VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
MCV Hospital and VA Medical Center
Inpatient Consultation Services
Description of Rotation or Educational Experience
The VCU Hematology-Oncology fellowship program MCV Hospital and VA Medical Center inpatient hematology-oncology
consultation rotations are designed to allow the fellow to become proficient and independent in the provision of inpatient
consultation services. The fellow is expected to participate in the care and management of adult patients admitted to the
hospital for any variety of medical conditions in which the primary team has an acute hematologic and/or oncologic question.
The fellow is responsible for efficiently synthesizing the available data from a variety of modalities and for augmenting the
existing data with targeted, specialty/consult question-specific collection of additional primary information from the patient,
family, outside providers, and additional diagnostics as necessary. The fellow is responsible for the development of the
assessment and recommendations through their synthesis of the data and through their review of the literature and other
resources. As the fellow functions as a specialty consultant to the primary admitting team, this rotation provides the
opportunity for the fellow to develop skills necessary for the effective and timely evaluation of the patient and for the
communication of the recommendations back to the consulting team.
In addition, the rotation emphasizes the role of consultant as an educator to both the patient and the consulting provider. The
fellow will be challenged to focus their clinical care and educational efforts on the specialty specific aspects of the patient’s
care but put into context as they relate and interact with the patient’s other systemic illnesses and needs. All of this occurs
under the supervision of the responsible faculty from the Division of Hematology, Oncology, and Palliative Care consult
attending faculty members at the two facilities.
Location:
VCUHS MCV Hospital inpatient facilities
Hunter Holmes McGuire VA Medical Center inpatient facilities
Length of Experience:
4 week block – days only without specific weekend or in-house night coverage.
Educational Goals
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Gain experience and knowledge in the diagnosis, prognosis, management, and complications of inpatients with nonmalignant, hematologic problems manifesting as a result of or in conjunction with acute medical conditions
necessitating hospitalization.
Gain experience and knowledge in the diagnosis, prognosis, management, and complications of inpatients with acute
non-malignant, hematologic problems necessitating hospitalization.
Gain experience and knowledge in the diagnosis, prognosis, management, and complications of inpatients with
hematologic and solid tumor malignancies
Gain experience in the diagnosis, prognosis, and management of acute hematologic and oncologic emergencies
Gain experience in the diagnosis, prognosis, and management of complications of advanced malignancy
Gain experience in the administration, monitoring, and toxicities of chemotherapy
Gain additional experience 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 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.
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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 knowledge in the unique aspects of the role of and effective functioning as a subspecialty
inpatient consultant
Gain experience in effective communication necessary to effective co-management
Gain experience in the effective transferring of subspecialty care to the outpatient provide(s)
YEAR 3
YEAR 2
YEAR 1
Progressive Responsibilities by Fellow Year
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 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).
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.
The third year fellow is expected to demonstrate proficiency and independence. The third year fellow is expected to
demonstrate full knowledge of the routine 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 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 acute inpatient hospital setting under the supervision of the appropriate subspecialty
faculty member. Fellows will participate in the evaluation, counseling, and management of acutely and chronically ill
hematology-oncology inpatients. This will provide the opportunity to learn the different approaches to inpatient management
of these conditions. Fellows will additionally coordinate the care plan with the patient’s primary team and, as necessary for
the coordination of the specific hematology-oncology aspects of care, with the patient’s multidisciplinary team of health
professionals including pharmacists, nurses, physical therapies, occupational therapists, social workers, and care coordinators.
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Competencies
Fellows are expected to:
 Gather appropriate clinical information
 Synthesize information into a care plan
 Perform the procedures necessary for the effective diagnosis and management of acute hematologic and oncologic
disorders
 Partner with patients/families in the implementation of the plan
 Coordinate care plans with the referring physicians, the inpatient multi-disciplinary team of health professionals, and
the home health agencies
Objectives
Fellows are expected to:
 Develop skills in history/physical examination of the patient with hematologic and oncologic disorders
 Develop skills as an outpatient subspecialty consultant
 Integrate clinical data in the formation of a comprehensive care plan
 Recognize the common sources of error in the performance and interpretation of hematology laboratory assays
 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
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
First year fellows are expected to:
 Medical knowledge acquisition should focus on the routine 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.
Second year fellows are expected to:
 Medical knowledge acquisition should focus 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.
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Third year fellows are expected to:
 Medical knowledge acquisition should focus on mastery of the knowledge obtained as a first and second year fellow
Content-Specific Objectives:
The medical conditions experienced during any single block of this rotation can be quite variable. However, in an effort to
provide guidance, the following core rotation-specific objectives outline specific medical knowledge content material that the
fellow is expected to obtain during this rotation:
 Demonstrate a knowledge of the diagnostic evaluation of the patient with a newly diagnosed lung mass
 Demonstrate a knowledge of the diagnostic evaluation of the patient with newly diagnosed adenopathy
 Demonstrate a knowledge of the diagnostic evaluation of the patient with newly diagnosed metastatic cancer of
undetermined primary
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new brain
metastasis in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new cord
compression in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new malignant
leptomeningeal involvement in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the differential diagnosis, diagnostic approach and therapeutic management of the
patient presenting with new superior vena cava syndrome in both the setting of an undiagnosed malignancy and a
known malignancy
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with bowel
obstruction in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate a knowledge of the diagnostic and therapeutic approach to the patient presenting with new malignant
pleural effusion and/or ascites in both the setting of an undiagnosed primary malignancy and a known malignancy
 Demonstrate an understanding of the management options of malignancy-related pain including the role of
pharmacologic agents, radiation, surgery, kyphoplasty, and neurologic blocks.
 Demonstrate a knowledge of the pathophysiologic mechanism leading to malignancy-associated hypercalcemia
 Demonstrate a knowledge of the diagnostic approach to the patient with malignancy-associated hypercalcemia
 Demonstrate a knowledge of the prognostic implications of malignancy-associated hypercalcemia in relationship to
the underlying malignant etiology
 Demonstrate a knowledge of the therapeutic approach to the patient with malignancy-associated hypercalcemia
including the indications, dosing, monitoring, toxicities, and therapeutic benefits of the hydration, bisphosphonates,
calcitonin, glucocorticoids, calcimimetics, and dialysis
 Understand the use and calculate a patients performance status using the Eastern Cooperative Group and the
Karnofsky performance scoring systems
 Demonstrate a knowledge of the pathophysiology, differential diagnosis, evaluation, and management of the acute
complications of the sickle cell disorders, including vasoocclusive bone pain, sickle chest syndrome, stroke, priapism,
acute hepatopathy, and acute hematologic crisis.
 Demonstrate an understanding of the differential diagnosis and evaluation of thrombocytosis in the inpatient setting
 Demonstrate an understanding of the pathophysiology, evaluation, diagnostic criteria, prognosis, and management
of hematophagocytic lymphohistiocytosis
 Demonstrate a knowledge of the evaluation of the various anemia in the inpatient setting
 Demonstrate a knowledge of the evaluation of the patient with thrombocytopenia in the inpatient setting
 Demonstrate a knowledge of the pathophysiology, manifestations, diagnosis, and management of the different
etiologies of microangiopathic hemolytic anemia including the ability to differentiate between thrombotic
thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and disseminated intravascular coagulation
(DIC) among others
 Recognize the morphologic features of a microangiopathic hemolytic anemia on a peripheral blood smear
 Demonstrate a knowledge of the pathophysiology, diagnosis, manifestations, and management of antiphopholipid
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syndrome including the unique aspects of the presentation and management of catastrophic antiphospholipid
syndrome.
Demonstrate a knowledge of the pathophysiology, manifestations, diagnosis, and management of heparin induced
thrombocytopenia (HIT) including the ability to determine pretest probability based on published literature.
Demonstrate a knowledge of the diagnostic approach to the patient with acute coagulopathy
Demonstrate a knowledge of the pathophysiology, diagnosis, manifestations, and management acute disseminated
intravascular coagulopathy
Recognize, diagnose, and manage the acute hematologic complications of pregnancy
Recognize and diagnose, and manage the acute hematologic complications of end-stage liver disease
Demonstrate a knowledge of the diagnostic evaluation and management of the patient presenting with a newly
acquired coagulation factor autoantibody to Factor VIII
Demonstrate practical competency with the specific factor replacement concentrates, inhibitor “bypass” products,
antifibrinolytic agents, and the role of blood products for the management of bleeding disorders presenting with
acute bleeding. 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.
Demonstrate a knowledge of the routine management of a patient with a bleeding disorder presenting for elective
surgical intervention, urgent surgical intervention, or obstetric delivery
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 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.
Demonstrate practical competency with the specific factor replacement concentrates, inhibitor “bypass” products,
antifibrinolytic agents, and the role of blood products for the management of bleeding disorders presenting with
acute bleeding. 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 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 lifelong learning. The fellow is
expected to present primary scientific and medical evidence to support their conclusions and care plans in the diagnosis,
prognosis, management, and monitoring of the patients on the service. The fellow is expected to recognize their areas of
deficiency. Depending upon the acuity of the care situation, the fellow is expected to be able to effectively utilize their
resources to arrive at necessary information and to apply the information to their patient care. Moreover, the fellow is
expected to recognize conditions and circumstances requiring escalation.
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. Fellows will work within a
multidisciplinary team of health professionals including the consulting providers, pharmacists, nurses, physical therapists,
occupational therapists, social workers, and care coordinators.
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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.
The fellow is expected to model professional and courteous behavior in the treatment of the patient and in working with the
entire health care team. The fellow is expected to complete documentation of their patient care, of their communications with
the patient and health care providers, and of their procedures in a timely fashion within the medical record. The fellow is also
expected to recognize the critical importance of their own education and the importance of life-long learning as part of their
professional responsibility. As such, it is the obligation of the fellow to themselves, their profession, and their patients to
attend and complete in a timely fashion all of fellowship training program’s expected educational activities.
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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Patient care/clinical experience
Modeling of observed behaviors of attending physicians
Case-based interactive discussions
Didactic sessions
Performance feedback
Self-directed learning
Assessment of Fellow Performance
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End-of-rotation evaluation of the fellow by the supervising attending physicians
360-evaluation by the medical students, interns, and residents when present as part of the team
Mini-CEX by supervising attending physicians of a counseling and communication encounter
Semi-annual self-assessment by the fellow
Assessment of Rotation
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End-of-rotation evaluation of the supervising attending physicians by the fellow
Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision
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Indirect supervision with faculty immediately available
Direct supervision by the faculty of select patient, family and professional health staff encounters to assess medical
knowledge as conveyed in the provided counseling and care coordination, system-based practice, professionalism,
and interpersonal communication skills
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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
Common Toxicity Criteria v4.0 (aka Common Terminology Criteria for Adverse Events)
GAIL model
Claus model
Adjuvant! Online
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