Hematology-oncology trainees spend at least 18 months of the 3-year training program as clinical fellows. During this period they gain extensive experience in the areas of solid tumor oncology, hematologic malignancy, classical hematology, hemostasis/thrombosis, and bone marrow transplantation. Each fellow participates in weekly clinics throughout the fellowship. Continuity of Care clinics run continuously throughout the fellowship as 6-month block assignments. Elective clinical rotations available during years 2 and 3 include radiation oncology, blood transfusion service, hematopathology, neoplastic pathology, urologic oncology, palliative care, and pediatric oncology.
Throughout the fellowship a number of weekly didactic seminars and lectures are held on an approximate 18-month rotation. Topics include most of those listed in the ASH Hematology Curriculum and the ASCO Curriculum for Medical Oncology for fellow training. During July of each academic year an “urgent-emergent” pod of lectures are given to facilitate the new fellow in becoming the “expert” in some of the fast-moving clinical scenarios they will be asked to see.
Training Expectations for Clinical Competency in Hematology-Oncology
As each fellow progresses through his/her 3 years of clinical training, there is an expectation of – and, evaluations will be based on – a graded but steadily increasing proficiency and independence in being able to:
- Assess and define a patient’s hematological and / or oncological problem; this will include competency in obtaining and synthesizing the relevant history as well as performing the bedside examination, ordering appropriate tests and performing procedures such as the bone marrow aspirate and biopsy, spinal or CNS reservoir tap with injection of chemotherapy. The essential competency is to clearly, efficiently and accurately establish a diagnosis.
- Obtain an appropriate battery of tests for the established diagnosis so that the proper stage of the disease can be determined. The essential competency is to understand the importance and components of staging for all major hematology-oncology disorders.
- Select evidence-based therapy, write chemotherapy orders and communicate effectively with personnel involved in executing the treatment plan. The essential competency is to be able to understand the natural history of the disease and, thus, define the goals of therapy.
- Counsel the patient and family on the risks and benefits of that therapy; this will include the collaboration with clinical trial personnel, understanding consenting documents and being able to explain complex regimens in a manner that can be understood by the patient. The essential competency is to appropriately frame and execute a treatment plan in the context of the defined therapeutic goals.
- Provide an appropriate follow-up plan of survivorship; this will include being able to articulate to the patient the natural history of their disease, appropriate intervals and testing for reassessment, potential complications of their therapy, a plan for health maintenance after therapy is completed and comprehensive plan for rehabilitation – physical, mental, occupational or vocational. The essential competency is to delineate a post-treatment plan for survivorship.
Fellows in their first year will initially be highly dependent on the faculty and/or senior fellows for guidance in the aforementioned areas of competence. Increasing independence in all training expectations will mark a successful transition from the first to the second year. In the final year, they are expected to be essentially independent in all facets of the provision of hematological-oncological care. Evaluations of the fellow by faculty will be based on graduated improvements in the six internal medicine competencies.