VCUHS HEMATOLOGY/ONCOLOGY FELLOWSHIP CURRICULUM
Bone Marrow/Stem Cell Transplantation Inpatient Rotation
Description of Rotation or Educational Experience
The inpatient bone marrow transplant rotation is an experience designed to educate the fellows on the management of the
patient referred for stem cell transplantation immediately prior to, during and following the transplant inclusive of the
myeloablation, stem cell infusion, acute post-transplant complications and marrow recovery.
Responsible faculty:
John McCarty, MD; Dr. Harold Chung, MD; Dr. Amir Toor, MD; and William Clark, MD
Location:
VCUHS Inpatient Bone Marrow Unit
Length of Experience:
Eight-week block during the first year of fellowship (combined with outpatient experience). The rotation includes weekends
and at-home call.
Educational Goals





Understand the indications and contraindications for all forms of transplantation, including autologous peripheral
blood stem cell transplant, myeloablative allogenic transplant and nonmyeloablative allogenic transplant.
Recognize some of the disease for which stem cell transplant can be utilized including: leukemia, lymphoma,
myeloma, immune deficiency, marrow failure states, hemoglobinopathies, inborn errors of metabolism, autoimmune
diseases, sarcoma, pediatric solid tumors, renal cell, melanoma, germ cell
Understand the rationale and mechanism of action of preparative chemotherapeutic agents.
Demonstrate knowledge of HLA matching.
Recognize and treat major complications of marrow transplantation, such as graft vs. host disease, infectious
complications, and regimen-related toxicities.
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
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
1
•
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:
 Distinguish the role and effects of the various preparative therapies including the role of radioablation, immunologic
agents, and chemotherapy ablative regimens.
 Recall and distinguish (by their clinical presentations and time course) the various possible short-term and long-term
complications of stem cell transplantation
 Recognize the signs and symptoms of and confirm the diagnosis of graft vs. host disease
 Understand the pathogenesis of graft vs. host disease, and treatment including but not limited to: cyclosporine,
tacrolimus, methotrexate, mycophenolate mofetil, alemtuzumab, corticosteroids, or antithymocyte globulin (ATG).
 Recall the management strategies for the evaluation and management of the febrile neutropenic patient following
stem cell transplantation.
 Understand the risk of infection in transplantation and the use of prophylactic antibiotics, antivirals, and antifungals
during the inpatient transplant process
 Recognize and manage the acute and sub-acute infectious complications following stem cell transplantation.
 Describe the specific manifestations, clinical presentations, early recognition monitoring, diagnosis, prevention and
management of the CMV
 Describe the specific manifestations, recognition, diagnosis, and management of the invasive fungi including but not
limited to aspergillus and mucor.
 Recognize the clinical presentation, recall the pathophysiology, and describe the management of veno-occlusive
disease in transplant patients including the role of ursodiol in the prevention of this complication
 Understand the supportive care involved in transplantation including use of blood products, use of nutritional
supplementation during mucositis, and emotional support by social workers
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.
2
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






Clinical teaching
Role modeling
Patient care/clinical experience
Didactic sessions (division, department, institution)
Performance feedback
Self-directed learning
Assessment of Fellow Performance

Evaluation by the attending of the fellow
Assessment of Rotation




End of rotation evaluation by the fellow of the attending
Annual program review
Discussions with fellows during biannual review
Review in-service and ABIM exam results
Level of Supervision

Indirect supervision with direct supervision available by trained Bone Marrow Transplant Physicians, NPS, and PAs
Educational Resources






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
3




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)
4