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Fellowship & Curriculum Description
Summary | Fellowship Goals & Objectives | Fellowship & Curriculum Description |
Faculty | Annual Reports | Bibliography | Applicant Requirements | Application Process
Housestaff Information | Center Tour | about U of A | about Tucson & Arizona
Greg Gerstner, M.D.
Sang-Hoon Ahn, M.D.
Maria Bishop, M.D.
Lee Cranmer, M.D.
Shona Dougherty, M.D.
Daruka Mahadevan, M.D.
Steve Stratton, Ph.D.Contents:
-HISTORY
-HEMATOLOGY CURRICULM CONTENT
-MEDICAL ONCOLOGY CURRICULUM CONTENT
-TRAINING TOOLS
-CLINICAL ROTATION SUMMARY
-HEMATOLOGY & MEDICAL ONCOLOGY IN-PATIENT AND CONSULTATIVE SERVICE
-BONE MARROW/PSC TRANSPLANT AND ACUTE LEUKEMIA IN-PATIENT SERVICE
-VA IN-PATIENT CONSULTATIVE AND NEW OUT-PATIENT EVALUATION ROTATION
-BREAST AND GU CANCER OUT-PATIENT CLINIC ROTATION
-OTHER SOLID TUMOR ROTATION
-LYMPHOMA, BENIGN & MALIGNANT HEMATOLOGY OUT-PATIENT CLINIC ROTATION
-HEMATOLOGY & MEDICAL ONCOLOGY FELLOWSHIP CONTINUITY CLINICS
-HEMATOLOGY & MEDICAL ONCOLOGY FELLOWSHIP ELECTIVES
-HEMATOLOGY & MEDICAL ONCOLOGY FELLOWSHIP CONFERENCES
-HEMATOLOGY & MEDICAL ONCOLOGY FELLOWSHIP CORE LECTURE TOPICS
-HEMATOLOGY & MEDICAL ONCOLOGY FACULTY EXPECTATIONS OF FELLOWS
-HEMATOLOGY & MEDICAL ONCOLOGY FELLOW EVALUATION PROCESS
HISTORYThe Hematology and Medical Oncology Fellowship training program at the University of Arizona/Arizona Cancer Center accepted its first trainees in 1974 and through July 2006, 88 fellows have completed two and more years of training. When the training program was initiated, the majority of the training experience was accomplished by training experiences on hospitalized patients. Training was accomplished by having fellows spend much of their first two years covering in-patient internal medicine services at the University Medical Center and at the Affiliated Southern Arizona VA Health Care facility. Continuity out-patient clinics were attended by the fellows but the major emphasis was on in-patient consultation and care. A third year of training was devoted primarily to design and conduction of basic laboratory or clinical research projects.
During the 1980s and to the early to mid 1990s, Hematology and Medical Oncology as clinical specialties evolved and became primarily based in the out-patient setting. Out-patient care came to include the use of bone marrow and stem cell transplantation (BMT/SCT) and even included treating individuals with acute leukemia as much as possible in out-patient clinics. Time in clinics dramatically expanded and hospitalized patients were predominately those with treatment or disease related complications, those receiving some types f BMT/SCT or those receiving complicated parenteral treatment regimens. At the same time scientifically gathered information about hematologic and malignant diseases “exploded” as did the number of available effective treatments. In response to these changes, academic faculty members began to limit their clinical practices and expertise to only a single or a few disorders. Furthermore the business aspect of the practice of Hematology and Medical Oncology evolved with Managed Care Organizations and insurance companies prescribing guidelines to keep hospitalizations as brief as possible. Even hospice and terminal care support program became primarily an out patient endeavor.
At the University of Arizona/Arizona Cancer Center the Fellowship training program revised our curriculum in 1998. It was concluded that fellows needed more dedicated time periods to concentrate on specific disease groups. As a consequence clinical training rotations were revised. Fellows were assigned 4 months of in-patient based care each year and then spent one month long rotations in the out-patient setting centered on only a few disease types each month. For example fellows did month long rotations concentrating on genitourinary cancer versus respiratory and GI cancers versus breast cancer, versus melanoma, sarcoma and head and neck cancer, versus benign and malignant hematology. Other out-patient month long rotations included radiation oncology, palliative care and hospice, plus hematopathology, blood banking and coagulation. A further change in 1998 was to add a second continuity clinic to continue throughout a fellow’s entire training experience. And lastly, two year long core lecture series was initiated.
I. Basic Principles
- Basic Laboratory Concepts and Techniques
- Pharmacology
- Clinical Laboratory Techniques
- Transfusion Medicine
- Radiation Therapy
- Diagnostic Imaging
- Geriatrics
- Pediatrics
II. Hematopoietic System
- Normal Hematopoiesis
- Red Blood Cell Disorders
- Hemochromatosis
- White blood cell disorders
- Platelet and Megakaryocyte Disorders
- Bone Marrow Failure States
III. Hemostasis
- Normal Mechanisms of Hemostasis
- Bleeding Disorders
- Thrombotic Disorders
- Pharmacologic Manipulation of Bleeding and Thrombosis
IV. Hematologic Neoplastic Disorders
- Introduction
- Cancer Biology
- Chronic Myeloproliferative Diseases
- Acute Myeloid Leukemias
- Myelodysplastic Syndrome Disorders
- B-cell Neoplasms
- B-cell Proliferations of Uncertain Malignant Potential
- T-Cell and KN-cell Neoplasms
- Hodgkin’s Disease
- Histiocytic and Dendritic Cell Neoplasms
- Mastocytosis
- Complications of Hematologic Malignancies
- Paraneoplastic Disorders
V. Pregnancy
- Hematologic changes
- Impact of hematologic disorders on pregnancy
- Potential impact of therapies on a pregnancy
VI. Palliative Care
- Pain Management
- Nutrition
- Hospice/End of Life Care
VII. Bone Marrow Transplantation (BMT)/Stem Cell Transplantation (SCT)
- Biology of hematopoiesis and BMT/SCT
- Indication and role of BMT/SCT in management of hematologic diseases.
- Preparative regimens used in anticipation of BMT/SCT
- Method of collecting and handling BM and SC for transplant
- Process of performing a BMT/SCT.
- Need for prophylactic and supportive care in management of patients undergoing BMT/SCT
- Recognize, diagnosis, and management post transplant complications
VIII. Hematologic Manifestations of Infectious Diseases
- Human Immunodeficiency Virus
IX. Multidisciplinary Care
- Cooperative nature of health care team
- Role of multidisciplinary approach
X. Psychosocial Issues
- Recognition of potential psychosocial problems
- Impact of hematologic disorders on quality of life and relationships
- Effects of culture, ethnic and religious background on patient approaches and attitudes
- Develop attitudes and coping skills appropriate and necessary for critically ill patients
XI. Ethics
- Understanding of ethical issues facing patients and family
- Recognize and deal with ethical issues related to delivery of health care
- Recognize and deal with ethical issues related to relationships with pharmaceutical and other health care industry companies and their representatives
- Demonstrate practical comprehension of ethical conduct of clinical trials
XII. Clinical Investigation and Research Skills
- Knowledge of purpose, goals and characteristics of different phases of clinical trials
- Knowledge of biostatistics of permit interpretation of published medical literature
- Elements of proper clinical trial design
- Purpose and function of the Institution Review Board and other regulatory bodies
- Knowledge of purpose, content and design of informed consent documents
- Ability to management a patient on a clinical trial
- General working knowledge of what “translational research” is and how it is conducted.
- Participate in didactic training in the clinical trial process
- Ability to seek out the existence and details of available clinical trials at their institution and elsewhere
- Demonstrate a general working knowledge of where funding resources for research can be found
XIII. Consultation Skills
- Demonstrate skills to provide medical recommendations and care for a patient with a hematologic disorder
XIV. Procedural Skills
- Preparation and Interpretation of peripheral blood smears
- Preparation and interpretation of bone marrow aspirations and biopsies
- Measurement of lymph node and tumor mass sizes
- Administration of chemotherapy via CVAD and implanted CNS access devices
- Diagnostic LPs and Intrathecal administration of chemotherapy
- Management of indwelling CVADs
- Therapeutic phlebotomy
Medical Oncology Curriculum Content
I. Basic Scientific Principles
- Cancer Biology and Genetics
- Carcinogenesis
- Tumor Immunology
- Epidemiology of Cancer
II. Basic Principles in the Management and Treatment of Cancer
- General
- Pathology/Laboratory Medicine
- Radiology
- Surgical Oncology
- Radiation Oncology
- Chemotherapy
- Hormonal Therapy
- Biologic/Targeted Therapy
III. Clinical Research
- Design of Phase I, II, and III Trials
- Tumor Assessment
IV. Cancer Types and Sites
- Acute Leukemia and Myelodysplasia
- AIDS Related Malignancies
- Anal Cancer
- Biliary Tree Cancer
- Bladder and Other Urothelial Cancers
- Bone Sarcomas
- Breast Cancer
- Central Nervous System Malignancies
- Cervical Cancer
- Chronic Leukemias
- Colorectal Cancer
- Esophageal Cancer
- Gallbladder Cancer
- Gastric Cancer
- Germ Cell Tumors
- Hairy Cell Leukemia
- Head and Neck Cancers
- Hepatocellular Cancer
- Hodgkin’s Lymphoma
- Lung Cancer
- Melanoma
- Mesothelioma
- Multiple Myeloma and Plasma Cell Dyscrasias
- Neuroendocrine (Carcinoid Tumors)
- Non-Hodgkin’s Lymphoma
- Ovarian Cancer
- Pancreatic Cancer
- Penile Cancer
- Prostate Cancer
- Renal Cell Cancer
- Salavary Gland Tumors
- Soft Tissue Sarcomas
- Thymomas and Thymic Cancer
- Thyroid Cancer
- Unknown Primary Site
- Uterine (Endometrial) Cancer
- Vulvar and Vaginal Cancers
- Other Treatment Related Issues
V. Other Treatment Related Issues
- Oncologic Emergencies
- Paraneoplastic syndromes
- Stem Cell and Bone Marrow Transplantation
- Local Therapy of Metastatic Cancers
VI. Complications
- Infections
- Other complications of treatment
VII. Supportive Care
- Pain
- Treatment of Symptoms and Cancer Related Complications.
- Hematopoietic Growth Factors
- Transfusion Therapy and Apheresis
- Nutritional Support
- Sexual Problems and Fertility
- End of Life Care
- Complementary and Alternative Medicine
- Unproven Methods of Treatment
VIII. Survivorship
- Follow-up Care at end of treatment
- Prevention of second malignancies
- Special Populations
- Psychosocial Issues
- Employment and Insurance
- Information and Education
- Advocacy
IX. Psychosocial Aspects of Cancer
- Psychosocial Support
- Psychosocial Stages of Cancer
- Cultural Issues that Impact on the Management of Disease
- Spiritual Conflicts Associated with Cancer
- Adaptive and Maladaptive Behavior in Coping with Disease
- Acceptable Coping Mechanisms
- Indications and Uses of Psychotropic Drugs
- Physicians’ Personal Coping
- Integration of Care
X. Bioethics, Legal and Economic Issues
- Legal Requirements of Obtaining Informed Consent
- Research Ethics
- Legal Issues and Life Support and Withdrawal of Support
- Cost Effectiveness and Cancer Prevention and Treatment
- Conflict of Interest
- Professionalism
- Medical Humanism
XI. Communication Skills
- Communication along the disease trajectory
- Delivering bad news
- Cross Cultural Issues
- Multidisciplinary Teams
XII. Procedures
- Chemotherapy Administration
- Bone Marrow Aspiration, Biopsy, and Interpretation
- Ommaya Reservoir and Lumbar Puncture
- Tumor Assessment
- Thoracentesis
- Paracentesis
XIII. Information Systems in Oncology
- Patient Resources
- Health Care Professional Resources
- The World Wide Web
- ASCO on the Web
- Locating an Oncologist
- Locating Clinical Trials
XIV. Geriatric Oncology
- Unique Issues of Cancer and Aging
- Patient Assessment
- Psychosocial Implications of Cancer in the Elderly
In order to teach the curriculum content, the following toots are available here at the University of Arizona/Arizona Cancer Center:
A Multi-Disciplinary Faculty:
Hematology and Medical Oncology
Frederick R. Ahmann, M.D.
Linda Garland, M.D.
Daruka Mahadevan, M.D., PhD.
Dan Persky, M.D.
Leona Downey, M.D.
Michael Carroll, M.D.
Harinder Garewal, M.D.
Scot Ringenberg, M.D.
JoAnne Jeter, M.D.
Lee Cranmer, M.D., PhD.
Ana Maria Lopez, M.D.
Tom Miller, M.D.
Alison Stopeck, M.D.
Bob Livingston, M.D.
Evan Hersh, M.D.
Andrew Yeager, M.D.
Maria Bishop, M.D.
Sang-Hoon Ahn, M.D., MPHRadiation Oncology
Dino Stea, M.D.
Shona Dougherty, M.D.
Deirdre Cohen, M.D.Surgical Oncology
Hugo Villar, M.D.
Michael Demeure, M.D.
James Warneke, M.D.YN-Oncology
Setsuko Chambers, M.D.
Urology
Bruce Dalkin, M.D.
Mathew Gretzer, M.D.
Jonathan Walker, M.D.Dermatology
Clara Curiel, M.D.
Pathology
Ray Nagle, M.D., Ph.D.
Radiology
Steve Smyth, M.D.
Eric Outwater, M.D.
Joseph Seeger, M.D.Nuclear Medicine/PET Imaging
James Wolfendon, M.D.
Basic Sciences
Anne Cress, Ph.D.
Tim Bowden, M.D.
Tina Trevor, Ph.D.
Steve Stratton, Ph.D.Pharmacology and Clinical Pharmacy
Robert Dorr, Ph.D.
Statistics
James Ranger-Moore, Ph.D.
In Patient Teaching Services
- Hematology and Oncology
- Adult BMT/SCT and Acute Leukemia
- General Medicine
- Surgery
- Urology
- Orthopedics
- Neurosurgery
- Neurology
- Ob-GYN
- Pediatrics
- Surgical and Medicine Intensive Care
- Cardiac Unit
Pathology Support Services
- Immunopathology
- Histopathology
- Clinical Pathology
- Blood Banking
- Flow cytometry and cytogenetics
- Coagulation
Diagnostic Imaging Services
- Radiology
- CT Imaging
- MRI Imaging
- PET Imaging
- Nuclear Medicine
- Ultrasonography
- Interventional radiology
Out-Patient Oncology Clinics
- 36 exam rooms
- 3 procedures
- 6 consultation rooms
- 36 treatment chairs/beds
Mentors
- All fellows are assigned a mentor who can be changed as the interests of a specific fellow evolve.
Office space
- Each fellow is assigned a work carrel with a phone and computer access.
Core Lecture series
- A 24 month core lecture series exists which covers the topics described by ASCO and ASH guidelines.
Multi-disciplinary Teaching Conferences with Morbidity and Mortality summaries
- Breast Cancer
- GU Cancers
- GI Cancers
- Lymphoma and Leukemia
- CNS malignancies
- Melanoma
Journal Club
- A journal club is held monthly
Research
- Fellows have 3 to 8 months each year of their fellowship assigned for electives and research
- Each fellow conducting research has a mentor who evaluates the fellow’s activities and accomplishments.
- It is expected that the fellows will prepare both abstracts and research manuscripts as a result of their research.
After this major change, the curriculum came to be viewed by the faculty as a work in progress and several addition changes have been made as follows: In 2003 the adult BMT/SCT program expanded to four faculty positions and an in-patient teaching acute leukemia and adult BMT service was established. In 2004, the disease concentration rotations were grouped to make more effective use of the disease concentration rotations. As the end of each academic year, the fellowship committee meets and reviews the curriculum and recommends changes to the curriculum to continually attempt to maximize the training experience.
Description of Hematology and Medical Oncology
Fellowship Training RotationsIn summary, the current curriculum schedule is as follows:
Notes:
Required Electives: Palliative Care/Hospice, Radiation Oncology,
Hemato-Pathology/BloodBanking/CoagulationFor Fellows who are targeting an academic career, year 2 and year 3 clinical rotations may be switched to permit an earlier initiation of research projects.
Hematology & Medical Oncology In-Patient and Consultative Service
Goals of the Rotation :
- To learn about and become experienced in the in-patient management of patients with cancers of blood related disorders whose conditions require in-patient therapies or evaluations. In particular, patients who require the therapy with complex chemotherapy, chemo-biotherapy or biologic therapies are emphasized.
- To learn about and become experience in performing in-patient consultations for cancers or blood related disorders including educating other physicians/trainees concerning the condition that the consultation was for.
- To lean about and become experienced in the management of symptoms or complications of cancer or blood related disorders which require a patient to be hospitalized.
- To learn about and become experienced in the management of symptoms or complications that result from the therapy of cancers or blood related disorders which require a patient to be hospitalized.
- To become competent and proficient the following skills and procedures:
- Bone marrow aspiration, biopsy, preparation and interpretation
- Preparation and interpretation of blood smears
- Ordering of and administrating chemotherapy
- Ordering of and accomplishing therapeutic phlebotomy
- Ordering of an accomplishing apheresis
- Management of Central Venous Access Devices (CVADs)
- Lumbar puncture and the administration of intrathecal chemotherapy
- Ordering and administering chemotherapy thru CVADs or CNS access devices (Ommaya Reservoirs)
- Paracentesis
- Measuring tumor masses on physical examination or imaging studies- Learning about and become experienced in the management of immuo-compromised patients.
- Learning about and become experienced in correlating clinical information (including physical examination) with findings on pathologic (both clinical and anatomic) and imaging studies.
- To participate in the education of other physicians, staff and support personnel regarding topics relating to the care of patients with cancers or blood related disorders.
- To learn professional attitudes and behaviors in the interacting and communicating with patients, their families, and other health care professionals.
- To learn to become a patient’s advocate in their medical care and to help patients deal with psycho-social issues.
- To learn about and become experienced in supportive and hospice care as well as end of life issues in general.
Responsible Faculty
Frederick R. Ahmann, M.D. Lee Cranmer, M.D., PhD.
Linda Garland, M.D. Ana Maria Lopez, M.D.
Daruka Mahadevan, M.D., PhD. Tom Miller, M.D.
Dan Persky, M.D. Alison Stopeck, M.D.
Bob Livingston, M.D. Leona Downey, M.D.
JoAnne Jeter, M.D.Brief Description of the Rotation
There are five internal medicine in-patient teams at University Medical Center. The E-Service is the team staffed by one 2nd or 3rd year medicine resident, a first year medical resident, a hematology and medical oncology fellow and a hematology and medical oncology attending. All admissions to the team must have a primary hematologic or medical oncologic diagnosis and must either be admitted to the team by a hematology and medical oncology faculty member or must be accepted by the E-Service hematology and medical oncology attending physician. The team is “capped” at a maximum of 12 patients. Additional patients can be accepted onto the team but the resident will not be their care provider. The care will be provided by the attending and the fellow. Admissions are accepted between 8 a.m. and 4 p.m. Mondays through Fridays. Transfers from other teams can be accepted on weekend days between 8 a.m. and noon. The E-Service attending physician and he fellow are responsible for providing consultations to other hospital services seven days per week.
The details of the E-Service daily schedule are left to the specific team and may vary slightly based on other clinical responsibilities of team members. However, in general, morning rounds begin at 7:30 a.m. and afternoon rounds typically begin between 4 and 6 p.m. The Internal Medicine residents are each given one day off per week as is the fellow. The details of which day are left to the specific team but in general, the first year resident takes Saturday off and the 2nd/3rd year resident takes Sunday off. In general, the fellow takes Sunday off. When the fellow is off, the attending is responsible for providing consultative services. The on call internal medicine service is available to help cover E-Service patients during night and weekends but phone questions from nurses covering E-Service patients are taken by the E-Service fellow or attending physician as are phone questions relating to consultations provided to other services.
Residents are expected to attend morning report and attend their out-patient continuity clinic as well as attend as many internal medicine teaching conferences as the clinical responsibility permits. If the clinical responsibility permits, one resident each day may attend the out-patient Hematology and Medical Oncology clinics held at the UMC-North/Arizona Cancer Center out-patient facility at 3838 North Campbell Avenue. Such attendance will be approved and coordinated by the E-Service attending physician.
Fellows are expected to attend both of their weekly out-patient continuity clinics as well as attend the weekly core lectures. Attendance at other conferences is strongly encouraged unless clinical responsibility prohibits this.
Bone Marrows/PSC Transplant and Acute Leukemia In-Patient Service
Goals of the Rotation :
- To learn about and become experienced in the in-patient management of patients with leukemia or cancers or blood related disorders for which a bone marrow or stem cell transplant has been or is to be performed as part of the management plan.
- To learn and become experienced in the management of symptoms or complications of patients with leukemia or cancers or blood related disorders for which BM/SC transplant has been performed and which requires a patient to be hospitalized.
- To become experienced and competent in the performance of the following skills
and procedures:
- Bone marrow aspiration, biopsy, preparation and interpretation
- Preparation and interpretation of blood smears
- Ordering of and administrating chemotherapy
- Ordering of and accomplishing therapeutic phlebotomy
- Ordering of and accomplishing apheresis
- Management of Central Venous Access Devices (CVADs)
- Lumbar puncture and the administration of intrathecal chemotherapy
- Ordering and administering chemotherapy thru CVADs or CNS access devices (Ommaya Reservoirs)
- Paracentesis
- Measuring tumor masses on physical examination or imaging studies
- Bone marrow or stem cell harvesting- To participate in the education of other physicians, trainees, staff and support personnel regarding topics relating to the case of the patients with acute leukemia or blood related disorders for which a BM/SC Transplant is to be or has been performed and which requires a patient to be hospitalized.
- To learn professional attitudes and behavior in interacting and communicating with patients, their families and other health care professions.
- To learn to become a patient’s advocate in their medical care and to help patients deal with psycho-social issues.
Responsible Faculty
Andrew Yeager, M.D. Michael Carroll, M.D.
BMT faculty (being recruited) BMT faculty (being recruited)Brief Description of the Rotation
The adult bone marrow and stem cell and acute leukemia service admits and cares for patients with acute leukemia or conditions for which a BM/SC Transplant is being considered or has been done. Admissions to this service come only from the BM/SC Transplant attending physicians. Care during the admissions is provided by a team comprised of an attending BM/SC Transplant physician, a fellow and a nurse practitioner (4 in number, two of which are assigned to the in-patient service). While assigned to this service, a fellow is responsible for participating in all aspects of the in-patient of patients on the service under the direction of the attending physician.
Fellows will make rounds every weekday with the patient care team. Fellows will share patient care responsibility with the nurse practitioners. Whenever possible, continuity of care will be preserved. Responsibilities will include, but are not limited to:
- pre-rounding on in-patients
- writing daily progress notes
- dictating procedure notes
- dictating discharge summaries
- performing invasive procedures as required
- ordering and administering chemotherapy
Fellows will take at home call every 4th night (on average). While it is anticipated that the majority of calls from the BM/SC Transplant and acute leukemia service can be handled by telephone, when necessary, the on-call fellows will be expected to come into the hospital after hours and/or weekends fro home to assist in the evaluation and management of patients. In addition, fellows will take at home call every fourth weekend (on average). Admissions to the BM/SC Transplant service after hours will be facilitated by the in-house internal medicine on call resident. The on-call fellow will be expected to provide guidance to the resident by telephone and to provide direct assistance in the hospital when necessary. The on-call fellow and/or nurse practitioners will sign out all patients on the BM/SC Transplant Acute Leukemia Service to the on-call in house internal medicine resident at the end of each day.
Bone Marrow and Stem Cell Transplant and Acute Leukemia In-Patient Rotation Trainee Evaluation Process
Rotation Evaluation Process Yes No Attending Evaluation 360 degree Coworker Evaluation Cognitive Testing Focused Observation (Mini CEX) Certification Examination Procedures Morbidity & Mortality Presentation
Competency Emphasis During Rotation Low Inter High Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal and Communication Skills Professionalism System Based Practice
Procedure Performance During Rotation Yes No Bone Smear Preparation & Interpretation Bone Marrow Aspiration/Biopsy & Interpretation Tumor Measurements on Exam and Imaging Administration of Chemotherapy Management of CVADs Administration of Chemotherapy thru CVAD andCNS access device (Ommaya Reservoir)
LP performance and intrathecal chemotherapy administration
Thoracentesis Paracentesis Therapeutic Phlebotomy
VA In-Patient Consultative and New Out-Patient Evaluation Rotation
Goals of the Rotation :
- To learn about and become experienced in the in-patient management of patients with cancers or blood related disorders whose conditions require in-patient therapies or evaluations.
- To learn about and become experienced in performing in-patient consultations for cancers or blood related disorders including educating other physicians/trainees concerning the condition that the consultation was for.
- To learn about and become experienced in the management of symptoms or complications of cancer or blood related disorders which require a patient to be hospitalized.
- To learn about and become experienced in the management of symptoms or complications that result from the therapy of cancers or blood related disorders which require a patient to be hospitalized.
- To become competent and proficient the following skills and procedures:
- Bone Marrow aspiration, biopsy, preparation and interpretation
- Preparation and interpretation of blood smears
- Ordering of and administrating chemotherapy
- Ordering of and accomplishing therapeutic phlebotomy
- Ordering of and accomplishing apheresis
- Management of Central Venous Access Devices (CVADs)
- Lumbar puncture and the administration of inrathecal chemotherapy
-Ordering and administering chemotherapy thru CVADs or CNS accessAccessdevices (Ommaya Reservoirs)
- Paracentesis
- Measuring tumor masses on physical examination of imaging studies- Learning about becoming experienced in the management of immuno-compromised patients.
- Learning about and become experienced in correlating clinical information (including physical examination) with findings on pathologic (both clinical and anatomic) and imaging studies.
- To participate in the education of other physicians, staff and support personnel regarding topics relating to the care of patients with cancers or blood related disorders.
- To learn professional attitudes and behaviors in interacting and communicating with patients, their families, and other health care professionals.
- To learn to become a patient’s advocate in their medical care and to help patients deal with psycho-social issues.
- To learn about and become experienced in supportive and hospice care as well as end of life issues in general.
Responsible Faculty
Harinder Garewal, M.D. Ph.D. Maria Bishop, M.D.
Scot Ringenberg, M.D.Brief Description of the Rotation
There is no dedicated cancer or hematologic disorder in-patient service at the Tucson VA Medical Center. All cancer patients whose out-patient care is directed by a hematology and medical oncology fellow or staff physician show requires admission to the VA Medical Center are admitted to an Internal Medicine or Surgical (if appropriate) In-patient Service. The VA Medical Center also has an in-patient Hospice Service, a Nursing home, and a Palliative Care Unit which are all separate from the internal medicine or surgical in-patient services and have their own dedicated hospital bed spaces. The fellow and a VA based Hematology and Medical Oncology Staff Physician perform all requested consultations and follow-up on all of these units. Rounding on these patients is performed Monday through Friday at a time the fellow and attending physician agree to. Rounding on consult patients on Saturdays and Sundays is performed as required.
In addition to these consultative services, the fellow, when assigned to the VA covered the Hematology and Medical Oncology out-patient infusion unit for problems Monday through Friday. A third major function is for the fellow to see and evaluate new out-patient referrals that cannot be accommodated during the regularly scheduled Thursday afternoon VA Hematology and Medical Oncology clinic. The fellow after his/her initial evaluation of each new patient will review the case with a VA based attending Hematology and Medical Oncology staff physician. The fellow will perform all necessary procedures and arrange for necessary diagnostic and therapeutic interventions. The patient will then be followed by the Fellow in his/her VA continuity clinic.
VA In-Patient Consultative and New Out-Patient Evaluation
Rotation Evaluation Process
Rotation Evaluation Process Yes No Attending Evaluation 360 degree Coworker Evaluation Cognitive Testing Focused Observation (Mini CEX) Certification Examination Procedures Morbidity & Mortality Presentation
Competency Emphasis During Rotation Low Inter High Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal and Communication Skills Professionalism System Based Practice
Procedure Performance During Rotation Yes No Bone Smear Preparation & Interpretation Bone Marrow Aspiration/Biopsy & Interpretation Tumor Measurements on Exam and Imaging Administration of Chemotherapy Management of CVADs Administration of Chemotherapy thru CVAD andCNS access device (Ommaya Reservoir)
LP performance and intrathecal chemotherapy administration
Thoracentesis Paracentesis Therapeutic Phlebotomy
Breast and GU Cancer Out-Patient Clinic RotationGoals of the Rotation :
- To learn about and become experienced in the out-patient management of patients with breast and genito-urinary malignancies in the out-patient setting.
- To learn about and become experienced in the management of symptoms or complications of breast cancer and genito-urinary malignancies and their treatments in the out-patient setting
- To become competent and proficient the following skills and procedures:
- the ordering and administration of chemotherapy
- Preparation and interpretation of blood smears
- the ordering and administration of hormonal therapy
- the ordering and administration of biologic therapries
- Management and care of CVADs
- Management of immunocompromised patients
- the measurement of tumor masses on physical exam and on imaging studies
- Thoracentesis
- Paracentesis
- To participate in the education of other physicians, trainees, staff and support personnel regarding topics relating to the care and management of patients with breast or genito-urinary malignancies.
- To learn professional attitudes and behaviors in interacting and communicating with patients, their families and other health care professionals.
- To participate in the education of other physicians, staff and support personnel regarding topics relating to the care of patients with cancers or blood related disorders.
- To learn professional attitudes and behaviors in interacting and communicating with patients, their families, and other health care professionals.
- To learn to be a patient’s advocate in their medical care and to help patients deal with psycho-social issues.
- To learn about and become experienced in supportive and hospice care as well as end of life issues in general in patients with breast or genito-urinary malignancies.
Responsible Faculty
Alison Stopeck, M.D.
Leona Downey, M.D.
Robert Livingston, M.D.
Joanne Jeter, M.D.
Ana Maria Lopez, M.D.
Frederick Ahmann, M.D.Brief Description of the Rotation
During this month, a fellow will attend the following attending physicians’ out-patient clinics at the Arizona Cancer Center:
Monday Mornings Downey or Livingston Monday Afternoons Downey or Livingston Tuesday Mornings Lopez, Jeter, Livingston or Ahmann Tuesday Afternoons Ahmann or Livingston Wednesday Mornings Ahmann, Downey or Stopeck Wednesday Afternoons Ahmann, Downey or Stopeck Thursday Mornings Lopez or Livingston Thursday Afternoons Fellows’ VA Continuity Clinic Friday Mornings Fellows’ UMC Continuity Clinic Friday Afternoons Conference Attendance, self study, project work During the clinics the fellow is expected to perform histories and physical exams and provide (if requested) documentation of the results of these activities. The fellow is also expected to complete the recommended curriculum core reading for breast caner, prostate cancer, germ cell cancers, bladder cancer, penile cancer, and kidney cancer. The fellow will perform all necessary procedures and arrange for necessary diagnostic and therapeutic interventions. The fellow will provide patient education, be the patient’s advocate, and provide all necessary patient support.
Breast and Genito-urinary Malignancy Out-Patient Rotation Evaluation Process
Rotation Evaluation Process Yes No Attending Evaluation 360 degree Coworker Evaluation Cognitive Testing Focused Observation (Mini CEX) Certification Examination Procedures Morbidity & Mortality Presentation
Competency Emphasis During Rotation Low Inter High Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal and Communication Skills Professionalism System Based Practice
Procedure Performance During Rotation Yes No Bone Smear Preparation & Interpretation Bone Marrow Aspiration/Biopsy & Interpretation Tumor Measurements on Exam and Imaging Administration of Chemotherapy Management of CVADs Administration of Chemotherapy thru CVAD andCNS access device (Ommaya Reservoir)
LP performance and intrathecal chemotherapy administration
Thoracentesis Paracentesis Therapeutic Phlebotomy
Other Solid Tumor Rotation
Goals of the Rotation :
- To learn about and become experienced in the out-patient management of patients with head and neck cancers, CNS tumors, lung cancers, GI malignancies, melanoma, and sarcomas in the out-patient setting.
- To learn about and become experienced in the management of symptoms or complications of head and neck cancers, CNS tumors, lung cancers, GI malignancies, melanoma, and sarcomas and their treatments in the out-patient setting.
- To become competent and proficient the following skills and procedures:
- the ordering and administration of chemotherapy
- the ordering and administration of biologic therapies
- management and care of CVADs
- Management of immunocompromised patients
- Measurement of tumor masses on physical exam and on imaging studies
- Thoracentesis
- Paracentesis
- To participate in the education of other physicians, trainees, staff and support personnel regarding topics relating to the care and management of patients with head and neck cancers, CNS tumors, lung cancers, GI malignancies, melanoma and sarcomas.
- To learn professional attitudes and behaviors in interacting and communicating with patients, their families and other health care professionals.
- To learn to be a patient’s advocate in their medical care and to help patients deal with psycho-social issues.
- To learn about and become experienced in supportive ad hospice care as well end of life issues in general in patients with head and neck cancers, CNS, tumors, lung cancers, GI malignancies, melanoma, and sarcomas.
Responsible Faculty
Linda Garland, M.D. Evan Hersh, M.D.
Lee Cranmer, M.D. Tom Dragovich, M.D.
Harinder Garewal, M.D. Maria Bishop, M.D.Brief Description of the Rotation
During this month, a fellow will attend the following attending physicians’ out-patient clinics at the Arizona Cancer Center:
Monday Mornings Garland Monday Afternoons Garland Tuesday Mornings Hersh, Cranmer or Dragovich Tuesday Afternoons Garewal or Dragovich Wednesday Mornings Downey or Stopeck Wednesday Afternoons Bishop Thursday Mornings Hersh, Garland or Dragovich Thursday Afternoons Fellows’ VA Continuity Clinic Friday Mornings Fellows’ UMC Continuity Clinic Friday Afternoons Conference Attendance, self study, project work During the clinics the fellow is expected to perform history and physical exams and provide (if requested) documentation of the results of theses activities. The fellow is also expected to complete the recommended curriculum core reading for head and neck cancers, CNS tumors, lung cancers, GI malignancies, melanoma, and sarcomas. The fellow will perform all necessary procedures and arrange for necessary diagnostic and therapeutic interventions. The fellow will provide patient education, be the patient’s advocate, and provide all necessary patient support.
Other Solid Tumor Out-Patient Rotation Evaluation Process
Rotation Evaluation Process Yes No Attending Evaluation 360 degree Coworker Evaluation Cognitive Testing Focused Observation (Mini CEX) Certification Examination Procedures Morbidity & Mortality Presentation
Competency Emphasis During Rotation Low Inter High Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal and Communication Skills Professionalism System Based Practice
Procedure Performance During Rotation Yes No Bone Smear Preparation & Interpretation Bone Marrow Aspiration/Biopsy & Interpretation Tumor Measurements on Exam and Imaging Administration of Chemotherapy Management of CVADs Administration of Chemotherapy thru CVAD andCNS access device (Ommaya Reservoir)
LP performance and intrathecal chemotherapy administration
Thoracentesis Paracentesis Therapeutic Phlebotomy
Lymphoma, Benign & Malignant Hematology Out-Patient Clinic Rotation
Goals of the Rotation :
- To learn about and become experienced in the out-patient management of patients with lymphoma, malignant hematology and hematologic disorders in the out-patient setting.
- To learn and become experienced in the management of symptoms or complications of lymphoma, malignant hematology, and hematologic and then treatments in the out-patient setting.
- To become competent and proficient the following skills and procedures:
- the ordering and administration of chemotherapy
- the ordering and administration of biologic therapies
- management and care of CVADs
- Management of immunocompromised patients
- Measurement of tumor masses on physical exam and on imaging studies
- Thoracentesis
- Paracentesis
- Bone marrow aspiration, biopsy, preparation and interpretation
- Preparation and interpretation of blood smears
- To participate in the education of other physicians, trainees, staff and support personnel regarding topics relating to the care and management of patients with lymphoma, malignant hematology and hematologic disorders.
- To learn professional attitudes and behaviors in the interacting and communicating with patients, their families and other health care professionals.
- To learn to be a patient’s advocate in their medical care and to help patients deal with psycho-social issues.
- To learn about and become experienced in supportive and hospice care as well as end of life issues in general in patients with lymphoma, malignant hematology, and hematologic disorders.
Responsible Faculty
Tom Miller, M.D.
Michael Carroll, M.D.
Daruka Mahadevan, M.D.
Dan Persky, M.D.
Andrew Yeager, M.D.Brief Description of the Rotation
During this month, a fellow will attend the following attending physicians’ out-patient clinics at the Arizona Cancer Center:
Monday Mornings Mahadevan, Persky or Miller Monday Afternoons Downey Tuesday Mornings Carroll, Cranmer or Dragovich Tuesday Afternoons Yeager Wednesday Mornings Miller or Persky Wednesday Afternoons Bishop Thursday Mornings Carroll Thursday Afternoons Fellows’ VA Continuity Clinic Friday Mornings Fellows’ UMC Continuity Clinic Friday Afternoons Conference Attendance, self study, project work
During the clinics the fellow is expected to perform history and physical exams and provide (if requested) documentation of the results of theses activities. The fellow is also expected to complete the recommended curriculum core reading for head and neck cancers, CNS tumors, lung cancers, GI malignancies, melanoma, and sarcomas. The fellow will perform all necessary procedures and arrange for necessary diagnostic and therapeutic interventions. The fellow will provide patient education, be the patient’s advocate, and provide all necessary patient support.
Other Solid Tumor Out-Patient Rotation Evaluation Process
Rotation Evaluation Process Yes No Attending Evaluation 360 degree Coworker Evaluation Cognitive Testing Focused Observation (Mini CEX) Certification Examination Procedures Morbidity & Mortality Presentation
Competency Emphasis During Rotation Low Inter High Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal and Communication Skills Professionalism System Based Practice
Procedure Performance During Rotation Yes No Bone Smear Preparation & Interpretation Bone Marrow Aspiration/Biopsy & Interpretation Tumor Measurements on Exam and Imaging Administration of Chemotherapy Management of CVADs Administration of Chemotherapy thru CVAD andCNS access device (Ommaya Reservoir)
LP performance and intrathecal chemotherapy administration
Thoracentesis Paracentesis Therapeutic Phlebotomy
Hematology & Medical Oncology Fellowship Continuity Clinics
Goals of the Rotation :
- To learn about and become experienced in the out-patient management of individuals with malignancies and blood disorders.
- To learn about and become experienced in the management of symptoms or complications of malignancies and blood disorders on an out-patient setting.
- To learn about and become experienced in the management of symptoms or complications that result from the therapy of malignancies and blood disorders in the out-patient setting.
- To become competent and proficient the following skills and procedures:
- Bone Marrow aspiration, biopsy, preparation and interpretation
- Preparation and interpretation of blood smears
- Ordering of and administrating chemotherapy
- Ordering of and accomplishing therapeutic phlebotomy
- Ordering of and accomplishing apheresis
- Management of Central Venous Access (CVADs)
- Lumbar puncture and the administration of intrathecal chemotherapy
- Ordering and administering chemotherapy thru CVADs or CNS access device (Ommaya Reservoirs)
- Paracentesis
- Measuring tumor masses on physical examination or imaging studies
- Thoracentesis
-Management of immunocompromised patients
- To participate in the education of other physicians, trainees, staff, and support personnel regarding topics relating to the care of patients with malignancies and blood disorders.
- To learn professional attitudes and behaviors in interacting and communicating with patients, their families, and other health care professionals.
- To learn to be a patient’s advocate in their medical care and to help patients deal with psycho-social issues
- To learn about and become experienced in supportive and hospice care as well as end of life issues in general in patients with lymphoma, malignant hematology, and hematologic disorders.
Responsible Faculty
Frederick R. Ahmann, M.D.
Linda Garland, M.D.
Daruka Mahadevan, M.D.,PhD.
Dan Persky, M.D.
Leona Downey, M.D.
Michael Carroll, M.D.
Maria Bishop, M.D.
Scot Ringengerg, M.D.
Sang-Hoon Ahn, M.D.
Lee Cranmer, M.D., PhD
Ana Maria Lopez, M.D.
Tom Miller, M.D.
Alison Stopeck, M.D.
Bob Livingston, M.D.
Evan Hersh, M.D.
Andrew Yeager, M.D.
Harinder Garewal, M.D, PhD.
JoAnne Jeter, M.D.Brief Description of the Clinics
Fellows are assigned two continuity clinics during their fellowship which they attend through all years of training. At the AZCC fellows are assigned a ½ day clinic slot on Friday mornings. During this time slot, each fellow will have a new hematology and a new oncology patient assigned as well as follow-up slots. Clinics can extend into the afternoon if needed. Two attending physicians are assigned to each Friday morning to review all new patients in person and to be available for consultation on any follow-up visit. The fellow is responsible for all care documentation and for ordering and arranging all therapy, diagnostic studies and follow-up visits with the help of a nurse coordinator and a scheduling clerk. It is expected that notes will be sent to referring or other active physicians active in the patient’s care.
The fellow’s continuity clinics at the VA Medical Center occur on Thursday afternoon and are held for all years of a fellow’s training. Three VA based faculty members are available during each clinic. Fellows utilize the VA electronic documentation and ordering system. New patients are assigned by the VA attending physicians and the VA attending physicians are responsible for the care supervision.
Continuity Clinic Fellow Evaluation Process
Rotation Evaluation Process Yes No Attending Evaluation 360 degree Coworker Evaluation Cognitive Testing Focused Observation (Mini CEX) Certification Examination Procedures Morbidity & Mortality Presentation
Competency Emphasis During Rotation Low Inter High Patient Care Medical Knowledge Practice Based Learning & Improvement Interpersonal and Communication Skills Professionalism System Based Practice
Procedure Performance During Rotation Yes No Bone Smear Preparation & Interpretation Bone Marrow Aspiration/Biopsy & Interpretation Tumor Measurements on Exam and Imaging Administration of Chemotherapy Management of CVADs