Hematology / Medical Oncology Fellowship Program – Goals and Objectives

Fellows who graduate from the combined hematology / medical oncology training program will:

• Be able to appropriately evaluate and manage patients with hematologic and oncologic disorders
• Have acquired the tools for continuous medical education and systems based learning
• Demonstrate professionalism with the continuous development of interpersonal skills, collegiality and team work
• Understand and participate in a multidisciplinary approach to cancer treatment
• Provide patient care that is compassionate, appropriate, and effective for the treatment of cancer and hematologic disease
• Provide patient care that is effective for the promotion of health, including cancer screening
• Be able to identify strengths, deficiencies, and limits in their knowledge and expertise
• Be able to set learning and improvement goals and to identify and perform appropriate learning activities as relates to hematology and medical oncology
• Be involved in process improvement, with an ability to systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement
• Incorporate formative evaluation feedback into daily practice
• Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
• Use information technology (web-based resources) to optimize learning
• Participate in the education of patients, families, students, residents and other health professionals
• Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member or leader of a health care team or other professional group
• Act in a consultative role to other physicians and health professionals
• Maintain comprehensive, timely, and legible medical records, if applicable
• Complete accurate dictated notes / letters in a timely fashion
• Demonstrate compassion, integrity, and respect for others
• Be responsive to patient needs that supersede self-interest
• Always show respect for patient privacy and autonomy; be accountable to patients, society and the profession
• Show sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
• Work effectively in various health care delivery settings and systems relevant to hematology and oncology
• Be able to coordinate patient care within the health care system relevant to hematology and oncology
• Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate
• Advocate for quality patient care and optimal patient care systems
• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Participate in identifying system errors and implementing potential systems solutions

Fellows will demonstrate proficiency in all areas of hematology and medical oncology, including the ability to:

• Understand the physiologic functions, kinetics, and morphology of blood cells as a conceptual background for diagnosis and management of hematologic disease
• Understand hematopoiesis, including the concepts of hematopoietic stem cells, clonality and hematopoietic growth factors, as related to pathophysiology, diagnosis and treatment of hematologic diseases
• Understand the initial laboratory evaluation in hematologic diagnosis; specifically, the CBC, red cell indices, reticulocyte count, leukocyte differential, examination of peripheral blood smear and indications for bone marrow examination
• Accurately diagnose and appropriately manage anemias; to differentiate normocytic, hypochromic and macrocytic anemias and understand the differential diagnosis and diagnostic approach for each morphologic type of anemia
• Understand iron, folic acid and vitamin B12 metabolism and their laboratory measurements as related to disorders of red blood cell production, anemia and iron overload
• Recognize the clinical and laboratory features of hemolysis
• Diagnose the common hereditary and acquired hemolytic anemias from clinical history and appropriate laboratory studies
• Understand the clinical syndromes, genetic basis and laboratory features of common quantitative and qualitative disorders of hemoglobin including the sickle cell syndromes and thalassemias
• Identify and manage the acute crises in patients with sickle cell disease
• Identify microangiopathic hemolytic anemia, know its differential diagnosis and understand the clinical approach to disorders associated with this finding including TTP/HUS and DIC
• Understand the Coombs test (direct and indirect antiglobulin test), its implications in the diagnosis of immunohemolytic anemias, the mechanisms of antibody-mediated hemolysis and the clinical features of the disorders associated with "warm-reactive" and "cold-reactive" antibodies
• Understand the clinical significance of granulocytopenia, the differential diagnosis and management of the granulocytopenic patient
• Understand the clinical significance of thrombocytopenia, the differential diagnosis and management of the thrombocytopenic patient
• Diagnose autoimmune thrombocytopenia (ITP) and understand management and prognosis
• Recognize the clinical features of stem cell failure including aplastic anemia and myelodysplasia
• Know the differential diagnosis of a leukoerythroblastic peripheral blood smear
• Know the differential diagnosis of eosinophilia
• Know the clinical features and treatment of the chronic myeloproliferative diseases (polycythemia vera, chronic myelogenous leukemia, idiopathic myelofibrosis, essential thrombocythemia) and the complications of these disorders
• Understand the clinical features of acute myelogenous leukemia and acute lymphoblastic leukemia, and the therapeutic approach, prognosis, and supportive care of the myelosuppressed patient
• Understand the principles of blood component transfusion, the indications for specific components, compatibility testing, evaluation of antibodies, transfusion reactions and the infectious disease risks of transfusion therapy; understand the indications for apheresis
• Understand the clinical features and therapy of plasma cell disorders and dysproteinemias including specific complications presenting as medical emergencies
• Understand the clinical features of chronic lymphocytic leukemia, as well as the indications for therapy and therapeutic approaches
• Understand the clinical and pathologic features of the indolent and aggressive non-Hodgkin lymphomas, including staging, prognosis and therapeutic approaches
• Understand the clinical and pathologic features of Hodgkin lymphoma and the role of clinical and pathologic staging in determining therapeutic approach and prognosis
• Understand the approach to supportive care, pain management, rehabilitation, home care and hospice care in the care of the patient with hematologic disease
• Understand the basic mechanisms of coagulation and fibrinolysis in order to evaluate patients with bleeding and clotting disorders
• Understand the basis of laboratory screening tests for coagulopathies, the PT, PTT, platelet count and bleeding time; be able to initiate further laboratory investigations based on the presence or absence of abnormalities in these screening tests
• Differentiate a factor deficiency versus an inhibitor, using mixing studies
• Have an approach to the evaluation of thromboembolic disorders; be conversant with the signs and symptoms of deep venous thrombosis and pulmonary embolism, and with the sensitivity and specificity of the tests used to evaluate these disorders
• Know when and how to use the anticoagulants heparin and coumadin, and fibrinolytic agents, and be aware of the side effects associated with these drugs
• Know how to manage patients overtreated with coumadin, heparin, or fibrinolytic agents
• Understand the pattern of inheritance, the incidence, and the appropriate patients to screen for the more common inherited thrombophilic disorders protein C, protein S, and antithrombin III deficiencies
• Understand the inheritance, presentation, and treatment of congenital disorders of hemostasis, including the biochemistry and pharmacology of coagulation factor replacement therapy
• Diagnose and treat von Willebrand's disease and know the role of DDAVP in the treatment of vWD and mild hemophilia
• Understand the coagulopathy associated with liver failure and its management
• Have a basic knowledge of inherited and acquired disorders of platelet function and their evaluation using the bleeding time and platelet function studies
• Be aware of commonly used drugs which interfere with coagulation and platelet function
• Be able to diagnose and treat Vitamin K deficiency
• Understand HIV-related hematologic disorders and HIV-related malignancies
• Recognize and manage paraneoplasic disorders
• Understand clinical epidemiology and medical statistics, including clinical study and experimental design, data collection and analysis
• Understand allogeneic and autologous hematopoietic stem cell transplantation and the nature and management of post-transplant complications
• Understand the principles and application of radiation medicine to hematopoietic and lymphopoietic malignancies
• Understand multiagent chemotherapy protocols and combined modality therapy for hematologic malignancies
• Understand relevant chemotherapeutic drugs, biologic products, and growth factors, their mechanisms of action, pharmacokinetics, clinical indications, and limitations
• Understand the molecular mechanisms of hematologic malignancies, including oncogenes and their products
• Understand immunophenotyping, cytochemical studies, cytogenetic and molecular analysis of hematologic malignancies
• Understand basic molecular mechanisms in the diagnosis and therapy of diseases of blood and disorders of hemostasis and thrombosis
• Understand related basic fields, including immunology, basic and clinical pharmacology and pharmacokinetics, cell and molecular biology, tumor immunology, molecular genetics, and prenatal diagnosis
• Be familiar with the basic principles of molecular biology of cancer, including cytogenetic, the ell cycle, invasion and metastasis of tumors
• Be familiar with known associations of cancer causation: chemical, physical, environmental, viral and hormonal factors
• Understand the concept of cancer as a genetic disease and to be familiar with common genetic syndromes that are associated with a higher risk of cancer; and to understand the appropriate role of genetic testing and counseling in selected situations
• Be familiar with surgical principles of cancer management
• Be familiar with radiation therapy and its appropriate role in cancer management, including palliation; be aware of the use of external beam therapy and brachytherapy conformal therapy, sterotactic radiation therapy in selected situations
• Be familiar with basic principles of tumor immunology and the role of biological response modifiers in primary therapy and supportive care of cancer
• Be familiar with the use of hormonal therapy in the treatment and prevention of cancer
• Be familiar with principles of cancer screening
• Be familiar with theory and use of cancer preventive agents, including retinoids, carotenoids, hormones, nonsteroidal anti-inflammatory agents, dietary fiber, and micronutrients
• Be familiar with epidemiology, staging and prognostic factors, natural history, pathology and therapy for primary and advanced disease for each of the major tumor types, including: cancers of the head and neck, lung, breast, esophagus, stomach, small and large intestine, colon and rectum, brain and central nervous system, gynecologic malignancies, genitourinary malignancies, skin (including melanoma), endocrine tumors and tumors of bone and soft tissue
• Be familiar with the adverse effects of cancer treatment, including immediate, early, delayed, and late effects
• Be familiar with infections in cancer patients associated with immune compromise and the use of indwelling devices
• Be familiar with the supportive therapy of the cancer patient, including the treatment and prevention of nausea and vomiting, stomatitis, cystitis, pulmonary and cardiotoxicity, alopecia, and gonadal dysfunction
• Be sensitive to the need for supportive care and the issue of quality of life in the cancer patient, including the management of cancer pain, nutritional support, problems of therapy-induced sexual dysfunction, and psychiatric and psychological disorders in cancer patients
• Be familiar with the use of hospice in the care of the terminally ill patient and be sensitive to meeting the needs of the dying patient

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