Pediatric Hematology / Oncology Fellowship

Goals & Objectives

Fellowship Goals & Objectives

Pediatric Hematology/Oncology
November 10, 2016

The UNMC/Nebraska Medicine/CHMC Fellowship in Pediatric Hematology Oncology is a three-year

program designed to provide the clinical, research, and teaching skills necessary for competence in this
subspecialty. The program is also designed to meet the American Board of Pediatrics (ABP) eligibility
criteria for certification. In order to meet these requirements fellows will spend one year devoting 90% of
their effort to clinical work, and 75% of years 2 and 3 to training in research and teaching skills. While
fellows may be expected to achieve competence in many components of patient care by the end of their 1st
year, there is expected to be ongoing training and improvement for all patient care issues over the entire
training period. During the first clinical year, fellows are expected to demonstrate knowledge during the
first four months, comprehension during the second four months, and application during the final four
months.

The clinical schedule for first year for fellows includes monthly rotations during the first year: 4 months
on the general pediatric hematology-oncology inpatient service at CHMC; 2 months on pediatric
hematology-oncology inpatient service at Nebraska Medicine, with a focus on the bone marrow transplant
service (in- and out-patient); 3 months on outpatient clinics to be divided between CHMC and Nebraska
Medicine (general hematology oncology; sickle cell, hemophilia and other coagulation disorders, bone
marrow transplantation). The first year fellow will also spend one month in pathology to include both solid
tumor and hematopathology split between CHMC and Nebraska Medicine, and one month split between
radiation oncology at Nebraska Medicine and transfusion services at CHMC. Fellows will receive 4 weeks
of vacation with 1-2 weeks at a time taken from outpatient rotations. Throughout the first year when not
on clinic rotations, and during the 2nd and 3rd years, fellows are expected to spend ½ day a week in
general hematology oncology clinics with some of that time spent focusing on subspecialty areas (e.g.,
sickle cell, coagulation) based on fellow preference and twice yearly assessment of individual strengths
and weaknesses. During first year inpatient rotations (CHMC and Nebraska Medicine), fellows are expected
to take first home call (with an attending as second call) for the relevant service Monday, Tuesday, and
Thursday. Weekend call throughout the 3 years of fellowship will be every 4-6 weeks. Also throughout the
3 years of fellowship, fellows are expected to take Wednesday home call for the CHMC or Nebraska
Medicine services no more than once every other week.

For each competency, the minimum capability expected of each fellow includes:

Years 1 and 2: Progress toward independent practice

Year 3: Competence to practice independently

Patient Care
Goal: Fellows must be able to provide patient care that is consistent with standard of care for the
treatment of pediatric hematology/oncology (including bone marrow transplantation) and related
problems, while being compassionate, culturally sensitive, and ethical. Each of the following objectives
will be attained in a level-based manner. Specifically, during the first four months of the clinical year, the
fellow will be instructed in the aspects of each objective to attain knowledge. During the second four
months, the fellow will be expected to describe each aspect of these objectives to express
2 | Goals & Objectives, PHO Fellowship

comprehension. During the final four months and during years two and three the fellow will be expected
to begin applying each aspect of these objectives independently.

Specific Objectives include:

• Employ management skills for the inpatient care of the following disorders as outlined by
the pediatric hematology-oncology sub-board, including: leukemias, lymphomas; solid
tumors; aplastic anemia; hematologic disorders of the newborn; hemoglobinopathies; red
cell membrane and metabolism disorders; autoimmune disorders; nutritional anemia;
inherited and acquired disorders of white blood cells; hemophilia and other inherited and
acquired coagulopathies; ITP and other platelet disorders; congenital and acquired
thrombotic disorders; congenital and acquired immunodeficiencies, post transpant
lymphoproliferative disease; issues of cancer survivorship and palliative care

• List the side effects and mechanisms of action of the common chemotherapies;

• Demonstrate the ability to interpret common laboratory tools including a complete blood
count, review of blood smears, PT, PTT and relate abnormalities to specific disease
processes;

• Demonstrate the ability to manage oncologic emergencies such as (but not limited to):
fever/neutropenia, SVC syndrome, Mediastinal Mass, Hyperleukocytosis, transfusion
reactions;

• Recognize the benefits of and a basic working relationship with the Cooperative
Childhood Cancer Groups (COG, NWTS, IRS) and define commonly utilized phase III
protocols.

• Demonstrate the ability to work with a multidisciplinary team;

• Demonstrate an ability to speak with patients who have chronic disease and their families
regarding diagnosis, treatment options and the presentation of informed consent;

• Demonstrate the ability to correctly write chemotherapy orders and follow protocol
guidelines.

• Identify research opportunities in the field, at UNMC/Nebraska Medicine/CHMC, and

elsewhere.

• Discuss patient presentation and management in tumor boards and board review
courses, including in preparation of presentations;

The first year fellows will observe attendings leading a multidisciplinary team (including residents, medical
students, nurses, nurse practitioners, social worker, psychologist, teacher, pharmacist, recreational
therapy, clergy, psychology, nutritionists) serving patients with cancer and hematologic disorders and
utilizing other disciplines to aid in the care of patients. By the end of the second of the 4 months on the
inpatient general hematology oncology and transplantation services, fellows should be able to direct the
multidisciplinary team themselves with the guidance of and under direct observation by the attending
physician. By the 4th month on service, fellows should be able to direct rounds independently with indirect
supervision by the attending. This will include performing daily examinations of all patients,
communicating with patients/families, writing chemotherapy orders, and with the help of the attending
3 | Goals & Objectives, PHO Fellowship

physician making management decisions. The fellow’s ability to deliver patient care will be reviewed with
the fellow after each rotation, and with formal written evaluations by the attending physicians twice yearly.

The fellow initially will assess all inpatient hematology- oncology and transplant admissions while on the
inpatient services, and new and follow up outpatient consults when in the outpatient clinic. The fellow will
be expected to formulate a differential diagnosis and a plan for further evaluation and management. This
will be reviewed with the attending physician who will co-sign orders and notes in the electronic record.
The fellow will understand the role of the consulting physician in the care of these patients. The fellow’s
ability to perform new patient consultations will be reviewed with the fellow after each rotation, and with
formal written evaluations by the attending physicians.

The fellow will contribute to providing continuity of care for patients with a range of diagnoses. This care
will always be delivered in collaboration with a supervising attending physician who will evaluate the
fellow after each rotation as part of ongoing evaluations.

Fellows will understand the indications for, the common complications of, and how to perform common
procedures (Bone marrow aspiration and biopsy, lumbar puncture with/without administration of
intrathecal chemotherapy) through a process of "see one, do one". Assessment of ability to perform
above procedures will be reviewed with the fellow after each clinic session and documented in
evaluations by supervising attending physicians and through maintenance of procedure logs.

Fellows will become comfortable with interpretation of basic laboratory tests, microscopy of peripheral
blood and bone marrow specimens through discussion and through review with a multi-disciplinary team
at tumor boards. Dedicated attention to microscopy will take place with the Hematopathology Division
during the dedicated hematopathology rotation during the first year. Assessment of capability in these
areas will be documented as part of evaluations by supervising attending physicians.

The fellow will understand the medical, psychological, and financial issues involved with dying patients,
including pain control, advanced directives, psychosocial support of the patient/family, hospice care, and
dealing with the feelings of care team members. The attending physicians, other members of the
healthcare team, and the patients/families, will assess the fellow’s progress in this area through formal
evaluations.

Medical Knowledge
Goal: Fellows must demonstrate knowledge of biomedical, clinical, epidemiological, and behavioral
sciences, as they relate to patient care. Each of the following objectives will be attained in a level-based
manner. Specifically, during the first four months of the clinical year, the fellow will be instructed in the
aspects of each objective to attain knowledge. During the second four months, the fellow will be
expected to describe each aspect of these objectives to express comprehension. During the final four
months and during years two and three the fellow will be expected to begin applying each aspect of these
objectives independently.

Specific Objectives include:

• Apply basic scientific and clinical knowledge of pediatric hematology, oncology, and stem
cell transplant.
4 | Goals & Objectives, PHO Fellowship

• Demonstrate the ability to obtain a comprehensive history and pursue an appropriate

diagnostic work-up relating to hematologic and oncologic issues, as well as formulate a
differential diagnosis.

Fellows will be expected to attend a formal didactic lecture series (every week) that will cover pertinent
topics of hematology/oncology. Attendance will be documented.
The fellow will learn to identify and manage disorders, as summarized by the sub-specialty board, and
listed above (Patient Care 1).

The fellow will develop a basic understanding of pharmacology of common and newer chemotherapies
and will become proficient at chemotherapy order writing. Progress will be assessed by evaluations by
the attending physicians during rounds in the in- and out-patient settings and by in-service examinations.

The fellow will develop a basic understanding of supportive care including transfusion therapy,
management of infectious complications in immunocompromised patients, nutritional support, pain
control, psychosocial support, palliative and hospice care. Progress will be assessed by evaluations
completed by the attending physicians during rounds in the in- and out-patient settings and by in-service
examinations.

Practice- Based Learning and Improvement

Goal: Fellows must demonstrate the ability to read about and synthesize literature relating to the care of
patients, and to continuously improve patient care based on ongoing self-evaluation and lifelong learning.

Specific Objectives include:

• Assess gaps in knowledge and skills to develop an individual learning plan which will be
updated yearly

• Critically review journal articles and other medical literature for journal club and tumor
boards

• Appraise research articles by critically reviewing study design and research

methodologies

• Analyze the fellow’s own practice experience and participate in practice-based

improvement activities

• Educate patients, families, students, residents and other health professionals,

 as documented by evaluations of a fellow’s teaching abilities by faculty and/or learners

The fellow will participate in providing bedside teaching to residents and medical students during inpatient
rounds. The fellows’ teaching ability will be reviewed with the fellow after each rotation and formally
documented in evaluations by the faculty and pediatric residents.

The fellow will lead clinical management meetings such as the weekly sign out at CHMC and Nebraska
Medicine.
5 | Goals & Objectives, PHO Fellowship

Systems Based Practice

Goal: Fellow must demonstrate an awareness of and responsiveness to the larger context and system of
health care, as well as the ability to call effectively on other resources in the system to provide optimal
health care.

Specific Objectives include:

• Analyze how different organizations within the healthcare system affect one another (e.g.,
insurance providers, advocacy groups, research organizations, government agencies, etc.).

• Identify systems errors and implement potential systems solutions.

• Understand cost-effective health care and resource allocation without compromising care.

• Assess quality care and assist patients in navigating the health care system.

The fellow will function as a member of a multidisciplinary team and should appreciate the different
perspectives offered by various team members and will be evaluated through 360° evaluations by faculty,
nursing staff and family evaluations.

The fellow will participate in at least one multi-disciplinary quality improvement project each year. This can
be the same carried over multiple years or several projects. The fellow’s performance working on this
project will be reviewed with the fellow at least twice yearly by the CQI committee mentor, and
evaluations.

The fellow will develop an understanding of the role of clinical trials in hematology/oncology practice. The
fellow’s performance in this area will be evaluated through review by the faculty of notes, chemotherapy
orders, patient and clinical conferences, and COG on-line certifications.

Professionalism
Goal: Fellows must demonstrate a commitment to carrying out professional responsibilities and an
adherence to ethical principles.

Specific Objectives include:

• Compassion, integrity, and respect for others.

• Sensitivity and responsiveness to a diverse patient population, including but not limited to
diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

• A commitment to excel in clinical care and ongoing professional development.

6 | Goals & Objectives, PHO Fellowship

• A full understanding of issues pertaining to confidentiality in patient care, informed

consent, and business practices.

• A commitment to ethical principles pertaining to provision or withholding of clinical care.

The fellow will communicate in a professional manner, after consultation with the attending physician, with
families daily in regards to the plan of care and with primary care providers at the time of initial diagnosis
and then at regular intervals thereafter. Professionalism will be formally assessed through written 360°
evaluations from patients/families and by regular review of written communication with the primary care
physicians.

The fellow will understand the issues surrounding the informed consent process for patients/families
considering participation in clinical trials and will effectively manage informed consent talks with families.
The fellows’ understanding and ability to lead such discussions will be evaluated formally by 360°
evaluations by families and patients, and by reviews by the supervising attending physicians.

Interpersonal and Communication Skills

Goal: Fellows must demonstrate interpersonal and communication skills that result in the effective
exchange of information with other healthcare providers, patients and their families.

Specific Objectives include:

• Communicate effectively with patients and families across a broad range of

socioeconomic and cultural backgrounds

• Communicate effectively with consultants, referring physicians, and other healthcare

professionals.

• Maintain comprehensive, timely, and legible medical records

• Demonstrate effective listening skills to elicit information, non-verbal skills, explanatory

questioning and writing skills

• Perform effective transfers of care to oncoming team members

The fellow will clearly communicate with patients/families daily in regard to concerns, and plan of care.
Such communication initially will be directly observed by the supervising attending physician and will be
reviewed with the fellow at least after each rotation, as well as through written evaluations by attending
staff, other healthcare team members, and patients/families.

The fellow will clearly communicate with the other members of the multidisciplinary healthcare team in
regard to the treatment plan for the patients on the hematology/oncology and transplant services. Such
communication will be directly observed by the supervising attending physician and will be formally
evaluated through written evaluations by attending staff and other healthcare team members.

The fellow must effectively communicate with primary care providers at the time of initial diagnosis and at
regular intervals thereafter. The fellow’s daily notes, letters to primary care physicians and clinic charts
will be reviewed by the attending staff and will be formally evaluated in faculty evaluations.
7 | Goals & Objectives, PHO Fellowship

Teaching Methods
• Continuous interaction with hematology/oncology and transplant faculty during case
presentations, rounds and decision making;
• In-formal teaching during clinic encounters
• Formal didactic lecture series
• Tumor boards and bone marrow transplant conference
• Reviewing peripheral blood smear and bone marrow slides
• Instruction in procedures

Assessment Method
Program Evaluation Fellow Evaluation
• In-service exam scores • Direct observation
• Board scores and pass rates • Confidential written evaluations by
• Fellow evaluations of program supervising physicians
• Procedure Log • 360 evaluations by patient/ family, and
• Internal and ACGME reviews other healthcare team members.
• ACGME surveys • In-service exam scores.
• Program Evaluation Committee • Twice yearly meetings and written
meetings twice yearly evaluations by the program director, as
a composite of all of the above

Level of Supervision
All clinical activities initially will be directly supervised by an attending physician. Direct supervision of
clinical performance will decrease commensurate with the fellow’s comfort and skill level, however the
attending will always be available for indirect supervision. Procedures will take place under direct
supervision throughout the 3 years of training.

Educational Resources
• Health Sciences Library with internet access including multiple
subspecialty journals and e-books
• Access to internet and COG website
• ASPHO lecture series and PREP subspecialty review
• Current textbooks
 Pediatric Hematology / Oncology Fellowship
Goals & Objectives
for BMT Rotation

Fellowship Goals & Objectives

Bone Marrow Transplantation
Rotation at Nebraska Medicine
Pediatric Hematology/Oncology
November 10, 2016

Rotation Goals
• To understand the principles of peripheral stem cell, bone marrow, and umbilical cord
blood transplantation
• To develop proficiency with basic transplantation techniques and complications
• To explore opportunities for clinical or basic research in transplantation

Rotation Objectives
Each of the following objectives will be attained in a level-based manner. Specifically, during the first four
months of the clinical year, the fellow will be instructed in the aspects of each objective to attain
knowledge. During the second four months, the fellow will be expected to describe each aspect of these
objectives to express comprehension. During the final four months and during years two and three the
fellow will be expected to begin applying each aspect of these objectives independently.

Competencies
Patient Care
Objectives

• Employ management skills for the inpatient care of the following disorders as outlined by
the pediatric hematology-oncology subboard, including: leukemias, lymphomas; solid
tumors; aplastic anemia; non-malignant hematologic and immunodeficiency disorders,
post-transplant lymphoproliferative disease; GVHD, acute and late complications of
transplantation, and donor selection

Evaluation Tools

• Review of EPIC & One Chart notes;

• 360° evaluations, online evaluations;
• Participation in management conferences;
• Procedures including marrow harvests
2 | Goals & Objectives for BMT Rotation, PHO Fellowship

Medical Knowledge
Objectives

• Gain specific expertise in inpatient and outpatient management as required by the

pediatric hematology-oncology sub-board, including: leukemias, lymphomas; solid
tumors; aplastic anemia; non-malignant hematologic and immunodeficiency disorders,
post-transplant lymphoproliferative disease; GVHD, acute and late complications of
transplantation, and donor selection
• Identify the various indications for stem cell transplant
• Analyze specific donor stem cell sources and their impact on engraftment and GVHD.
• Analyze the HLA typing of both recipient and potential donors to identify appropriate stem
cell sources.
• Demonstrate the ability to obtain a comprehensive history, pursue an appropriate
diagnostic work-up, and formulate a differential diagnosis.
• Explain the purpose of the preparative regimen and immunosuppressive therapy
• Define the most common infectious complications of stem cell transplant and their
management.

Evaluation Tools

• Presentations on rounds, at tumor board, management conferences

• Informal oral quizzes on rounds, and during rotations with each of the above disciplines
• Review of EPIC notes and orders
• In-service exam progress

Interpersonal/Communication Skills
Objectives

• Demonstrate the ability to communicate effectively with patients and families across a
broad range of socioeconomic and cultural backgrounds
• Demonstrate the ability to communicate effectively with consultants, referring physicians,
and other healthcare professionals.
• Demonstrate the ability to maintain comprehensive, timely medical records
• Demonstrate effective listening skills to elicit information, non-verbal skills, explanatory
questioning and writing skills

Evaluation Tools

• Presentations on rounds, at tumor board, and management conferences

• Contributions during family conferences;
• 360° evaluations, online evaluations
• Manuscript or grant development

Professionalism
Objectives

• Demonstrate compassion, integrity, and respect for others

3 | Goals & Objectives for BMT Rotation, PHO Fellowship

• Demonstrate sensitivity and responsiveness to a diverse patient population, including but

not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation
• Demonstrate a commitment to excel in clinical care and ongoing professional
development
• Demonstrate an understanding of issues pertaining to confidentiality in patient care,
informed consent, and business practices.
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care.
• Recognize the role of FACT accreditation for stem cell transplantation

Evaluation Tools

• Presentations on rounds, at tumor board, and management conferences

• 360 ° evaluations, online evaluations

Practice-Based Learning
Objectives

• Synthesize literature to continuously improve patient care based on ongoing self-

evaluation and lifelong learning.
• Critically review journal articles and other medical literature
• Educate patients, families, students, residents and other health professionals, as
documented by evaluations of the fellow’s teaching ability by faculty and / or learners
• Role of CQI in patient safety

Evaluation Tools

• Individual learning plan and personal statement updated yearly

• Direct observation and 360° reviews of participation in family conferences
• Participation in CQI project(s)

Systems-Based Learning
Objectives

• Analyze how different organizations within the healthcare system affect one another (e.g.,
insurance providers, advocacy groups, research organizations, government agencies,
etc.).
• Identify systems errors and implement potential systems solutions.
• Analyze cost-effective health care and resource allocation without compromising care.

Evaluation Tools

• Participation at multidisciplinary rounds and conferences

• Participation in CQI projects
• COG, NMDP, other organizational online certifications
 Pediatric Hematology / Oncology Fellowship
Goals & Objectives
for Inpatient Rotation

Fellowship Goals & Objectives

Inpatient Rotation
Pediatric Hematology/Oncology
November 10, 2016

Rotation Goals
• To develop expertise in the fundamentals of clinical diagnosis and treatment in the
inpatient setting of pediatric hematologic and oncologic diagnoses with emphasis on
history taking, physical exam, and evaluation of basic radiographic and core laboratory
tests.
• To develop an individualized approach to the emotional issues of dealing with chronically
ill hematology and oncology patients.
• To explore clinical research in hematology or oncology.

Rotation Objectives
Each of the following objectives will be attained in a level-based manner. Specifically, during the first four
months of the clinical year, the fellow will be instructed in the aspects of each objective to attain
knowledge. During the second four months, the fellow will be expected to describe each aspect of these
objectives to express comprehension. During the final four months and during years two and three the
fellow will be expected to begin applying each aspect of these objectives independently.

Competencies
Patient Care
Objectives

• Employ management skills for the inpatient care of the following disorders as outlined by
the pediatric hematology-oncology subboard, including: leukemias, lymphomas; solid
tumors; aplastic anemia; hematologic disorders of the newborn; hemoglobinopathies; red
cell membrane and metabolism disorders; autoimmune disorders; nutritional anemia;
inherited and acquired disorders of white blood cells; hemophilia and other inherited and
acquired coagulopathies; ITP and other platelet disorders; congenital and acquired
thrombotic disorders; congenital and acquired immunodeficiencies, post transpant
lymphoproliferative disease

Evaluation Tools

• Review of EPIC & One Chart notes;

• 360° evaluations, online evaluations;
• Participation in management conferences;
• Procedure logs
2 | Goals & Objectives for Inpatient Rotation, PHO Fellowship

Medical Knowledge
Objectives

• Employ management skills for the inpatient care of the following disorders as outlined by
the pediatric hematology-oncology subboard , including: leukemias, lymphomas; solid
tumors; aplastic anemia; hematologic disorders of the newborn; hemoglobinopathies; red
cell membrane and metabolism disorders; autoimmune disorders; nutritional anemia;
inherited and acquired disorders of white blood cells; hemophilia and other inherited and
acquired coagulopathies; ITP and other platelet disorders; congenital and acquired
thrombotic disorders; congenital and acquired immunodeficiencies, post-transplant
lymphoproliferative disease
• Demonstrate the ability to obtain a comprehensive history, pursue an appropriate
diagnostic work-up, and formulate a differential diagnosis.

Evaluation Tools

• Presentations on rounds, at tumor board, management conferences

• Informal oral quizzes on rounds, and during rotations with each of the above disciplines
• Review of EPIC notes and orders
• In-service exam progress

Interpersonal/Communication Skills
Objectives

• Demonstrate the ability to communicate effectively with patients and families across a
broad range of socioeconomic and cultural backgrounds
• Demonstrate the ability to communicate effectively with consultants, referring physicians,
and other healthcare professionals.
• Demonstrate the ability to maintain comprehensive, timely medical records
• Demonstrate effective listening skills to elicit information, non-verbal skills, explanatory
questioning and writing skills

Evaluation Tools

• Presentations on rounds, at tumor board, and management conferences

• Contributions during family conferences;
• 360° evaluations, on line evaluations
• Presentations at SOC meetings, journal clubs/lecture series
• Manuscripts/grant development
• Participation in CQI projects

Professionalism
Objectives

• Demonstrate compassion, integrity, and respect for others

• Demonstrate sensitivity and responsiveness to a diverse patient population, including but
not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation
3 | Goals & Objectives for Inpatient Rotation, PHO Fellowship

• Demonstrate a commitment to excel in clinical care and ongoing professional

development
• Demonstrate an understanding of issues pertaining to confidentiality in patient care,
informed consent, and business practices.
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care.

Evaluation Tools

• Presentations on rounds, at tumor board, and management conferences

• 360 ° evaluations, online evaluations
• Certification by COG in HIPAA and consents

Practice-Based Learning
Objectives

• Synthesize literature to continuously improve patient care based on ongoing self-

evaluation and lifelong learning.
• Critically review journal articles and other medical literature
• Educate patients, families, students, residents and other health professionals, as
documented by evaluations of the fellow’s teaching ability by faculty and / or learners

Evaluation Tools

• Individual learning plan and personal statement updated yearly

• Journal club presentations
• Participate in core curricula
• Direct observation and 360° reviews of participation in family conferences
• Participation in CQI project(s)
• Publications

Systems-Based Learning
Objectives

• Analyze how different organizations within the healthcare system affect one another (e.g.,
insurance providers, advocacy groups, research organizations, government agencies,
etc.).
• Identify systems errors and implement potential systems solutions.
• Analyze cost-effective health care and resource allocation without compromising care.

Evaluation Tools

• Participation at multidisciplinary rounds and conferences

• Participation in CQI projects
• COG online certifications
 Pediatric Hematology / Oncology Fellowship
Goals & Objectives
for Elective Rotations

Fellowship Goals & Objectives

Elective Rotations
Pediatric Hematology/Oncology
November 10, 2016

The goal of an elective rotation is to develop expertise in the fundamentals of hematopathology,

transfusion medicine, coagulation laboratory medicine, radiation oncology, hospice, and palliative care.
Fellows must be competent in the proper use of the laboratory techniques for diagnosis, with recognition
of the limitations of the various methods and the pitfalls in interpretation of laboratory results. Lab
rotations should include the normal variations in laboratory data that occur at different ages, as well as
the influence of medications, toxins, and systemic disease on hematologic test results

Fellows much be competent to perform and interpret:

• Bone marrow aspiration and biopsy

• Lumbar puncture with evaluation of cerebrospinal fluid
• Microscopic interpretation of peripheral blood films and
• Hematologic laboratory diagnostic tests

Fellows should develop the skills needed to review and interpret peripheral smear, bone marrow
aspiration, and biopsy.

Fellows should keep a personal log of bone marrow biopsies and lumbar punctures and should make an
attempt to review the bone marrows whenever possible.

Rotation Objectives:
Hematopathology
• Explain the basics of light microscopy;
• Define the microscopic findings of peripheral blood smears in common hematologic and
oncologic entities including the microcytic, macrocytic , and hemolytic anemias,
leukemias;
• List the microcopic findings of bone marrow aspirations and biopsies of leukemias and
solid tumors, aplastic anemia, red cell aplasias, neutropenias, ITP, and common storage
diseases;
• Describe the basic techniques of flow cytometry and immunophenotyping of leukemias.

Transfusion Medicine
• Describe the principles of transfusing red cells, platelets, granulocytes, plasma, and
coagulation factors;
• List the indications and methods for pheresing donors for routine blood products and for
peripheral blood stem cells;
2 | Goals & Objectives for Elective Rotations, PHO Fellowship

• Pheresis experience-- Understand the indications and methods of pheresing donors for
routine blood products and for peripheral blood stem cells
• Understand the risks of transfusions and approaches to minimizing risks
• Participate in transfusion medicine didactics with other students / hem/onc fellows

Coagulation Laboratory
• Explain the techniques to complete such laboratory tests such as PT, PTT, PFA, and
factor and inhibitor analysis.
• Define possible sources of error in the completion and analysis of basic coagulation test

Radiation Oncology
• Explain the basic principles of radiation oncology including types of radiation (x-ray, orth-,
megavoltage, cobalt therapies, brachytherapy, external beam/intraoperative RT), dose
rates and fractionation, construction of ports;
• Define the indications for and basic techniques of radiation in specific pediatric cancers;
• List the acute and long term side effects of radiation to different ports

Hospice and Palliative Care

• Define the issues that impact the successful institution and management of palliative care
or hospice for pediatric hematology oncology patients.
• Analyze the available systems for the transition of pediatric oncology and hematology
patients to palliative care or hospice.

Cytogenetics
• Become familiar with cytogenetic testing of bone patient samples: flow cytometry,
molecular, and karyotype analysis

Competencies
Patient Care
Objectives

• Employ expertise in each of the five rotations listed above.

Evaluation Tools

• 360° evaluations, on line evaluations by faculty from each of the above areas
• Participation in management, palliative care conferences;
• Direct observation by supervising faculty

Medical Knowledge
Objectives

• Employ expertise in each of the five rotations listed above.

3 | Goals & Objectives for Elective Rotations, PHO Fellowship

Evaluation Tools

• Presentations on rounds, at tumor board, management conferences

• Informal oral quizzes on rounds, and during rotations with each of the above disciplines
• Review of EPIC notes and orders
• In-service exam progress

Interpersonal/Communication Skills
Objectives

• Demonstrate the ability to communicate effectively with patients and families across a
broad range of socioeconomic and cultural backgrounds
• Demonstrate the ability to communicate effectively with consultants, referring physicians,
and other healthcare professionals.
• Demonstrate the ability to maintain comprehensive, timely medical records
• Demonstrate effective listening skills to elicit information, non-verbal skills, explanatory
questioning and writing skills

Evaluation Tools

• Presentations on rounds, at tumor board, and management conferences

• Contributions during family conferences;
• 360 ° evaluations, on line evaluations
• Participation in CQI projects

Professionalism
Objectives

• Demonstrate compassion, integrity, and respect for others

• Demonstrate sensitivity and responsiveness to a diverse patient population, including but
not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual
orientation
• Demonstrate a commitment to excel in clinical care and ongoing professional
development
• Demonstrate an understanding of issues pertaining to confidentiality in patient care,
informed consent, and business practices.
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care.

Evaluation Tools

• Presentations on rounds, at tumor board, and management conferences

• 360 ° evaluations, on line evaluations
4 | Goals & Objectives for Elective Rotations, PHO Fellowship

Practice-Based Learning
Objectives

• Synthesize literature to continuously improve patient care based on ongoing self-

evaluation and lifelong learning.
• Critically review journal articles and other medical literature
• Educate patients, families, students, residents and other health professionals, as
documented by evaluations of the fellow’s teaching ability by faculty and / or learners
• Role of CQI in patient safety

Evaluation Tools

• Individual learning plan and personal statement updated yearly

• Direct observation and 360° reviews of participation in family conferences
• Participation in CQI project(s)

Systems-Based Practice
Objectives

• Recognize the role of the different divisions and services including TNMC’s hospice and
palliative care consultation service, rad onc, transfusion medicine, and the laboratory
aspects of hem-path, coagulation and transfusion medicine

Evaluation Tools

• Participation at multidisciplinary rounds and conferences

• Participation in CQI projects