Department of Medicine
Hematology / Oncology Division
Fellowship Combined Education Program
The University of Massachusetts Medical School and its affiliated hospitals offers a comprehensive training program to selected applicants interested in the study of hematology, oncology and stem cell transplantation.
The overall goal of this training program is to assist seriously committed physicians, who are board-eligible or certified in General Internal Medicine, to develop the attitudes, knowledge, and skills needed for them and to become outstanding scholars, practitioners and investigators in the field of adult hematology and oncology. Training in our fellowship program will also prepare them for further training in stem cell transplantation.
GENERAL PHILOSOPHY AND PRINCIPLES
The training program is based on the supposition that Fellows-in-Training are mature and responsible physicians. As such, they are to be treated by the senior staff and faculty as junior colleagues in the discipline of internal medicine and the subspecialty disciplines of hematology, oncology and stem cell transplantation. It is also presupposed that the trainees are capable and willing to accept a major share of the responsibility for their own education.
Holistic approach: The goal of the faculty is to convey, by example and by didactic teaching, a comprehensive, thoughtful, analytical approach to the whole patient. All humane and competent physicians must take the time to view the patient as a whole and come to understand the particular illness with which the patient presents in the broad social and cultural context of that patient's prior and current experiences. This requires a broad base of knowledge in general internal medicine with emphasis on the underlying scientific principles of physiology, biochemistry, immunology, pathology, and other relevant biomedical disciplines. The teaching and learning of these underlying principles of basic science and particularly of pathophysiology and rational therapeutics are central to all good medical education. Excellent care in oncology also requires expertise in geriatrics, care of the dying patient and supplemental issues such as nutrition and pain control.
Practice as clinical research: Each patient represents an opportunity for diagnosis and therapeutics that is, in some sense, unique. Therefore each patient encounter is an instance and opportunity for carrying out clinical investigation. This mandates the careful gathering of information about the patient, e.g., from the history, physical examination, laboratory studies, special procedures, etc., and the careful recording of effects of therapeutic interventions. We further emphasize this relationship by requiring that each fellow participate in clinical research and write a basic science or clinical research proposal during his fellowship.
Role of procedures: In hematology/oncology there are specialized technical procedures with which practitioners of the specialties must develop technical competence. A goal of this training program is to assure that all fellows will have had experience with the administration of chemotherapy, bone marrow biopsy and aspiration, interpretation of blood and marrow smears and other procedures required by the American Board of Internal Medicine and the subspecialty Board of Hematology and Oncology. Within the context of the three years of our basic fellowship, we provide all fellows who choose such training and who prove to be competent the opportunity to perform the numbers of bone marrow biopsies, chemotherapy administration and other procedures generally recommended by ASCO and ASH. It is essential that considerations and discussion be given to the indications, the contraindications, the costs, the benefits, the limitations and risks of chemotherapy and other special procedures. Discussion of all of these aspects is equally as important as performance of the procedure themselves.
Experience in related disciplines: The Fellowship experience is intended to be well-rounded and to include not only opportunities to see and participate in the evaluation and treatment of adult patients with oncologic and hematologic diseases. Experience in clinical pathology, stem cell transplantation, gynecological oncology, radiotherapy, radiology, transfusion medicine and basic aspects of surgical oncology are additional goals. This is not to say that the fellows will themselves be competent in all these areas, but rather that they will have had exposure to specialists in these areas and will have had some direct experience in these areas to provide the necessary perspective concerning their potential contributions and limitations. It is also intended that trainees will have contact with the physicians and basic scientists whose special expertise is in the areas of hematology, malignancy, molecular biology, immunology, and pharmacology.
Research activities: Another essential part of the Fellowship is to provide the opportunity, the time, and the resources, for scholarly and investigative activity, to be carried out by all trainees during their fellowship experience. Serious participation in such activities, with research presentation at seminars and regional and national medical and scientific meetings is expected. Such research and scholarly activities will occupy a minimum of 6 months and maximum of 18 months of the thirty-six months of the standard fellowship. The research will include the development of a specific, written and orally presented proposal, performance of the research, gathering and analysis of data, and organized presentation of results in suitable reports and manuscripts.
Each trainee will work with a senior faculty member who will serve as preceptor for the research experience and there may be more than one experience during the fellowship. This faculty member may be a member of the hematology/oncology division, another division of the Department of Medicine, or a member of some other Department. Fellows with definite interest in academic careers will have the option of spending up to 18 months primarily doing research. The goal is to tailor a flexible experience to the needs and interests of the trainee insofar as possible. Research rotations are intended to be times when the primary and major responsibility of the Fellow is to carry out meaningful research project. The research activity can range from clinical bedside investigation to more basic bench-type research.
It is expected that the fellows will work as diligently during this time and put forth a similar quantity of efforts as at all other times of their fellowship experiences. The specific projects to be worked on may often be ongoing research projects being carried out by the faculty of the Division. It is recognized that, particularly for clinical studies, a period of one year may be insufficient time for meaningful studies to come to completion. Thus, the ideal research training experience in hematology/oncology should allow, for at least some fellows, a greater amount of time than the minimal 6 months outlined above.
Conferences and seminars: As part of the fellowship training program, it is expected that trainees will have regular and active participation in weekly journal clubs (September-June), mentoring conferences, weekly patient care conferences, tumor boards, research seminars and other scientific and medical conferences. These activities are important to assure that fellows will develop the abilities to read biomedical literature critically and to speak effectively, both in small and larger groups.
PROGRAM OUTLINE
During the clinical time, the months are divided into four-week rotations. There are three different clinical rotations outlined below. The number of months on the various rotations for each fellow will be decided by the division chief or clinical training program director. The months off clinical rotations will consist of continuing outpatient clinical responsibilities (continuity clinic), electives in stem cell transplantation, clinical pathology, bone marrow/lymph node reading, blood banking, and/or continuing research projects.
Clinical rotation 1: INPATIENT/CONSULTATION SERVICE: UNIVERSITY
Inpatient
- Provide timely assessment of hematology/oncology consults patients with or without residents/students
- Assist with the management of the inpatient hematology/oncology ward service and have a working knowledge of all inpatients, especially complicated cases
- Follow-up of inpatients on ward service or consult service until issues resolved
- Arrange for outpatient follow-up if necessary
- Perform (or supervise) all necessary procedures
- Follow-up of pending laboratory tests and communicate them to the patient 's primary care physician once patient is discharged
Outpatient or ER
- Arrange timely consult; preferably seeing patients in hematology/oncology clinic
- Arrange for follow-up of patients if necessary
Other Responsibilities
- Keep duplicate forms of consult notes and log into consult book
- Decide (along with attending) which cases from the consult or ward service to present at Patient Management Conference (Friday a.m.)
Clinical rotation 2: OUTPATIENT/CONSULTATION SERVICE: MEMORIAL
Inpatient
- Provide timely assessment of hematology/oncology consults patients with or without residents/students
- Follow-up of inpatients on consults service until issues resolved
- Arrange for outpatient follow-up if necessary
- Perform (or supervise) all necessary procedures
- Follow-up of pending laboratory tests and communicate them to the patient's primary care physician once patient is discharged
Outpatient or ER
- Daily clinic exercise on rotating basis with faculty in a variety of hematologic and oncologic areas in the outpatient Memorial oncology clinic
- Arrange timely consult preferably seeing patients in hematology/oncology clinic
- Arrange for follow-up of patients if necessary
Other Responsibilities
- Keep duplicate forms of consult notes and log into consult book
- Decide (along with attending) which cases from the consult service to present at Patient Management Conference (Friday a.m.)
Clinical rotation 3: " FLOAT “ FELLOW
Inpatient
- Provide timely assessment of consults patients with or without residents/students when there is a large number of consults (overflow from the primary fellow)
- Read all bone marrow aspirates done at the UMass University campus with hematology attending
Outpatient or ER
- Rotating outpatient clinical responsibilities as determined by fellowship director
Other Responsibilities
- A variety of other clinical experiences will be encountered during this rotation including:
- Stem cell transplantation
- Clinical pathology rotations
- Blood banking
- Radiation oncology
- Gynecologic oncology
- Neuro-oncology
- Keep duplicate forms of consult note and log into consult book
OTHER CLINICAL RESPONSIBILITIES FOR ALL ROTATIONS:
- Take night call on weekly schedule from Friday through Friday of the following week
- Respond to prescription refills, patient phone calls, and (if necessary) outpatient evaluation if the patient ' s primary attending is unavailable.
- Rotate weekend call with other fellows; responsibilities include answering any telephone calls from patients or physicians, rounding on inpatients on the consult service, and evaluating any patients requested by inpatient ward or ER physicians.
Conferences
- Patient management conferences: each fellow should present every other week a brief (5-10 min) pertinent review of topic relevant to a recent case
- Mentoring sessions: Each fellow will be responsible for patient presentations during the mentoring sessions on a rotating basis.
- Journal Club: each fellow will be responsible for 3-4 journal clubs each year
- Topic Presentation: Each fellow will be responsible for 2 formal topic reviews each year.
- Other responsibilities: Each fellow will be responsible for the production of one clinical or research protocol during their fellowship
First Year of Fellowship: The goals and objectives in this year include the initial and intensive introduction to diseases as outlined in the curriculum. Concurrently, fellows entering the program will begin to develop their clinical skills as a hematologist/oncologist under the supervision of attending hematologists/oncologists in the division.
In addition to those goals stated above, the first year fellow will learn and develop:
- Role of the consultant in the inpatient and outpatient setting
- Communication skills with patients and their families, other physicians, and other health care providers
- Skills in telephone triage and consultation while on call
- Professional relationships with patients in the continuity clinics under the guidance of preceptor
- Skills as teacher in both informal and formal teaching opportunities
- Scholarship skills in critical evaluation of the medical literature and promotion of life-long learning
- Possible area of focused clinical or basic research to be further developed in the second year
Second Year of Fellowship: Entering the second year, the clinical fellow will continue to develop the objectives and skills from the first year. In addition, the second year will provide opportunities that include:
- Greater autonomy in teaching
- Involvement and training in clinical research
- Opportunities for basic science research experience and skills training
Second and Third Year of Research Fellowship: The research fellow will devote most of his/her effort in his/her chosen research area under the supervision of designated mentor in either a basic science or clinical research area. The educational goals will be determined by the mentor and fellow in the beginning of the research years and reassessed over the course of the project months on a regular basis. ABIM forms with written commentary will be used for this evaluation. During research time, the fellow will continue to have limited clinical responsibilities that are similar to the clinical fellows and include:
- One continuity clinic per week
- Rotation in the weekly on call schedule
- Clinical electives as deemed appropriate by the mentor, fellowship director and division chief
- A mechanism for formal evaluation of fellows ' research exists.