VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
First-Year Fellow
Hematology/Oncology Faculty Ambulatory Block Rotation
Description of Rotation or Educational Experience
The Hematology/Oncology Subspecialty Ambulatory Rotation is a combination of experiences in various subspecialty and
general faculty Hematology/Oncology clinics designed to supplement the outpatient experience provided by the
Hematology/Oncology Continuity Clinic Rotation.
Clinics in this rotation include:
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Thoracic Oncology clinic (Monday PM clinic). This clinic is a multidisciplinary clinic comprised of interventional
pulmonologists, thoracic surgeons, radiation oncologists, medical oncologists, social workers, clinical research
coordinators. Responsible faculty: Dr. Sherman Baker, MD.
Breast Oncology Clinic (Tuesday PM clinic). This clinic is a multidisciplinary clinic comprised of medical oncologists,
radiation oncologists, surgical oncologists, radiologists, pathologists, social workers, and clinical research
coordinators. Responsible faculty: Mary Helen Hackney, MD; Craig Swainey, MD; Hetal Vachani, MD
Hematologic Malignancy Clinic (Wednesday AM clinic). This clinic is a multidisciplinary clinic comprised of medical
oncologists, hematologists, radiation oncologists, social workers, and clinical research coordinators. Responsible
faculty: Kevin Brigle, NP; John Christian Barrett, MD; Prtihviraj Bose, MBBS; Gordon Ginder, MD; Beata Holkova, MD;
Shejal Patel, DO; and Brent Perkins, MD, PhD.
Gastrointestinal Oncology Clinic. (Thursday PM Clinic) This clinic is a multidisciplinary clinic comprised of medical
oncologists, radiation oncologists, surgical oncologists; radiologists; pathologists; social workers; and clinical research
coordinators. Responsible faculty: Stephen Grossman MD, PhD; Bhaumik Patel, MD; Andrew Poklepovic, MD; and
James Shaw, MD
Genitourinary and Soft Tissue/Melanoma Clinics (Tuesday and Friday AM clinics). This clinic is a faculty practice clinic.
Responsible faculty: Andrew Poklepovic, MD and Craig Swainey, MD.
Interventional/Procedural clinics. These clinics are comprised of nurse practitioners trained in specialized procedures
who operate under attending physician authority. Under the direct supervision of the proceduralist NP, the fellows
perform and become proficient in intrathecal chemotherapy administration both through both lumbar puncture and
Omaya Reservoir and in the performance of bone marrow aspiration and biopsy. Responsible faculty: Kevin Brigle, NP
and William Hall, NP.
Location:
MCVH/VCUHS Massey Cancer Center Dalton Oncology Clinic and Bone Marrow Transplantation Clinic
Length of Experience:
2-4 week blocks – days only, no weekend or night call
Educational Goals
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Gain knowledge of the role of the various oncologic specialties in managing the complexities of the oncology patient
in a multidisciplinary model
Gain additional experience and knowledge in the diagnosis, staging, and management options of outpatients with
thoracic malignancies
Gain additional experience and knowledge in the diagnosis, staging, and management options of outpatients with
breast malignancies
Gain additional experience and knowledge in the diagnosis, staging, and management options of outpatients with
hematologic malignancies
Gain additional experience and knowledge in the diagnosis, staging, and management options of outpatients with
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gastrointestinal malignancies
Gain experience and become proficient in intrathecal chemotherapy administration via lumbar puncture.
Gain experience and become proficient in performing bone marrow aspiration and biopsy.
Patient Care
Goal
Fellows 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
Objectives
Fellows 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 Knowledge
Goal
Fellows 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.
Competencies
Fellows are expected to demonstrate skills in:
 Acquisition of knowledge
 Analysis of information
 Application of knowledge
Objectives
All 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
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clinical assessment, differential diagnosis, and diagnostic and management plans
Content-Specific Objectives
Thoracic Oncology
 Demonstrate knowledge of epidemiology and work up of thoracic oncology.
 Recognize the treatment options for thoracic malignancy as related to the disease stage
 Identify and manage complications of the treatment of thoracic cancers such as radiation pneumonitis, infection,
dyspnea
 Recognize the importance of palliation of symptoms including pain and dyspnea in patients with thoracic
malignancies.
 Recall the interventional options for patients with thoracic malignancies and pleural effusions for palliative purposes
 Understand the importance of clinical trials in thoracic malignancies
Breast Oncology
 Demonstrate knowledge of the diagnosis, staging and management of breast cancer
 Demonstrate knowledge of the treatment of breast malignancy and its relationship to disease stage
 Demonstrate the ability to access and use the available prognostic models and online lines used in the management
of breast cancer including but not limited to the Gail model, the Claus model, Adjuvant online and OncotypeDX.
 Identify and manage complications of the treatment of breast cancers
 Recognize the importance of palliation of symptoms in patients with breast malignancies.
 Understand the importance of clinical trials in breast malignancies
Hematologic Malignancies
 Demonstrate the knowledge of the WHO classifications, prognostic scores, and staging used for the hematologic
malignancies
 Demonstrate an understanding of the diagnostic modalities used in differentiating hematologic malignancies such as
lymph node biopsy, bone marrow biopsy, flow cytometry, molecular assays, and cytogenetics along with means of
demonstrating clonality in hematologic malignancies
 Understand the importance of clinical trials in hematologic malignancies
Gastrointestinal Oncology
 Demonstrate knowledge of epidemiology, work up, and staging of GI oncology.
 Demonstrate a knowledge of the treatments of GI malignancy as they relate to disease stage
 Identify and manage complications of the treatment of GI cancers such as pain, mucositis, infection, and diarrhea
 Recognize the importance of palliation of symptoms in patients with GI malignancies.
 Understand the importance of clinical trials in GI malignancies
Practice- Based Learning and Improvement
Goal
Fellows 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 life long learning.
Please refer to overview of the fellowship curriculum for competencies/objectives for practice based learning and improvement.
Systems Based Practice
Goal
Fellows 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.
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Professionalism
Goal
Fellows 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 Skills
Goal
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and
teaming with patients, their families, and professional associates.
Please refer to overview of the fellowship curriculum for competencies/objectives for interpersonal and communication skills.
Teaching Methods
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Clinical teaching
Role modeling
Patient care/clinical experience
Didactic sessions (division, department, institution)
Performance feedback
Self-directed learning
Assessment of Fellow Performance
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Evaluation by the attending of the fellow
Procedural assessment of each performed procedure by the supervising faculty member
Assessment of Rotation
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Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision
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For non-procedural patient encounters supervision is indirect with direct supervision immediately available by adulttrained hematology and/or oncology physicians
All procedures during the rotation are performed under the direct supervision of a faculty member
Educational Resources
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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
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Common Toxicity Criteria v4.0 (aka Common Terminology Criteria for Adverse Events)
GAIL model
Claus model
Adjuvant! Online
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