VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
Bone Marrow/Stem Cell Transplantation Outpatient Transplantation
Description of Rotation or Educational Experience
The outpatient bone marrow transplant rotation is an experience designed to educate the fellows on the evaluation and
management of the patient referred for stem cell transplantation during the pre-transplant evaluation and post-transplant
follow-up phases.
Responsible faculty:
John McCarty, MD; Dr. Harold Chung, MD; Dr. Amir Toor, MD; and William Clark, MD
Location:
MCVH/VCUHS Outpatient Bone Marrow Clinic
Length of Experience:
Eight-week block (combined with inpatient bone marrow transplant) during the first year. Four-week block as an upper level
fellow. The rotation includes weekends and at-home call.
Educational Goals
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Understand the indications and contraindications for all forms of transplantation, including autologous peripheral
blood stem cell transplant, myeloablative allogenic transplant and nonmyeloablative allogenic transplant.
Understand the indications and contraindications for each type of stem cell transplantation and for each type of
donor source
Understand the indications for stem cell transplantation and for an appropriate referral for the procedure
Understand the process leading up to stem cell transplant including patient history and physical exam, and donor
evaluation.
Demonstrate knowledge of HLA matching and donor selection.
Recount the processes and the physiologic basis of the stem cell mobilization and collection
Understand the rationale and mechanism of action of preparative chemotherapeutic agents.
Recognize, diagnose, and treat infectious and non-infectious complications of marrow transplantation
Discuss the long-term post-transplantation management and monitoring needs of the patient
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 ill stem cell transplant patients in order to
learn the different approaches to treatment and complications which arise during and after stem cell transplant
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
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Objectives
Fellows are expected to:
• Develop skills in history/physical examination of the patient undergoing stem cell transplant
• 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
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
clinical assessment, differential diagnosis, and diagnostic and management plans
Content-Specific Objectives
In addition, learning objectives specific to this rotation include:
 Recall and discuss the indications for stem cell transplantation in the following disease: Leukemia (various types of
acute and chronic), lymphoma (Hodgkin and non-Hodgkin types), myeloma, immune deficiency, marrow failure
states, hemoglobinopathies, inborn errors of metabolism, autoimmune diseases, sarcoma, adult and pediatric solid
tumors, renal cell, melanoma, and germ cell
 Recognize patient characteristics that define their potential eligibility and risks associated with stem cell
transplantation along with the pre-transplant evaluation testing performed to determine candidacy for the procedure
 Describe the HLA system and the immunologic basis for recognizing self vs. non-self
 Demonstrate knowledge of HLA typing and it’s application in donor selection.
 Recognize donor characteristics and testing used to determine donor eligibility, to select the best available donor, and
to make final assessment as to their fitness to donate.
 Recount the processes and the physiologic basis of the stem cell mobilization and collection
 Directly witness (at least once) the peripheral stem cell collection process
 Describe and witness (at least once) the bone marrow harvesting process
 Understand the immediate supportive needs of patients being discharged from the inpatient bone marrow transplant
unit including: blood transfusion, electrolyte repletion, and intravenous fluids
 Recognize, distinguish, diagnose, and treat infectious and non-infectious complications of marrow transplantation (by
their clinical presentations and time course) – including the acute, subacute, and long-term complications
 Recognize the signs and symptoms of and confirm the diagnosis of graft vs. host disease
 Discuss the pathophysiology of graft vs. host disease and the means for prevention and treatment [including the
potential benefits and adverse effects of these therapies, including but not limited to the following: cyclosporine,
tacrolimus, methotrexate, mycophenolate mofetil, alemtuzumab, corticosteroids, or antithymocyte globulin (ATG)].
 Understand the risk of infection in transplantation and the use of prophylactic antibiotics, antivirals, and antifungals
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during post-transplant period
Recall the use and schedule of vaccination in the post-transplant patient
Recognize when a patient is ready to be discharged back to their referring physician and make recommendations for
continued follow up care
Demonstrate knowledge of long term effects of stem cell transplantation
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.
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)
Multi-disciplinary patient and donor selection meeting
Performance feedback
Self-directed learning
Assessment of Fellow Performance
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Evaluation by the attending of the fellow
Assessment of Rotation
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End of rotation evaluation by the fellow of the attending
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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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Direct supervision and indirect supervision with direct supervision immediately available by trained Bone Marrow
Transplant Physicians, NPS, and PAs
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)
Common Toxicity Criteria v4.0 (aka Common Terminology Criteria for Adverse Events)
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