VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM

MCV and VA Hospitals Continuity of Care ClinicsDescription of Rotation or Educational ExperienceThe VCU Hematology/Oncology Fellowship Program Continuity of Care Clinics at MCVH and the VA Hospitals are designed to enable fellows to be exposed to a wide variety of patients with oncologic malignancies, hematological malignancies, and benign hematologic conditions whom the fellows follow throughout the disease process. The fellows are assigned a clinic at both MCVH and the VA that they maintain through the duration of their training. The continuity clinics consist of one half day per week at each location, with approximately 6-7 follow up patients and 1-2 new patients.

Location: VCUHS Massey Cancer Center Dalton Oncology Clinic Hunter Holmes McGuire VA Medical Center

Length of Experience: All 3 years of fellowship

Educational Goals Gain experience, competence and independence in the outpatient evaluation, staging, prognosis, management, and

complications of patients with a wide variety of hematologic and oncologic disorders. Gain experience, competence and independence in the ordering, administration, monitoring, and identifying toxicities

of chemotherapy Gain experience, competence, and independence in the management of hematologic and oncologic emergencies in

the outpatient setting, including acute chemotherapy toxicities and reactions. Gain experience, competence, and independence in performing the procedures essential to the diagnosis and to the

delivery of care of acute hematologic and oncologic disorders, including bone marrow biopsy and aspiration; lumbar puncture with the intrathecal administration of chemotherapy; and the access and administration of chemotherapy via an Omaya reservoir.

Gain experience, competence, and independence in identifying, discussing, and arranging home care and hospice as they pertain to the patient with hematologic and oncologic disease.

Gain experience, competence and independence in the management pain and other symptoms in the outpatient setting.

Gain experience in communication with and the counseling of patients and families regarding their acute hematologic and oncologic medical conditions and in providing the necessary support and ancillary services to effectively meet their medical and psychosocial needs.

Gain experience, competence in effectively, truthfully, and compassionately discussing end of life issues with patients and their families.

Gain experience in the management of end-of-life issues, including advanced directives, resuscitation status, surrogate decision-making, and home/inpatient hospice resource utilization.

Gain experience and proficiency in identifying and understanding the specific barriers posed to patients who are underinsured and/or indigent.

Gain an appreciation of the value of continuity of care in cancer treatment Gain experience in effective communication with patients, caregivers, and other health care providers necessary to

effective co-management Gain experience and knowledge in the unique aspects of the role of and effective functioning as a subspecialty

outpatient consultant Gain experience and proficiency in the effective transferring/returning of subspecialty care back to the primary care

provider Obtaining efficiency in the outpatient setting, review literature critically, and to learn how to plan for and manage

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clinic days

Progressive Responsibilities by Fellow Year

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The first year fellow is expected to focus on primary medical knowledge, communication skill and procedural skill development. Medical knowledge acquisition should focus on the routine screening, diagnosis, natural history, staging, prognosis, and first-line management of the hematologic-oncologic conditions. Additionally, the first year fellow should focus on the pharmacologic mechanism of action, dosing considerations, and common toxicities of the medications being employed for the treatment of the hematologic-oncologic condition. Consult recommendations and care plans should be developed independently or in conjunction with attending physician and health care team but reviewed in full with the attending physician in advance of communication to the patient, family, and consulting providers. Initial counseling of the patient and family regarding the goals of care, the care plan, and chemotherapy counseling should be done with direct supervision of the attending physician or only after full review of the goals of care and care plan with the attending physician. (The PharmD may provide the direct supervision of chemotherapy counseling and consenting once the care plan has been established with the attending physician).

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The second year fellow is expected to refine their medical knowledge by focusing on an understanding of the underlying pathophysiology, the basis and use of molecular and genetic markers to refine prognostic determinations and treatment planning; and considerations/options in second-line and beyond. Consult recommendations and care plans should be developed independently with only moderate need for input from the attending physician though reviewed in full with the attending physician in advance of communication to the patient, family, and consulting providers. Initial counseling of the patient and family regarding the goals of care, the care plan, and chemotherapy counseling may be done independently but only after full review of the goals of care and care plan with the attending physician.

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The third year fellow is expected to demonstrate proficiency and independence. The third year fellow is expected to demonstrate full knowledge of the routine screening, diagnosis, natural history, staging, prognosis, and first-line management of the hematologic-oncologic conditions. They should demonstrate a proficient understanding of the underlying pathophysiology, the basis and use of molecular and genetic markers to refine prognostic determinations and treatment planning; and considerations/options in second-line and beyond. Consult recommendations and care plans should be developed independently with minimal input from the attending physician though still reviewed with the attending physician. Initial counseling of the patient and family regarding the goals of care, the care plan, and chemotherapy counseling should be done independently though reviewed with the attending physician.

Patient CareGoalFellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Please refer to overview of the fellowship curriculum for competencies/objectives for patient care.

Specifically, fellows will see patients in all of these clinic settings under the supervision of the appropriate subspecialty faculty member. Fellows will participate in the evaluation and management of acutely and chronically ill oncology outpatients in order to learn the different approaches to subspecialty cancer treatment.

Competencies Fellows are expected to:

• Gather appropriate clinical information• Synthesize information into a care plan• Partner with patients/families in the implementation of the plan• Coordinate care plans with referring physicians, social workers, and home health agencies

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ObjectivesFellows are expected to:

• Develop skills in history/physical examination of the patient with cancer• Develop skills as an outpatient subspecialty consultant• Integrate clinical data in the formation of a comprehensive care plan• Document the encounter in the medical record in sufficient detail to communicate to other physicians and meet

billing requirements• Provide compassionate, appropriate, and comprehensive patient care through:

o Responding to requests for outpatient consultation, evaluation and/or management in a timely and appropriate fashion,

o Providing appropriate follow-up management

Medical KnowledgeGoalFellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.

CompetenciesFellows are expected to demonstrate skills in:

Acquisition of knowledge Analysis of information Application of knowledge

ObjectivesAll fellows are expected to:

Demonstrate the ability to perform a comprehensive and accurate physical examination; demonstrate the ability to arrive at an appropriate differential diagnosis; outline a logical plan for specific and targeted investigations pertaining to the patient’s complaints; and formulate a plan for management and follow-up treatment of the patient

Demonstrate their knowledge by presenting the results of a consultation orally and in writing and by defending the clinical assessment, differential diagnosis, and diagnostic and management plans

First year fellows are expected to:ONCOLOGYThoracic Oncology

Demonstrate knowledge of the epidemiology of thoracic cancers including incidence rates and mortality rates Demonstrate knowledge of non-small cell histology and natural history including adenocarcinoma, bronchoalveolar,

squamous cell, and large-cell carcinoma Demonstrate knowledge of small cell histology and natural history Understand the risk factors for lung cancer including lifestyle, active and passive smoking, asbestos and radon

exposure Understand prevention of lung cancer through smoking cessation Demonstrate knowledge of clinical signs and symptoms of lung cancer including cough, weight loss, dyspnea,

hemoptysis, pleuritic pain Demonstrate knowledge of diagnosis via sputum cytology, imaging, CT guided biopsy, thoracotomy, bronchoscopy Demonstrate knowledge of staging and prognostic factors of non-small cell lung cancer (NSCLC) via the TNM system

and small cell lung cancer via the TNM system and/or limited vs. extensive disease Demonstrate knowledge of the treatment of non-small cell lung cancer based on stage of NSCLC including:

neoadjuvant chemotherapy followed by surgery, surgery, surgery followed by adjuvant chemotherapy for early stage disease (stage I, II, III, N0-1), combined chemotherapy and radiation therapy and/or surgery for Stage IIIA and IIIB disease, and systemic therapy for stage IV disease

Understand the first-line chemotherapy choices for advanced NSCLC

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Demonstrate knowledge of the treatment of limited stage small cell lung cancer with combined chemotherapy and radiation therapy, use of prophylactic brain irradiation, and indication for resection of solitary pulmonary nodule

Demonstrate knowledge of the treatment of first-line chemotherapy for extensive stage small cell lung cancer, use of prophylactic brain irradiation, and treatment of brain metastases

Demonstrate the knowledge of follow-up of Lung cancer according to ASCO and other guidelines Understand the importance of clinical trials in thoracic malignancies

Breast Oncology Demonstrate knowledge of the epidemiology of breast cancer including incidence rates and mortality rates Understand the histology and natural history of the subtypes of breast cancer Demonstrate an awareness of the genetic association of BRCA-1 and BRCA-2 as well as other genetic syndromes Demonstrate knowledge of screening with mammography, u/s, and MRI, breast self-exam and by a health care

provider Demonstrate knowledge of the diagnosis of breast cancer by fine-needle aspiration, core biopsy, excision, and needle

localization biopsy Understand the differences between the axillary node sampling via a complete dissection vs. a sentinel node

dissection Understand staging and prognostic factors including TNM system, histologic type, estrogen and progesterone

receptors, HER-2 neu, and other biologic and molecular markers Demonstrate knowledge of the treatment recommendations based on stage of lobular and ductal cancer including

but not limited to surgery, radiation, preoperative vs. post-operative chemotherapy, endocrine therapy, traztuzumab and other biologic therapy

Demonstrate an awareness of the use of Oncotype testing and/or Adjuvant online Demonstrate knowledge of therapy for metastatic breast cancer including: surgery, radiation therapy, or systemic

therapy with endocrine therapy vs. single agent chemotherapy vs. combination therapy +/- monoclonal antibody therapy

Demonstrate knowledge regarding follow-up of breast cancer based on ASCO and NCCN guidelines Discuss the benefits if supportive management of metastatic breast cancer using the bisphosphonates for bone

metastases Understand the importance of clinical trials in breast malignancies

Gastrointestinal Oncology Demonstrate knowledge of epidemiology and natural history of the GI cancers including esophageal, gastric,

colorectal, gallbladder, hepatocellular, and pancreatic cancers Discuss first-line therapies of the GI malignancies as they relate to disease stage Understand the importance of palliation of symptoms in patients with GI malignancies. Understand the importance of clinical trials in GI malignancies

Anal Cancer Demonstrate knowledge of the epidemiology and incidence rates and mortality rates of anal cancer Demonstrate knowledge of the histology of anal cancer including premalignant lesions and cloacogenic vs. squamous

histology Demonstrate knowledge of the risk factors associated with anal cancer including HPV infection, sexual activity,

condyloma, HIV infection Demonstrate knowledge on diagnosis of anal cancer via physical examination, biopsy, anoscopy/proctoscopy,

transrectal ultrasound, FNA of palpable inguinal nodes Demonstrate knowledge of the TMN Staging System and the treatment based on stage including surgery for Stage I

disease, local disease or positive inguinal lymph nodes combined modality, recurrent residual disease with surgery, radiation, chemotherapy, and metastatic disease with chemotherapy.

Biliary Tree Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Demonstrate knowledge of the risk factors associated with biliary tree cancer including primary sclerosing cholangitis,

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gallstones, choledochalcysts Demonstrate knowledge related to the diagnosis including clinical signs and symptoms such as obstructive jaundice,

imaging, ERCP, and endoscopic biopsy Demonstrate knowledge of TMN Staging and histologic grade of the cancer and treatment by stage including surgery

+/- radiation therapy for resectable disease, liver transplant for unresectable disease, and chemotherapy via Intravenous or hepatic infusion +/- radiation therapy for advanced or recurrent disease

Colorectal Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Recall the genetic basis of Familial adenomatous polyps and hereditary nonpolyposis colorectal cancer. Understanding of risk factors such as family history, dietary factors, inflammatory bowel disease Demonstrate knowledge of screening of colorectal cancer with rectal examination, fecal occult blood test,

colonoscopy, virtual colonoscopy in both the general population and high-risk populations Demonstrate knowledge of the diagnosis including clinical signs and symptoms, imaging, and endoscopic biopsy Demonstrate knowledge of staging and prognostic factors based on TNM Staging system, histology and grade, and

genetic and molecular abnormalities Demonstrate knowledge of treatment by stage including: cancer in a polyp, surgery +/- chemotherapy in Stage II

colorectal cancer based on region and histology, surgery followed by chemotherapy in Stage III colorectal cancer, v adjuvant or neoadjuvant chemotherapy and radiation in local rectal cancer, and chemotherapy vs. surgery in metastatic or recurrent disease based on specifics of the disease locations and number of metastatic lesions

Esophageal Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Demonstrate knowledge of pathology including squamous cell, adenocarcinoma, and mixed histology Demonstrate knowledge of risk factors including Barrett's esophagus, gastroesophageal reflux disease, smoking and

alcohol use, genetic and molecular abnormalities Demonstrate knowledge of diagnosis of esophageal cancer including as clinical signs and symptoms such as

dysphagia, early satiety, and weight loss; endoscopy and biopsy, imaging Demonstrate knowledge of TNM staging and treatment of local-regional disease or recurrent and metastatic disease

with a multimodality approach which may include surgery, radiation therapy, and chemotherapy pending multidisciplinary approach

Gallbladder Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Demonstrate knowledge of the risk factors including inflammatory bowel disease, cholesterol type gallstones, and

chronic inflammation Demonstrate knowledge of clinical signs and symptoms of gallbladder cancer Demonstrate knowledge of imaging, surgery, bile cytology in making a diagnosis Demonstrate knowledge of the TMN staging system for gallbladder cancer Demonstrate knowledge of first-line treatment: T1/2 tumors surgery, T3/T$ surgery+/- chemotherapy +/- radiation

therapy Demonstrate knowledge of the first-line treatment of recurrent or metastatic disease with chemotherapy or radiation

therapy

Gastric Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Demonstrate knowledge of risk factors such as b12 deficiency/pernicious anemia, tobacco use, occupational

exposure, and H pylori infection and its association with gastric cancer Understand the role of screening with endoscopy for patients at risk for gastric cancer Understand the clinical signs and symptoms, imaging, and use of endoscopy with biopsy in diagnosing gastric cancer Demonstrate knowledge of the TMN staging of gastric cancer Demonstrate knowledge regarding treatment options for local gastric cancer including surgery, radiation therapy,

chemotherapy, laparoscopy, and combined modality treatment

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Demonstrate knowledge of the use of first-line chemotherapy +/- radiation therapy for unresectable and metastatic disease

Hepatocellular cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Demonstrate knowledge of the relationship of Hepatitis B, Hepatitis C, and cirrhosis to the development of HCC Demonstrate knowledge of the genetic relationship between hemochromatosis, Wilson's disease, alpha1-antitrypsin

deficiency and HCC Understand the environmental factors including but not limited to exposure to alcohol and alphatoxin and HCC Understand prevention of HCC with hepatitis B vaccines, alcohol and tobacco cessation Demonstrate clinical signs and symptoms of HCC including ascites, jaundice, confusion, pain, weight loss Demonstrate knowledge of imaging techniques used in diagnosis and staging of HCC including ultrasound, MRI, and

four phase CT scans of the liver Demonstrate knowledge of treatment of resectable disease with surgery +/- liver transplantation Demonstrate knowledge of treatment options for unresectable liver- only disease including ablative procedures,

chemoembolization, and systemic therapy Understand the role of sorafenib and traditional chemotherapy in treating multifocal liver cancer and metastatic

disease

Pancreatic Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rate of pancreatic cancer Understand risk factors associated with pancreatic cancer including tobacco use, pancreatitis, BRCA2, familial

pancreatic cancer, and MEN Demonstrate knowledge of the clinical signs and symptoms of pancreatic cancer including pain, jaundice, and weight

loss Understand the role of endoscopy, ERCP, biopsy, laparoscopy, imaging, imaging directed biopsy, and surgery in

diagnosing pancreatic cancer Demonstrate knowledge of treatment of resectable disease with a Whipple procedure, and combined modality

(surgery followed by chemotherapy +/- radiation therapy) pending clinical scenario Demonstrate knowledge of treatment of unresectable, locoregional disease with chemotherapy +/- radiation therapy Demonstrate knowledge of metastatic and recurrent disease with systemic chemotherapy including but not limited to

FOLFIRONOX vs. gemcitabine and the appropriate candidates for these chemotherapy regimens

Prostate cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Understand genetic factors such as family history Understand the role of PSA screening and digital rectal exam in prostate cancer Understand the use of transrectal ultrasound in diagnosis of prostate cancer Understand the Gleason grading, TNM staging, and PSA use in prognosis Demonstrate knowledge of treatment of organ confined prostate cancer with observation, surgery, or radiation

therapy +/- neoadjuvant or adjuvant hormonal manipulation Demonstrate knowledge of treatment of metastatic prostate cancer with radiation therapy, hormonal therapy, or

chemotherapy, radiopharmaceuticals, biphosphonates, vaccines, and indications for each Understand the survival benefit of docetaxel and prednisone in metastatic prostate cancer Demonstrate knowledge of the FDA approved treatments of prostate cancer in including but not limited to Provenge,

carbazitaxel, abiraterone, and denosumab

Renal Cell Cancer Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Understand the diagnosis of renal cell cancer, signs and symptoms, and imaging techniques used for staging Understand the TNM staging system for renal cell cancer, histology, and prognostic factors Understand the treatment of local disease with nephrectomy, partial nephrectomy, RFA Understand the treatment of pulmonary metastatic disease with surgery

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Understand the treatment of metastatic disease with sunitinib, temsirolimus, everolimus, IL-2, interferon

Bladder and other Urothelial cancers Demonstrate knowledge of the epidemiology, incidence rates, and mortality rates Understand the relation of cigarette smoking, phenacetin, schistosomiasis infection Understand screening with urine cytology and imaging Understand TNM staging, tumor grading, localized vs invasive disease in terms of prognosis Demonstrate knowledge of treatment of superficial bladder cancer with resection +/- intravesical BCG Demonstrate knowledge of treatment of early stage and locally advanced disease with surgery, radiation therapy,

chemotherapy in the adjuvant and neoadjuvant setting, or combined modality treatment Demonstrate knowledge of treatment of recurrent disease Demonstrate knowledge of treatment of metastatic disease with chemotherapy Demonstrate knowledge of treatment options for metastatic disease with chemotherapy

Hematologic Malignancies Demonstrate an understanding of the diagnostic modalities used in differentiating hematologic malignancies such as

lymph node biopsy, bone marrow biopsy, flow cytometry, cytogenetics, and molecular diagnostics. Demonstrate an understanding of the importance of histologic grade in hematologic malignancies Demonstrate knowledge of staging and prognostic factors for lymphoma including the Ann Arbor Staging System and

the International Prognostic Index. Demonstrate knowledge of the first-line treatment of Non-Hodgkins lymphoma based on grade (low, intermediate vs.

high), as well as aggressive vs. indolent nature and stage of disease Demonstrate knowledge of the first-line treatment of Hodgkins lymphoma based on the stage of disease Demonstrate knowledge of the diagnosis of chronic leukemias based on peripheral blood smear review, PCR or FISH

for CML, and flow cytometry for CLL Demonstrate knowledge of the chronic, accelerated, and blast phase of CML Demonstrate knowledge of the RAI and Binet staging in CLL Demonstrate knowledge of first-line treatment of CML in chronic phase Demonstrate knowledge of treatment options based on stage of CLL including observation, purine analogues,

alkylating agents, and monoclonal antibody-therapies Demonstrate knowledge of the natural history, staging, prognosis, and therapeutic options for multiple myeloma. Discuss the options for initial induction therapy in the transplant-eligible patient Demonstrate knowledge of the first-line therapy for the non-transplant-eligible patient Understand the importance of clinical trials in hematologic malignancies

HEMATOLOGY Red Blood Cell Disorders: Anemia

Categorize anemia on the basis of production vs. post-production etiologies and discuss diagnostic use of laboratory findings such as the reticulocyte count for so classifying an anemia

Use a complete blood count with RBC indices to categorize the likely causes of anemia. Likewise, the trainee should understand what the RBC indices represent and what leads to their abnormality.

Interpret and recognize common morphologic variations of RBCs (on peripheral blood smear and bone marrow aspirate) and correlate these with their likely pathophysiological conditions.

Demonstrate a working knowledge and practical competency of the indications and interpretation of a bone marrow aspirate and biopsy in the evaluation of anemia.

Demonstrate a comprehensive working knowledge of the physiology of iron, vitamin B12 and folate utilization, storage and transport and determine the appropriate replacement therapy for nutritional deficiency anemia. This includes demonstrating the ability to calculate the magnitude of the deficit and the proper replacement regimen.

Demonstrate knowledge of the underlying causes, the pathophysiologic basis, the diagnostic criteria, differential diagnosis, and management of anemia of chronic disease.

Demonstrate a comprehensive working knowledge of the etiologies of autoantibody development. This includes an understanding of primary autoantibody production and autoantibodies that develop as sequelae of other diseases (secondary causes).

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Demonstrate a comprehensive working knowledge of the different mechanisms by which autoantibodies can lead to destruction of RBCs. This includes understanding how to distinguish between warm autoantibodies, cold autoantibodies, cryoglobulins and cold agglutinins in the etiology of hemolytic anemia.

Demonstrate practical competency for evaluating, diagnosing and recognizing the clinical sequelae of the hemolytic anemia. This should include demonstrating an understanding of the direct and indirect antiglobulin tests and of the methods used to identify and classify autoantibodies.

The Hematology trainee should demonstrate a comprehensive working knowledge of the pathophysiology of the different causes of MAHA. This should include demonstrating the ability to differentiate between thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), among others.

The Hematology trainee should demonstrate practical competency for diagnosing and managing TTP, HUS, disseminated intravascular coagulation (DIC) and the other MAHA.

Red Blood Cell Disorders: Erythrocytosis The Hematology trainee should demonstrate a working knowledge and practical competency of the diagnosis of

disorders that cause an increase in RBC number and/or mass. These include polycythemia rubra vera (see Section IV.C.2.) and secondary causes. The trainee should be able to differentiate between primary (polycythemia rubra vera) and secondary causes of erythrocytosis.

Discuss the use of low dose aspirin, hydroxyurea, and phlebotomy in the management of the patient with polycythemia vera.

The Hematology trainee should demonstrate a working knowledge of the physiology and role of erythropoietin in erythropoiesis and of the practical application and interpretation of measured erythropoietin levels. The trainee should be familiar with the American Society of Clinical Oncology (ASCO)/ASH evidence-based clinical practice guidelines for the use of erythropoietin in cancer patients.

White Blood Cell Disorders Demonstrate a comprehensive working knowledge and practical competency of the pathophysiologic mechanisms

that lead to generation of a differential diagnosis of granulocytopenia and understanding the diagnostic approach to identifying the etiology of granulocytopenia and agranulocytosis.

Demonstrate a comprehensive working knowledge of the risks associated with granulocytopenia along with an understanding of the indication and role of cytokines (e.g. G-CSF, GM-CSF) in management of patients with granulocytopenia and agranulocytosis.

Generate a differential diagnosis, develop a diagnostic approach to identifying the etiology, and describe the clinical consequences of both primary and secondary leukocytosis.

Platelet and Megakaryocyte Disorders Demonstrate the ability to identify and interpret the appropriate studies needed to diagnose von Willebrand’s

disease. Demonstrate a comprehensive working knowledge and practical competency of the differential diagnosis, approach

to diagnosis, and therapy of diseases that result in qualitative diminishment of platelets due to a decreased production of or an increased destruction of platelets.

Recall the International Consensus and ASH guidelines for the diagnosis and management of patients with immune thrombocytopenic purpura (ITP).

Assess the bleeding risk for a given level of thrombocytopenia. Generate an approach to diagnosis of the cause and management of thrombocytosis. Recognize the consequences associated with thrombocytosis that may range from bleeding to thrombosis. The Hematology trainee should demonstrate an understanding of the anti-platelet function drugs including

mechanism of actions, pharmacokinetics, toxicities, indications, dosages and interactions of all classes of anti-platelet drugs (i.e. aspirin, ticlopidine/clopidogrel, dipyridamole, GP IIb/IIIa inhibitors, etc).

Bone Marrow Failure States and Stem Cell Disorders Demonstrate the ability to provide a differential diagnosis and the acquisition of practical knowledge of the role of

medications, other drugs and environmental pathogens (including chemicals and infectious diseases) in the

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development of bone marrow failure states. An understanding of the approach to diagnosis and management of these disorders should be demonstrated.

Demonstrate a comprehensive working knowledge and practical competency of the diagnosis and therapy of aplastic anemia. An understanding of the indications and risks of various treatment approaches (including stem cell transplantation, anti-thymocyte globulin, cyclosporine, other immune mediators) should be demonstrated by the trainee.

Generate a differential diagnosis of and an approach to diagnosis of the etiology of pancytopenia. Recall the diagnostic criteria, differential, prognosis, and first-line management of the non-CML myeloproliferative

disorders.

Hemostasis Discuss the basic mechanisms and components of normal hemostasis and thrombosis. This should include a practical

knowledge of the function and interactions of procoagulant and anticoagulant proteins, cellular contributions and interactions between these components as well as with vascular endothelium.

Bleeding Disorders Discuss the classification of the different types of von Willebrand disease and recognize the clinical presentation,

diagnose and characterize the different types of von Willebrand disease. The Hematology trainee should have knowledge of the clinical implications of the different types of von Willebrand disease.

Demonstrate a working knowledge of the diagnosis and clinical presentation of hemophilia A and B and other inherited bleeding disorders of coagulation

Recall the role of vascular abnormalities in the etiology of specific bleeding disorders.

Thrombotic Disorders The Hematology trainee should demonstrate a working knowledge and practical competency of the differential

diagnosis of the inherited deficiencies that lead to an increased risk of thrombosis. Recall the methods for prophylaxis, diagnosis, and treatment of venous thrombosis, including the proper use of

anticoagulant therapies in both medical and surgical populations. Demonstrate a comprehensive working knowledge of the clinical presentation, pathogenic mechanism, diagnosis and

management of heparin-induced thrombocytopenia. The trainee should also demonstrate an understanding of the risk and consequences of thrombosis in these patients.

Demonstrate a working knowledge and practical competency for diagnosing and managing the manifestations of antiphospholipid syndrome.

Pharmacologic Manipulation of Bleeding and Thrombosis Demonstrate a practical competency with the use of the various classes of antithrombotics and anticoagulants that

are available including their mechanisms of action, indications, appropriate dosing, monitoring, means of reversal, and appropriate duration of therapy for various clinical situations.

Second and Third Year ObjectivesThe second and third year fellow is expected to refine and further develop a mastery of the first year objectives. Additional disease-specific objectives for the second and third year fellows are as follows with the expectation that by completion of the third year of training, the fellow will have achieved competence and independence in each of the following:

ONCOLOGY Thoracic Oncology

Demonstrate knowledge of the biology and molecular pathways of non-small cell biology Demonstrate knowledge of the biology and molecular pathways of small cell histology and biology Understand the first-line, second-line, and third line chemotherapy choices and the pharmacotherapy of the common

agents administered including but not limited to the platinums, taxanes, and antimetabolites Understand the use of biologic agents including but not limited to erlotinib, bevacizumab, and cextuximab in NSCLC

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Demonstrate knowledge of the treatment of extensive disease with first-line chemotherapy, second-line treatment, use of prophylactic brain irradiation, and treatment of brain metastases

Demonstrate the knowledge of follow-up of Lung cancer according to ASCO and other guidelines Demonstrate knowledge of treatment of Pancoast tumors Understand how to identify and manage complications of the treatment of thoracic cancers such as radiation

pneumonitis, infection, dyspnea, and neuropathy Understand the importance of palliation of symptoms including pain and dyspnea in patients with thoracic

malignancies. Understand the interventional options in patients with thoracic malignancies and pleural effusions for palliative

purposes such as pleurodesis and pleurovac devices Understand the rationale of the clinical trials in thoracic malignancies Recall and discuss the findings of chemoprevention studies in the thoracic malignancies

Breast Oncology Understand the pathogenesis, biology and molecular pathways of the various histologic subtypes of breast cancer and

the molecular basis for differences of triple negative breast cancer Understand the molecular basis of the genetic association of BRCA-1 and BRCA-2 as well as other genetic syndromes,

and recommendations for genetic counseling and testing Understand how to assess the risk of breast cancer in a patient based on family history, lifestyle factors, hormone

replacement therapy, and use the Gail and Claus models Demonstrate knowledge on the prevention of breast cancer including chemoprevention with tamoxifen and other

SERMS, prophylactic bilateral mastectomies, prophylactic bilateral oophorectomy Discuss the scientific data behind the recommendations for breast cancer screening with mammography, u/s, and

MRI, breast self-exam and by a health care provider Understand axillary dissection techniques including complete dissection vs. sentinel node dissection Understand the molecular basis for the differences among prognostic factors including histologic type, estrogen and

progesterone receptors, HER-2 neu, and other biologic and molecular markers Demonstrate knowledge on estimating the benefits of systemic adjuvant therapy utilizing Oncotype testing and/or

Adjuvant online Understand treatment of locally advanced and inflammatory breast cancer using multimodal therapy Understand the treatment of locally recurrent breast cancer in the breast or chest wall with surgery or radiation

therapy. Demonstrate knowledge of rationale for the therapy of metastatic breast cancer including: surgery, radiation therapy,

or systemic therapy with endocrine therapy vs. single agent chemotherapy vs. combination therapy +/- monoclonal antibody therapy

Demonstrate proficiency in the utilization and an understanding of the evidence for supportive care of breast cancer including: psychosocial issues and support groups, lymphedema, bisphosphonates for bone metastases, menopausal symptoms, sexuality and fertility, cognitive dysfunction, surgical reconstruction

Discuss the differences in biology, management, and prognostic implications of other special patient populations including male breast cancer, breast cancer in pregnancy, in elderly women, in very young women and recommendations for oophorectomy

Demonstrate knowledge of the pharmacology of the common chemotherapies used for the treatment of breast cancer including anthracyclines, traztuzumab, taxanes, cyclophosphamide

Understand how to identify and manage complications of the treatment of breast cancers including neuropathy Understand the importance of palliation of symptoms in patients with breast malignancies. Understand the scientific rationale of clinical trials in breast malignancies Recall and discuss the findings of chemoprevention studies in the breast malignancies

Gastrointestinal Oncology Demonstrate knowledge of biology, pathophysiology, and molecular pathways of the GI cancers including esophageal,

gastric, colorectal, gallbladder, hepatocellular, and pancreatic cancers Understandand discuss the scientific data supporting the treatment of GI malignancies as they relate to the disease

stage

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Understand how to identify and manage complications of the treatment of GI cancers such as pain, mucositis, infection, diarrhea

Understand and effectively utilize management options for the palliation of symptoms in patients with GI malignancies.

Understand the scientific rationale of ongoing clinical trials in GI malignancies Recall and discuss the findings of chemoprevention studies in the GI malignancies

Anal Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of anal cancer including

premalignant lesions and cloacogenic vs squamous histology Demonstrate knowledge of the literature for the treatment of anal cancer based on stage Demonstrate knowledge of supportive care of patients with anal cancer Demonstrate knowledge of follow-up of anal cancer

Biliary Tree Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of biliary tree cancer Demonstrate knowledge of the literature for treatment of biliary tree cancer based on the disease stage Demonstrate knowledge of supportive care including biliary drainage for biliary tree cancer Demonstrate knowledge of follow-up of anal cancer

Colorectal Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of colorectal cancer Demonstrate knowledge of the molecular basis for the genetics of colon cancer including such familial syndromes as

familial adenomatous polyps and hereditary nonpolyposis colorectal cancer. Discuss the data behind the recommendation for screening in colorectal cancer with rectal examination, fecal occult

blood test, colonoscopy, virtual colonoscopy in both the general population and high-risk populations Discuss the scientific data in the literature supporting the of treatment of colorectal cancer at the various stages Discuss second and third-line therapy options for advanced colorectal cancer Demonstrate knowledge of follow-up after curative resection based on ASCO and NCCN guidelines Demonstrate knowledge of supportive care of treatment-related toxicities such as ostomy care, radiation proctitis,

diarrhea, neuropathy

Esophageal Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of esophageal cancer Discuss the scientific data in the literature supporting the of treatment of esophageal cancer at the various stages Demonstrate knowledge of supportive care including management of obstruction with endoscopic stenting

Gallbladder Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of gallbladder cancer Discuss the scientific data in the literature supporting the of treatment of gallbladder cancer at the various stages Demonstrate knowledge of supportive care for gallbladder cancer including use of biliary drainage

Gastric Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of gastric cancer Demonstrate knowledge of the genetic and molecular factors involved in the development of gastric cancer including

precursor lesions, adenomatous and gastric polyps Understand the scientific data regarding screening with endoscopy for patients at risk for gastric cancer Demonstrate scientific data supporting the treatment options for local gastric cancer including surgery, radiation

therapy, chemotherapy, laparoscopy, and combined modality treatment Demonstrate knowledge of the use of the first-line and beyond chemotherapy +/- radiation therapy for unresectable

and metastatic disease

Hepatocellular cancer

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Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of hepatocellular cancer Demonstrate knowledge of the scientific literature regarding the screening of high risk patients with ultrasound and

alpha-fetoprotein Discuss the patient and disease characteristics used to determine eligibility for respectability of disease with surgery

+/- liver transplantation Demonstrate knowledge of technical aspects, relative indications/contraindications, benefits and risks of the

treatment options for unresectable liver- only disease including ablative procedures, chemoembolization, and systemic therapy

Understand the pharmacology and molecular basis for use of sorafenib and traditional chemotherapy in treating multifocal liver cancer and metastatic disease

Understand the role of supportive care for patients with HCC including therapeutic paracentesis

Pancreatic Cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of pancreatic cancer Demonstrate knowledge of the pathogenesis of pancreatic cancer including progression from ductal epithelial

dysplasia Demonstrate knowledge of patient selection criteria, the complications and the management of the complications of

surgical resection of pancreatic cancer via a Whipple procedure Demonstrate knowledge of the literature regarding the treatment of metastatic and recurrent disease with systemic

chemotherapy Demonstrate knowledge of follow up after curative resection Demonstrate knowledge of supportive care for pancreatic cancer including pain control with celiac block, biliary

stenting for obstruction, and treatment of malabsorption

Prostate cancer Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of prostate cancer Understand molecular basis of genetic factors associated with familial prostate cancer Demonstrate knowledge of the benefits and data on finasteride for chemoprevention Understand the literature data regarding the use of PSA screening and digital rectal exam in prostate cancer Demonstrate knowledge of literature comparing the various options of locoregional prostate cancer including the

comparative advantages and disadvantages of each therapeutic option. Understand the survival benefit of docetaxel and prednisone in metastatic prostate cancer Demonstrate knowledge of the pharmacology and literature data regarding the approved treatments of prostate

cancer in including but not limited to Provenge, carbazitaxel, abiraterone, and denosumab Demonstrate knowledge of supportive care for patients with prostate cancer including sexual dysfunction, hot

flushes, osteoporosis, proctitis, urinary incontinence

Renal Cell Cancer Demonstrate knowledge of biology, pathophysiology, and molecular pathways of renal cell cancer Understand molecular basis for the genetic factors including Von Hippel-Lindau and Li-Fraumini associated with renal

cell cancer Understand the pharmacology of the treatments for metastatic disease including but not limited to sunitinib,

temsirolimus, everolimus, IL-2, interferon

Bladder and other Urothelial cancers Demonstrate knowledge of the biology, pathophysiology, and molecular pathways of bladder and urothelial cancers Demonstrate knowledge of pharmacology for the therapies used in bladder and urothelial cancers Understand survellance of urothelial cancers with cystoscopy, urine cytology, and imaging

Hematologic Malignancies Demonstrate the knowledge of the WHO classifications of Hematologic malignancies Demonstrate knowledge of the genetic and molecular basis for the development of the hematologic malignancies Discuss the role of infectious agents in the development of hematologic malignancies

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Discuss the molecular and genetic factors in the context of their prognostic impact and therapeutic impact in the management of hematologic malignancies

Demonstrate knowledge of the treatment of relapsed/refractory Non-Hodgkins lymphoma based on grade (low, intermediate vs. high), as well as aggressive vs. indolent nature and stage of disease

Demonstrate knowledge of the treatment of relapsed/refractory Hodgkins lymphoma based on the stage of disease Demonstrate knowledge of referral for stem cell transplant in relapsed or refractory lymphomas Demonstrate knowledge of the treatment of CML including chemotherapy, tyrosine kinase inhibitors, interferon,

treatment of blast phase, and the role of stem cell transplantation with resistance to first-line therapy, in accelerated phase, and in blast crisis

Demonstrate knowledge of pharmacology of the therapies for CML including chemotherapy, tyrosine kinase inhibitors and interferon, including their common adverse effects, molecular basis of resistance

Demonstrate knowledge of treatment options based on stage of CLL including refractory to purine-based therapies Demonstrate knowledge of hypogammoglobinemia, infection risk, and autoimmune hemolytic anemia and

thrombocytopenia in CLL Demonstrate knowledge of follow up and continued treatment of the acute leukemias after discharge from the

inpatient setting, including maintenance therapy in APL and ALL Demonstrate knowledge of the biology, pathophysiology, and molecular pathways for multiple myeloma. Discuss the role of stem cell transplantation and the timing of utilization in multiple myeloma including the role of

maintenance therapy following stem cell transplantation Discuss the therapeutic options for relapsed/refractory multiple myeloma in the patient status post autologous stem

cell transplantation Discuss the therapeutic options for relapsed/refractory multiple myeloma in the non-transplant-eligible patient Demonstrate knowledge of the use of supportive therapies for bony disease including neuororadiologic interventions,

radiation therapy, radioactive biologics, medical pain management, and bisphosphonates. Understand supportive care related to treatment of hematologic malignancies including fertility and sexuality issues,

development of secondary malignancy due to prior chemotherapy +/- radiation exposure, and long term cardiac complications

Understand the scientific rationale of clinical trials in hematologic malignancies

HEMATOLOGY Red Blood Cell Disorders: Anemias

Demonstrate a comprehensive working knowledge and practical competency of the basic molecular and pathophysiologic mechanisms, diagnosis and therapy of anemia.

Interpret and recognize morphologic variations of RBCs (on peripheral blood smear and bone marrow aspirate) and correlate these with their likely pathophysiological conditions.

Demonstrate a comprehensive working knowledge and practical competency of the underlying causes, diagnosis and management of red cell aplasia and hypoplasia inclusive of understanding the direct toxicity to the bone marrow of infectious diseases, toxins and metabolic insults and the role and use of immunologic modifier therapy (e.g. antithymocyte globulin, cyclosporine, glucocorticoids) and stem cell transplantation.

Demonstrate a comprehensive working knowledge and practical competency in the genetics, pathophysiology, diagnosis pathophysiology, diagnosis (including interpretation of a bone marrow aspirate iron stain), and management of the sideroblastic anemias.

Demonstrate a comprehensive working knowledge of the genetics and pre-natal diagnosis of the thalassemias; the ability to make a diagnosis of thalassemia with the ability to distinguish between the different “types” of thalassemia (i.e. , , major, minor, etc.); and the ability to manage the various types of thalassemia along with their clinical sequelae (iron overload, skeletal abnormalities and organomegalies).

Demonstrate a comprehensive working knowledge of the genetics and physical properties of hemoglobin S. The trainee should be capable of establishing the diagnosis of sickle cell disease and the variant sickle cell syndromes (e.g. S/Thalassemia, SC disease, etc.) along with the recognition, diagnosis, and management of their clinical sequelae (especially the life-threatening aspects, such as pain, acute chest syndrome, hemolytic and aplastic crises, risk of infections, sickle cell lung disease, and strokes)

Demonstrate a comprehensive working knowledge and practical competency for the role and use of fetal hemoglobin synthesis stimulators (e.g. hydroxyurea, butyrate), transfusion therapy, and stem cell transplantation in the

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management of sickle cell disease. Demonstrate practical competency in managing autoimmune hemolytic anemia. This should include demonstrating

the ability to recognize indications for treatment, the use of glucocorticoids, IVIg, immunosuppressives, and RBC transfusions. In addition, the trainee should demonstrate the ability to recognize and manage the sequelae of autoimmune hemolytic anemia.

The Hematology trainee should demonstrate a comprehensive working knowledge of RBC metabolic deficiencies that lead to hemolysis. This includes an understanding of deficiencies of glucose-6-phosphate-dehydrogenase (G6PD) and pyruvate kinase (PK), among others, and the conditions that aggravate these deficiencies. The trainee should demonstrate an understanding of the biochemical pathways affected by these enzyme deficiencies.

The Hematology trainee should demonstrate practical competency in diagnosing and managing the metabolic enzyme deficiency hemolytic anemias.

The Hematology trainee should demonstrate a comprehensive working knowledge and practical competency for the pathophysiology, diagnosis and management of PNH and its associated complications.

The Hematology trainee should demonstrate a comprehensive working knowledge of the relationship between structure and function of the RBC membrane and how mutations in the different membrane components lead to hemolytic syndromes.

The Hematology trainee should demonstrate practical competency for differentiating between these disorders, recognizing microscopic morphologic presentations of these disorders, managing these different disorders and their associated clinical sequelae, and counseling patients about their disease and associated complications.

The Hematology trainee should demonstrate a working knowledge and practical competency of the pathophysiology, diagnosis and management of a variety of other acquired etiologies of hemolytic anemia. These etiologies should include physical (traumatic) fragmentation, infectious diseases, chemicals and toxins, physical agents (e.g. burns), and the impact of disorders of other organ systems.

Red Blood Cell Disorders: Erythrocytosis The Hematology trainee should demonstrate a working knowledge and practical competency of the basic molecular

and pathophysiologic mechanisms of disorders that cause an increase in RBC number and/or mass. These include polycythemia rubra vera (see Section IV.C.2.) and secondary causes.

Discuss therapeutic options beyond hydroxyurea for the treatment of polycythemia vera

Red Blood Cell Disorders: Hemochromatosis The Hematology trainee should demonstrate a comprehensive working knowledge of the basic molecular and

pathophysiologic mechanisms that lead to the development of hemochromatosis. This should include identifying risk factors and the common genetic mutations that are associated with an increased risk of a person developing hemochromatosis.

The Hematology trainee should demonstrate practical competency for recognizing the presentation and making the diagnosis of hemochromatosis. This should include the ability to use and interpret molecular diagnosis assays, including those that identify the C282Y and H63D mutations of the hemochromatosis gene (HFE).

The Hematology trainee should demonstrate the ability to recognize the clinical sequelae and complications of hemochromatosis on systemic organ systems.

The Hematology trainee should demonstrate practical competency for managing patients with hemochromatosis. This should include understanding the indications for the initiation and choice of therapy and the expected outcome and toxicities of phlebotomy and iron chelation therapies.

White Blood Cell Disorders Demonstrate a comprehensive working knowledge and practical competency of the basic pathophysiologic

mechanisms, diagnosis and therapy of qualitative granulocyte dysfunction disorders, including enzyme deficiencies, enzyme storage disorders, Chediak Higashi syndrome, chronic granulomatous disease and leukocyte adhesion deficiency. In order to accomplish this understanding of granulocyte disorders, a basic understanding of normal white blood cell development, differentiation, migration and trafficking should be acquired by the trainee.

Discuss normal B and T lymphocyte differentiation and development and demonstrate a basic understanding of the genetics and pathophysiological mechanisms of B and T lymphocyte functional and numerical deficiencies

Demonstrate a comprehensive working knowledge and practical competency of recognizing, diagnosing and

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managing specific diseases that consist of lymphocyte dysfunction, including common variable immunodeficiency, severe combined immunodeficiency, adenosine deaminase deficiency, Wiskott-Aldrich syndrome, ataxia-telangiectasia, DiGeorge anomaly, selective immunoglobulin deficiencies, Omenn syndrome, reticular dysgenesis and others.

Demonstrate a working knowledge and a practical competency of the basic molecular and pathophysiologic mechanisms that can lead to leukocytosis (e.g. neutrophilia, lymphocytosis, hypereosinophilia).

Demonstrate a working knowledge and practical competency of the indications and approaches for interfering with increased white blood cell production by pharmacologic agents, biologic agents, and mechanical methods (i.e. leukopheresis) to transiently decrease the elevated leukocyte number. The indications, pharmacologic agents, and dosages and toxicities of these agents and approaches should be understood.

Platelet and Megakaryocyte Disorders Demonstrate an understanding of the pathophysiologic mechanisms, the ability to identify and interpret the

appropriate studies needed to diagnose, and the ability to manage the various inherited disorders of platelet phase hemostasis, including von Willebrand’s disease, Bernard-Soulier syndrome, platelet collagen receptor deficiency, Glanzmann thrombasthenia gray platelet syndrome, dense granule deficiency, primary secretion defects and platelet procoagulant activity disorders.

Demonstrate a working knowledge of the technical aspects of performing and interpreting platelet aggregation assays and platelet antigen identification assays.

Demonstrate a working knowledge and practical competency of the basic pathophysiologic mechanisms, diagnosis and therapy of acquired platelet function disorders.

Demonstrate a comprehensive working knowledge and practical competency of the differential diagnosis, basic molecular and pathophysiologic mechanisms, approach to diagnosis, and therapy of diseases that result in qualitative diminishment of platelets due to a decreased production of or an increased destruction of platelets.

Demonstrate a comprehensive working knowledge and practical competency of the basic molecular and pathophysiologic mechanisms that lead to primary and secondary thrombocytosis

Discuss management of essential thrombocythemia beyond the use of hydroxurea. Assess the associated risks of thrombocytosis to individual patients with essential thrombocythemia and

polycythemia vera.

Bone Marrow Failure States and Stem Cell Disorders List and describe the clinical characteristics of the inherited and congenital forms of bone marrow failure states. The

trainee should demonstrate a basic working knowledge and practical competency of diagnosing and managing these disorders.

Discuss the pathophysiologic basis for the development of aplastic anemia and the therapies employed for the treatment of the disease.

Discuss the pathophysiology of the non-CML myeloproliferative disorders and the implications for targeted therapies.

Hemostasis: Bleeding Disorders Demonstrate a comprehensive working knowledge and practical competency of the basic molecular and

pathophysiologic mechanisms of genetic and acquired causes of disorders of hemostasis. Demonstrate an understanding of the molecular and pathophysiologic abnormalities associated with the different

types of von Willebrand disease/ Demonstrate a practical competency in the treatment of the various subtypes of von Willebrand disorders. Demonstrate a working knowledge of the management of hemophilia A and B, and other inherited factor deficiency

states in the acute bleeding and procedure prophylaxis settings Recall the role of vascular abnormalities in the etiology of specific bleeding disorders.

Thrombotic Disorders Discuss the indication, approaches to and limitations of genetic testing to assess risk factors for thrombosis. Demonstrate a comprehensive working knowledge of the clinical presentation, pathogenic mechanism, diagnosis and

management of heparin-induced thrombocytopenia. The trainee should also demonstrate an understanding of the risk and consequences of thrombosis in these patients.

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Demonstrate a comprehensive working knowledge and practical competency for diagnosing and managing the manifestations of antiphospholipid syndrome. This should include a comprehensive working knowledge of the different antibodies that can be assayed and used in the diagnosis of this syndrome and a practical competency for the use of prophylaxis for those patients at risk of thrombosis. The trainee should also demonstrate practical competency for recognizing and managing the clinical manifestations associated with antiphospholipid syndrome, including the implications and risks associated with pregnancy and surgery.

Pharmacologic Manipulation of Bleeding and Thrombosis Demonstrate practical competency with various factor replacement products, inhibitor “bypass” products,

antifibrinolytic agents, and the role of blood products for the management of bleeding disorders. The trainee should demonstrate a general understanding of the pharmacology dosing and administration of these agents as well as of their toxicity and potential interactions with other medications and factors.

Practice- Based Learning and ImprovementGoalFellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.

Please refer to overview of the fellowship curriculum for competencies/objectives for practice based learning and improvement.

Systems Based PracticeGoalFellows 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.

Please refer to overview of the fellowship curriculum for competencies/objectives for systems based practice.

ProfessionalismGoalFellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Please refer to overview of the fellowship curriculum for competencies/objectives for professionalism.

Interpersonal and Communication SkillsGoalFellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.

Effectively discusses and teaches patient and family about their hematological/oncological condition, results of tests, choices, and goals of treatment, Effectively, honestly and compassionately tells bad news and helps patient and family clarify goals; facilitate family meetings, explain advance directives and establish code status. Provide courteous, professional and timely consultation and work effectively with consultants. Communicate effectively, courteously, and professionally with nursing and clinic staff and peers.

Please refer to overview of the fellowship curriculum for competencies/objectives for interpersonal and communication skills.

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Teaching Methods Clinical teaching Role modeling Patient care/clinical experience Didactic sessions (division, department, institution) Performance feedback Self-directed learning Pre-clinic conference and in depth discussion of each patient Nurse Partner mentoring in chemotherapy administration, psychosocial aspects of patient care, interpersonal skill

sets. Oncology Pharm D teaches short didactics on new chemotherapy and supportive medications, assists in teaching

fellows to write orders one-on-one. Oncology Social Worker provides mentoring in psychosocial and socioeconomic issues.

Assessment of Fellow Performance Quarterly evaluation by the attending of the fellow Annual 360 assessment by the nursing staff and clinic patients of the fellow

Assessment of Rotation Quarterly evaluation by the fellow of the attending Annual program review Discussions with fellows during biannual review Review in-service and ABIM exam results

Level of SupervisionThe level of supervision of the fellows in the continuity clinics is indirect supervision with direct supervision immediately available by adult trained hematologists/oncologists

Throughout the week when not in clinic, the attending faculty are available for questions, problems, etc.

Educational Resources Devita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology (9th Edition) Hoffman Hematology: Basic Principles and Practice (4th Edition) UpToDate ASCO University ASCO Practice and Guidelines ASCO-SEP ASH-SEP NCCN Guidelines (www.nccn.org) NCI Common Cancer Types and Clinical Trails by Cancer Type/Disease (www.cancer.gov ) The AJCC 7th edition TMN staging of Cancer Common Toxicity Criteria v4.0 (aka Common Terminology Criteria for Adverse Events) GAIL model Claus model Adjuvant! Online

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