Hematology/Oncology
INTERNAL MEDICINE RESIDENCY PROGRAM
Faculty: Sohail Chaudhry, MD; Naveen Manchanda, MD; Gary Schultz, MD; Ronnie Luyun, MD
Sites: Christie Clinic, Provena Covenant Medical Center , Carle Clinic Association, Carle Foundation Hospital
Duration: Block Rotation PGY2 or PGY 3
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DESCRIPTION
Block rotation under the supervision of Dr. Sohail Chaudhry in the direct experience in progressive responsibility for treatment and competent care management of patients with hematological and oncological disorders.
Other Hematology/Oncology training occurs during core conferences and Grand Rounds; Quality Review; and Journal Club.
I. GOALS
Demonstrate attitudes, skills and knowledge for diagnosis, treatment and competent care management of patients with hematologic and oncologic disorders.
II. OBJECTIVES
A. PATIENT CARE
Objective 1: Demonstrate clinical skills of comprehensive medical interview, history and physical examination in the ambulatory setting and the hospital bedside, including functional assessment and mental status as needed.
Objective 2: Demonstrate clinical skills in the diagnosis and medical management of hematologic and oncologic disease. Generate a differential diagnosis and problem list in accepted format.
Objective 3: Describe and demonstrate ability to outline an outpatient and home care plan, and palliative support care plan as need.
Objective 3: Perform and record procedures
a. Perform and demonstrate competence in common diagnostic and/or therapeutic procedures.
- Bone marrow aspiration and core biopsy
- Fine needle aspiration
- Thoracentesis
- Paracentesis
- Central line placement
b. Demonstrate ability to interpret bone marrow slides and peripheral blood films.
B . MEDICAL KNOWLEDGE
Objective 1: Identify and appropriately manage common oncologic emergencies, and complications of treatment
a. Fever
b. Pancytopenia
c. Bleeding
d. Hypercalcemia
e. Superior vena cava obstruction
f. Spinal cord compression
g. Brain Metastasis
Objective 2: Discuss diagnostic criteria, potential therapy plans, and potential completion of the following:
Hematology
a. Anemia of the following causes:
• Nutrient deficiency
• Anemia of chronic disease
• Drug-induced
• Hemolysis, e.g., immunologic, toxic, enzyme deficiency, membrane abnormalities, paroxysmal nocturnal hemoglobinuria
• Hemoglobinopathies
b. Polycythemia vera
c. Erythrocytosis, physiologic and secondary
d. Coagulation deficiency states
• Thrombocytopenia due to idiopathic, drugs or chemicals, alcohol, or infections
• Therapeutic anticoagulation
• Deficiency of coagulation factors due to hereditary, nutrition, malabsorption, or liver failure
• Hypercoagulable states
• Thrombocytosis, mild
• Neutropenia, mild
• Leukocytosis, mild
• Hemochromatosis
• Transfusion reactions and complications
• Rh incompatibility
• Disorders of spleen (rupture, infarct, hypersplenism, splenomegaly)
• Mononucleosis
• Marrow replacement - myelophthisis
• Consumption coagulopathy, mild
• Hematolytic malignancy
- Acute leukemias
- Hodgkin disease
- Indolent lymphoma
- Aggressive lymphoma
- Myeloproliferative syndromes
- Myelodysplastic syndromes
- Myeloma
e. Bone marrow failure
f. Idiopathic sideroblastic, refractory anemia
g. Functional disorders of platelets, e.g. problems in adhesion, aggregation, and facto release
h. Fibrinolytic states, i.e., spontaneous and therapeutic
i. Consumption coagulopathy, severe
j. Major bleeding due to circulating anticoagulants
k. Porphyria
l. Dysproteinemias
m. Coagulation factor antibodies
n. Disorders or reticuloendothelial system (histiocytosis, eosinophilic granuloma)
o. Thrombotic thrombocytopenic purpura
p. Idiopathic thrombocytopenic purpura
q. Neutropenia, severe
Oncology
a. Primary carcinomas
• Breast
• Colon and rectum
• Lung
• Esophagus, stomach, and small bowel
• Uterine endometrium, uterine cervis, and ovary
• Testicle
• Skin
• Brain and spinal cord
• Pancreas and gall bladder
• Liver
• Kidney
• Bladder
• Oral-pharyngeal
• Nose and paranasal sinuses
• Larynx
• Salivary gland
• Thyroid gland
• Mesothelioma
b. Secondary carcinomas
• Lung
• Liver
• Brain
• Lymph nodes
• Pleura
• Peritoneum
• Adrenals
• Bone
• Pericardium
• Eye
c. Primary sarcomas
• Leiomyosarcoma
• Osteosarcoma
• Chondrosarcoma
• Kaposi
• Angiosarcoma
• Liposarcoma
• Rhabdomyosarcoma
• Fibrosarcoma
• Malignant fibrous histiocytoma
• Malignant schwannoma
• Synovial sarcoma
• Malignant mesenchymoma
- Melanoma and other neural crest malignancies
- Multiple myeloma
- Malignancies of the eye
Objective 2: Describe and evaluate a pharmacotherapeutic approach which includes definition of therapeutic objectives and options, selection of dose and parameters to be monitored, and measurement of therapeutic response and outcome.
Objective 3: Assimilate knowledge of patient condition to recognize when consultation is indicated
C. PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 1: Demonstrate evidenced based practice through appraisal and assimilation of scientific information, e.g. scientific journals, related to patient care
Objective 2: Demonstrate ability in medical decision making, which incorporates medical assessment and patient values and preferences.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Create an atmosphere of positive regard for the patient and family to promote the best medical outcome through accessibility, affability and continuity.
Objective 2: Incorporate psychosocial and ethical concerns of the patient and family in the development of the care management plan.
Objective 3: Dictate timely, comprehensive patient care notes, including admission and discharge summaries, and write thorough, succinct daily progress notes in accepted format.
E. PROFESSIONALISM
Objective 1: Demonstrate compassionate use of medical skills for patients. This includes high-quality care and technology and, in the event of terminal illness, an awareness of the limits of medical intervention and the obligation to provide humane care.
Objective 2: Recognize the legal requirements of advanced directives and describe the process of assessing a patient's advance directives, including the patient's perspective.
Objective 3: Model appropriate professional attitudes and behaviors of time management and punctuality, reliability, peer support, objective peer evaluation, community teaching, and ethical behavior.
F. SYSTEM-BASED PRACTICE
Objective 1: Recognize financial issues of heath care, with emphasis on understanding acute and chronic care, and medication coverage and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.
Objective 2: Actively participate in the multidisciplinary approach to caring for patients, including appropriate recognition of other health professional and paraprofessionals' roles and demonstrate competence in team interactions, i.e. pharmacist, physician's assistant, advanced practice nurse, nurses, occupational and physical therapist, social worker.
III. METHODS
The hematology/oncology rotation is a four-week experience supervised by faculty members of the University Of Illinois College Of Medicine at Urbana-Champaign, Department of Internal Medicine. All faculty members are certified by the American Board of Internal Medicine.
The rotation includes four weeks of meaningful patient responsibility in ambulatory and hospital settings. Residents work in the Christie Clinic Department of Hematology/Oncology and Provena Covenant Medical Center; and the Carle Clinic Association Department of Hematology/Oncology, and Carle Foundation Hospital.
Patient care responsibilities extend from Monday through Friday, 0730 to 1700. A sample schedule is attached. Responsibilities include daily inpatient management rounds and may include weekends and holidays, excluding the weekly day off. On-call responsibilities are not scheduled. Work hours are followed in strict accordance of ACGME requirements.
The resident works under the direct supervision of an assigned attending oncologist. The resident performs the initial history and physical examination, and presents the findings and available laboratory data to the attending. After reviewing patient data and pertinent teaching points, the resident and attending complete the patient encounter together. Selected components of the examination may be repeated and demonstrated to the resident. Residents are responsible for documenting the patient encounter with a written or dictated note.
The resident supervises the care of a small number of inpatients. Responsibilities include history, physical exam, management orders.
Residents evaluate all consultations requested for Hematology/Oncology in-patients. After evaluating each patient, the resident staffs the case with the appropriate attending .
Residents participate in the conferences conducted by the Hematology/Oncology division and weekly conferences of the Department of Internal Medicine.
The resident attends subspecialty teaching rounds at least 5 days per week.
| Mon | Tue | Wed | Thu | Fri | |
| 0730 | Subspec Rounds | Hem/Onc Teaching Rounds | Subspec Rounds | Subspec Rounds | Subspec Rounds |
| 0800 | Inpatient Rounds: Chaudhry | Inpatient Rounds: Chaudhry | N.Manchanda Carle | Inpatient Rounds: Chaudhry | Inpatient Rounds: Chaudhry |
| 0930 | Outpatient Clinic: Chaudhry | Outpatient Clinic: Chaudhry | N.Manchanda Carle | Outpatient Clinic: Chaudhry | Outpatient Clinic: Chaudhry |
| 1200 | Tumor Board Provena(1st & 3rd Wed) |
1230 Tumor Board Carle every Friday | |||
| 1330- 1700 | Outpatient Clinic & Consults: Chaudhry | Outpatient Clinic and Consults: Chaudhry | Radiation Oncology G.Shultz | Resident Conference | No clinic. Read, research & review slides |
This schedule is modified as needed to assure attendance of residents at continuity clinic, geriatrics rounds and required program conferences.
IV. EVALUATION
ACGME Competencies
According to Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice – Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by assessment of the attending physician. Procedures performed will be documented.
Medical Knowledge will be evaluated by assessment of the attending physician.
Practice-Based Learning and Improvement will be evaluated by assessment of the attending physician.
Interpersonal and Communication Skills will be evaluated by assessment of attending physician and additional information from nursing staff, patients and families.
Professionalism will be evaluated by assessment of attending physician and additional information from nursing staff, patients and families.
System-Based Practice will be evaluated by assessment of the attending physician.
The evaluation method is primarily accomplished electronically. Residents' performance is evaluated by the attending physician. Evaluations are reviewed with the residents for formal feedback. Face to face interaction between the attending physician and the resident is the required method. At the midway point of the rotation, the resident is encouraged to approach the attending to assess and discuss performance. In addition, ongoing feedback is provided related to residents' patient care responsibilities and activities.
Residents will document the Hematology/Oncology rotation in portfolios, e.g. patient care responsibilities. This tool will provide individual learning, reflection and assessment. Additionally, residents will evaluate the rotation experience.
Residents provide input on the Hematology/Oncology Medicine core lecture series, which is used in scheduling future topics and speakers. Conference lectures include: Acute Leukemia, Anemia, Bleeding Disorders, Breast Cancer, Colon Cancer, Gammopathies, Grand Rounds, Hemolytic Anemias, Hodgkin's Lymphoma, Lung Caner, Myelodysphasia, Non-Hodgkins Lymphoma, Oncological Emergencies, Pain Management, Cancer Prevention Guidelines, Prostate Cancer, Testicular Cancer, Thrombocytopenia, and Workup for the Hypercoagulable State. Periodically, residents are surveyed to evaluate the curriculum and teaching faculty.
V. REFERENCES
DeVito, Cancer Principles of Oncology, Lippincot
Hematology: Harrison's Principles of Internal Medicine, 1993
Williams, Textbook of Hematology, McGraw Hill
Specific articles will be suggested by the attendings based on patients seen during the rotation
Revised 8/8/05, 7/1/06, 7/1/07