Educational Goals – Outpatient Clinic Service:

(Competencies addressed)

Team Structure and Responsibilities:

 The Outpatient service consists of 3-4 Attending physicians,  4 Advanced Practice Nurses, 4 Hem-Onc fellows and 1-2 residents.

Attending Physician

·      Holds appropriate clinical privileges at UCLA.

·      Supervises and assumes ultimate responsibility for the care of outpatients in their respective clinics.

·      Reviews the clinical information and plan for each patient and performs patient-based teaching.

·      Oversees order writing, but residents must routinely write all orders for patients under their care.  In those unusual circumstances when the attending writes an order, he/she must communicate this to the resident in a timely manner.

·      Responsible for providing verbal feedback and written evaluation of all members of the team.

Fellow

·      Oversees the care of all patients seen in an outpatient setting.

·      Responsible for communicating test results to patients and family members.

·      Writes all chemotherapy orders.

Goals:

To be competent in the comprehensive care of chronically and acutely ill patients with hematologic and solid organ malignancies and benign hematologic disorders.

(Patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, systems-based practice)

• To learn about the pathophysiology, diagnosis and basic principles of management of common pediatric malignancies including, but not limited to, acute leukemias, lymphomas, brain tumors and sarcomas, as well as benign hematologic disorders such as hemoglobinopathies (sickle cell anemia, thalassemia syndromes, etc.), other hemolytic anemias, disorders of hemostasis, disorders of WBC’s, and immune function.

(Patient care, medical knowledge, practice-based learning and improvement)

• To be competent in the medical management of chronically and acutely ill patients with a broad range of hematologic and solid organ tumors.  This includes understanding general goals of therapy (i.e., curative, neoadjuvant, adjuvant, or palliative) as well as recognizing and managing complications of chemotherapy, neutropenic fevers, anemia, thrombocytopenia, DIC, graft versus host disease, gastrointestinal hemorrhage, metabolic and electrolyte derangements, and infection. In particular, to recognize when patients require immediate hospitalization, and know how to implement prompt care for the acutely ill patient.

(Patient care, medical knowledge, systems-based practice)

• To understand the basic principles in managing patients who are undergoing chemotherapy, radiation therapy and bone marrow transplantation.

(Medical knowledge)

• To develop a rational approach to pain management in the cancer patient. 

(Patient care, medical knowledge) 

• To learn how to function as a member of an outpatient multidisciplinary team  caring for patients with hematologic malignancies and solid tumors, as well as chronic benign hematologic disorders. To learn to provide prompt evidenced-based consultation on a wide variety of hematologic and oncologic conditions, and to communicate those findings and recommendations to referring physicians in a professional manner.

(Patient care, professionalism, interpersonal and communication skills, systems-based practice)

• To be able to participate in family meetings and be an effective communicator.

(Professionalism, interpersonal and communication skills)

• To learn how to address end of life issues with patients and family members.  This includes an understanding of effective pain management and palliative care.

(Medical knowledge, professionalism, interpersonal and communication skills, systems-based practice)

Objectives

(Competencies addressed) 

At the completion of this rotation, will be able to:

 

YEAR 1

• Formulate a differential diagnosis and outline a plan for evaluating and managing patients referred as a consultation. (Patient care, medical knowledge)

 

• Demonstrate organizational skills necessary for the care of out-patients, including prioritization of patient problems and the use of information technology. (Practice-based learning and improvement, Systems-based practice)

 

• Demonstrate baseline competency and improvement in medical interviewing and physical diagnosis. (Patient care, Interpersonal and communication skills)

 

• Discuss the differential diagnosis and direct the evaluation and management out-patients. (Patient care, medical knowledge, Professionalism, Interpersonal and communication skills)
• Participate in family meetings and communicate effectively with patients and their families.  (Professionalism, Interpersonal and communication skills)
• Demonstrate ability to supervise admission planning and appropriate level of care. (Patient care, medical knowledge, Systems-based practice)
• Promptly document all patient interactions in a concise, thorough manner. (Professionalism, Systems-based practice, Interpersonal and communication skills)
• Demonstrate organizational skills necessary for supervising the care of community-based patients. (Patient care, Prtactice-based learning and improvement, Systems-based practice)

YEAR  2:

•  Demonstrate an understanding of the appropriate utilization of consult services and diagnostic testing. (Medical knowledge, Practice-based learning and Improvement, Systems-based practice)
• Understand the indications for, risks of and be able to supervise house staff in the performance of procedures such as bone marrow aspiration, bone marrow biopsy, and lumbar puncture. (Patient care, Medical knowledge)

YEAR 3:

• Demonstrate competency in the diagnosis and management of patients with hematologic and solid organ malignancies, as well as benign hematologic disorders as outlined above. Understand the natural history of hematologic and oncologic disorders through longitudinal experience with out-patients. (Patient care,Medical knowledge, Professionalism, Interpersonal and communication skills, Practice-based learning and improvement, Systems-based practice)
• Function effectively as the head of an out-patient multi-disciplinary team to ensureproper care and welfare of patients. (Patient care, Professionalism, Interpersonal and communication skills, Systems-based practice)
• Function as an effective team manager, leader and teacher. (Patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, systems-based practice)
• Lead family meetings and communicate effectively with respect to explaining the diagnosis, prognosis, plan of therapy, and any research issues. (Patient care, medical knowledge)

 

Educational Goals – Inpatient Service:

(Competencies Addressed)

 

Team Structure and Responsibilities:

The Pediatric Hematology/Oncology inpatient team consists of an attending physician (full-time faculty), a Hem/Onc fellow, a junior (PL-2) or senior (PL-3) resident and two interns (PL-1). 

 

The attending physician has the following responsibilities:

·  Holds appropriate clinical privileges at UCLA

·  Supervises and has ultimate responsibility for the care of patients on the inpatient service of the team

·  Conducts daily rounds with the team, which includes reviewing clinical information and the plan for each patient and patient-based teaching. Rounds are not to exceed 2 hours.

·  Oversees order writing. Residents routinely write all routine orders (ie, not chemotherapy) for patients under their care. In the unusual circumstance when the attending physician writes an order, he/she must communicate that information to the appropriate resident in a timely fashion.

·  Writes admission notes and a daily progress notes in conjunction with the residents for all patients on the service. Notes for patients in the ICU are written in conjunction with the inpatient fellow.

·  Provides verbal feedback and written evaluation of all members of the team.

 

Responsibilities of the fellows::

• Oversees care of all patients on the service, including those in the ICU.
• Writes all chemotherapy orders (checked by attending, staff nurses and pharmacist).
• Home night and weekend/holiday call one week in six.
• Third year fellows do 2-4 weeks of “pre-tending”. That service is done with a first year fellow on service, as well. During those periods, the faculty person does not attend ward rounds and the third year fellow functions as attending for the team, and is responsible for all clinical and teaching responsibilities. The third year fellow and the attending then round daily on all patients, independently.

 

Goals:

 

·      To be competent in the comprehensive care of acutely ill pediatric patients with malignancies and hematologic diseases.(Patient care, medical knowledge,professionalism, interpersonal and communication skills, practice-based learning and improvement, systems-based practice)

·      To learn about the pathophysiology, diagnosis, and management of malignancies (including, but not limited to acute leukemias, lymphomas, brain tumors, sarcomas), as well as hematologic disorders (such as bone marrow failure states, hemolytic anemias, immune thrombocytopenic purpura, bleeding disorders and thrombophilic states).(Patient care, medical knowledge, practice-based learning and improvement)

·      To be competent in the recognition and management of a broad range of complications in patients with hematologic disorders and malignancies, including, but not limited to, neutropenic fevers, anemia, thrombocytopenia, DIC, tumor lysis syndrome, graft-versus-host disease, gastrointestinal hemorrhage, acute renal failure, metabolic and electrolyte imbalance, and infection.(Patient care, medical knowledge)

·      To understand the basic principles in managing patients who are undergoing chemotherapy, radiation therapy, and bone marrow transplantation.(Medical knowledge)

·      To recognize and manage hematologic and oncologic emergencies, such as spinal cord compression, acute chest syndrome, superior vena cava syndrome, and tumor lysis syndrome.(Patient care, medical knowledge)

·      To perform and interpret the technical procedures requisite to our sub-specialty (including, but not limited to, reading a peripheral blood smear, performance of bone marrow aspirate and biopsy, reading bone marrow aspirates and biopsies, perform lumbar puncture, access Ommaya reservoirs, administer intrathecal chemotherapy, interpret CSF cytology, interpret laboratory studies of hemostasis, and interpret histocompatibility testing).(Patient care, medical knowledge)

·      To function as a member of a multidisciplinary team caring for patients with cancer or hematologic disorders.(Patient care, professionalism, interpersonal and communication skills, systems-based practice)

·      To participate in and, ultimately lead family meetings and be an effective communicator.(Professionalism, interpersonal and communication skills)

·      To learn to address end-of-life issues with patients and family members, including an understanding of effective pain management and palliative care.(Patient care, medical knowledge, professionalism, interpersonal and communication skills, and systems-based practice)

 

Objectives:

(Competencies addressed)

 

At the completion of these rotations, the fellow will be able to:

 

YEAR 1:

 

·      Gather complete clinical data, including the performance of a detailed history, a complete and accurate physical examination, and order, collect and interpret relevant laboratory tests and imaging studies. (Patient care, medical knowledge, professionalism, practice-based learning and improvement, interpersonal and communication skills, systems-based practice)

·      Formulate a differential diagnosis, and outline a plan for evaluating and managing patients admitted to his/her service. (Patient care, medical knowledge)

·      Demonstrate organizational skills necessary for the care of hospitalized patients, including prioritization of patient problems and the use of information technology. (Practice-based learning and improvement, systems-based practice)

·      Demonstrate the appropriate utilization of consult services and diagnostic testing. (Medical knowledge, practice-based learning and improvement, systems-based practice)

·      Provide accurate, thorough, and prompt documentation of all patient/family interactions.(Profesionalism, communication and interpersonal skills)

·      Participate in family conferences and communicate effectively  to patients and families.(Professionalism, communication and interpersonal skills)

 

YEAR 2:

·      Function effectively as a consultant to other multidisciplinary teams to ensure proper care and welfare of patients. (Patient care, medical knowledge, professionalism, interpersonal and communication skills, systems-based practice)

 

YEAR 3:

 

·      Understand the indications for, risks of, and be able to perform and supervise residents in the performance of procedures, such as bone marrow aspirates, biopsies, and lumbar punctures. (Patient care, medical knowledge)

·      Function effectively as an effective team leader and teacher. Lead family conferences and communicate effectively with patients and families. (Professionalism, Interpersonal and communication skills.

·      Demonstrate ability to supervise discharge planning and follow-up, including provision of appropriate level of care. Patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, systems-based practice)

Transfusion Medicine Rotation

       (one week in second year)

Course Objective:

Apply the fundamental concepts and principles of Transfusion Medicine (TM)  to clinical practice:

 

1. Demonstrate knowledge through discussion and case studies:

(Medical knowledge)

1. Collection and preparation of blood components
2. Pretransfusion testing
3. Selection and transfusion of blood components
4. Resolution of ABO-Rh discrepancies and antibody problems
5. Adverse effects of transfusions
6. Diagnosis and treatment of auto-immune hemolytic anemias
7. Diagnosis, treatment, and prevention of hemolytic disease of the newborn
8. Transfusion issues in transplant patients
1. Observe and perform laboratory procedures:

(Patient care, medical knowledge)

1. ABO-Rh
2. Antibody screen
3. Crossmatch
4. Direct anti-globulin test
5. Antibody identification
6. Antigen phenotyping
7. Elution
8. Auto-antibody adsorption studies
9. Cold agglutinin studies
2. Recognize and clinically evaluate patients with TM-problems:

(Patient care, medical knowledge, professionalism, interpersonal andcommunication skills, practice-based learning and improvement, systems-based practice)

1. Work with TM attendings to formulate solutions and interact with colleagues regarding diagnosis and treatment
3. Recognize potential areas of research in TM.

 

 Fellow Scholarship Goals

 

Year 1:

·  The fellow will identify a project that will be pursued during the second and third years of training

·  The fellow will identify a mentor for the project, with approval by the Division Chief and the Training Program Director.

·  The fellow will identify members for his/her SOC with the assistance of the primary mentor. At least one member of the SOC must be from outside the Division of Pediatric Hematology/Oncology.

·  The fellow will write at least one grant proposal to seek salary support  for the second and third years of fellowship, while the fellow is pursuing the project. This may be directed toward one of the internal training grants.

           

 Year 2:

• Pursue scholarly activity at least 80% time.
• Schedule SOC meeting no less often than every 6 months. First meeting must be before or during the Summer of the second year of training.
• Get satisfactory progress reports from the SOC
• Prepare and present poster reporting progress on project at Science Day (Fellow Graduation).

 

Year 3:

• Continue to pursue project 80% time
• SOC to meet no less often than every 6 months. Last meeting in June of third year must independently conclude that fellow has made satisfactory progress.
• The fellow will present a 10 minute “stand up” of his/her project at Science Day (Fellow Graduation)
• Submit written report of scholarly activity.to Program Director. Preferably this would be in the form of a first author publication, suitable for submission to a peer-reviewed journal. If the project is incomplete, a summary progress report will be considered, but only if the SOC report from June of the third year has documented satisfactory progress.
• If the fellow is staying on as faculty, submit grant proposal for continuing salary support for scholarly activity.
• It is desirable that, in addition to a report of the fellow’s scholarly activity, that the fellow also publish reviews and case reports.

 

 

HEMOSTASIS ROTATION

 

Team Structure and Responsibilities:

 

The Hematology Service is comprised of several faculty, advanced practice nurses, technicians, fellows, and occasional rotating residents and students.

 

The Attending Physician holds appropriate clinical privileges at UCLA Medical Center. One faculty member will be supervising the clinical aspects of the service. He/she reviews the clinical information and plan for each patient and performs patient-based teaching.  The attending –physician will be responsible for providing verbal feedback and written evaluation of all members of the team. The laboratory experience of the fellow will be under the immediate supervision of the technical staff, with oversight by the Attending Physician. This will be part of a course directed by Dr. Victor Marder, Professor of Medicine at UCLA.

 

The fellow will participate in clinics and consultation, as requested and will learn laboratory skills relevant to the hemostasis consultation service. The fellow will be expected to participate in the performance and, especially the interpretation of the results of such tests.

 

Educational Goals:

(Competencies Addressed)

 

• To be competent in the comprehensive care of pediatric patients with disorders of hemostasis.

(Patient care, medical knowledge ,professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based learning and improvement)

• To learn the developmental aspects of normal hemostasis in children.

(Patient care, medical knowledge)

• To learn the pathophysiology, diagnosis, and basic principles of management of disorders of hemostasis.

(Patient care, medical knowledge)

• To learn to function as a member of a multidisciplinary team caring for patients with disorders of hemostasis.

(Patient care, professionalism, interpersonal and communication skills, systems-based practice and improvement)

 

Objectives:

(Competencies Addressed)

 

At the end of this rotation, the fellow will be able to:

• Demonstrate competency in the diagnosis and management of pediatric patients with disorders of hemostasis.

(Patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice)

• Formulate a differential diagnosis and outline an appropriate plan for the diagnosis and management of these patients.

(Patient care, medical knowledge)

• Understand the basic principles behind the laboratory testing for disorders of hemostasis, including the ordering of appropriate tests, and the interpretation and limitations of such tests.

(Patient care, medical knowledge, systems-based practice)

• Participate in family meetings and communicate effectively to patients and their families.

(Professionalism, interpersonal and communication skills)

• Function effectively as a participant in, and leader of a multidisciplinary team caring for children with disorders of hemostasis.

(Patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice)

 

 

RADIATION ONCOLOGY ROTATION

GOALS AND OBJECTIVES

 

Team Structure and Responsibilities:

 

The Hem/Onc fellow will liaise with the Training Director in Radiation Oncology and be in close contact with the Senior Resident or his/her designee and be a member of the Radiation Oncology Team. The Hem/Onc fellow has no responsibikity for managing patients on the Radiation Oncology Service.

 

Attending Physician

• Holds appropriate clinical privileges at UCLA
• Supervises and assumes ultimate responsibility for the care of Radiation Oncology patients
• Reviews the clinical information and plan for every patient and performs patient-based teaching
• Is responsible for providing verbal feedback to the Hem/Onc fellow and written evaluation to the Hem/Onc Program Director regarding the performance of the Hem/Onc fellow during his/her rotation on the Radiation Oncology service.

 

Educational Goals:

 

(Competencies addressed)

 

• To learn the basic principles of radiation oncology, including, but not limited to, indications, therapeutic index, tolerance, dose fractionation image-guided dose targeting, brachytherapy, and traditional techniques.

(Medical knowledge)

• To learn about the side effects of radiation therapy, including somatic/growth effects

(Medical knowledge)

• To learn to appreciate how radiation oncology can be effectively integrated into multi-modality cancer therapies

(Medical knowledge)

 

Objectives:

At the completion of this rotation, the Hem/Onc fellow will be able to:

• Demonstrate an understanding of the principles of radiation oncology, including the topics listed above

(Medical knowledge)

• Demonstrate an understanding of the role of radiation therapy in multi-modal cancer therapies.

(Medical Knowledge)

Kathleen M. Sakamoto, MD, PhD

Division Chief

Stephen A. Feig, M.D.

Fellowship Program Director

Karen Lieberman

Administrator

 Contact: Division of Pediatric Hematology & Oncology

Mattel Children's Hospital UCLA

c/o Kathleen M. Sakamoto, MD, PhD

10833 Le Conte Avenue

Los Angeles, California 90095-1752

Links:

Madison Foundation