balance this with their reduced clinical responsibilities.
- To have skills described for PGY 4.
- To be able to develop and administer appropriate treatment plans for children with cancer and non-malignant blood diseases.
- To be able to manage high-risk patients.
- To be able to evaluate and treat complications including bleeding and infection.
- To be able to interpret normal and abnormal laboratory results correctly.
- To be able to read bone marrow aspirate slides with complete differential counts.
- To be able to provide counseling for patients at risk for hematologic and oncologic problems.
- To be able to interpret pathology materials including flow cytometry, tissue pathology and blood banking facilities.
- To be able to interpret red cell enzyme studies and identify unusual hemoglobinopathies.
- To be able to interpret HLA typing and immune-phenotyping of blast cells and cytogenetic analysis.
- To be able to identify and diagnose and treat complex congenital and/or acquired hemostatic abnormalities.
- To be able to understand genetic abnormalities associated with various cancers and blood diseases.
- To have designed & implemented a research plan.
- To identify sources of Grant support of their research project develop preliminary data in preparation to apply for support.
In the third year, the fellow should be capable of managing patients with virtually any routine or complicated condition with input and supervision of the faculty. The fellow is responsible for coordinating the care of multiple patients on the pediatric hematology/oncology service. Individuals in their third year may perform routine diagnostic and therapeutic procedures (non-invasive) without direct supervision at faculty discretion. The PGY 6 can perform progressively more complex procedures (including invasive procedures) under the direct (on-site) supervision of the faculty. The fellow can perform the most complex and high-risk procedures expected of a physician. It is expected that the fellow can adept in the use of the literature and routinely demonstrate the ability to research selected topics and present these to the team. During the final year of training, the fellow should have the opportunity to demonstrate the mature, ethical judgment and clinical skills needed for independent practice in the field of pediatric hematology/oncology. The PGY 6 will be expected to deliver formal presentations at scientific assemblies and assumes a leadership role in teaching on the service. The mores and values of the profession should be highly developed, including the expected selfless dedication to patient care, a habit of lifelong study, and commitment to the continuous improvement of self and the practice of medicine.
- To have skills above in PGY 4 and 5.
- To be able to develop a hypothesis and develop a research plan to prove or disprove a hypothesis.
- To be able to review literature and present information clearly to other professionals.
- To be able to present information about a research plan.
- To be able to have written at least two abstracts and two manuscripts relating to a research plan.
- To have presented research at a national meeting.
- To have submitted a research grant.
- Demonstration of meaningful research accomplishment as required for Sub-Board eligibility.
- To submit a grant application in support of their research project.