Course/Rotation Title: Outpatient Hematology/Oncology
Date of Last Review/Update:
3/07
Course/Rotation Director: Michael DeLeo, MD
Location of clinical encounters
Inpatient % time = 5%
(Check all that apply)
[X]
Wards
[X]
ICU
[X]
ED
Outpatient% time = 95%
(Check all that apply)
[X]
Clinic
[ ]
Home
[X]
Other: Cancer conference, Hospice, Infusion Center.
Course/Rotation description with educational purpose/value
The goal of this rotation is to prepare future general internists with the skills and knowledge to
appropriately evaluate, treat, and refer in a timely fashion patients with acute and chronic
hematologic and oncologic illnesses. The rotation is divided equally among both specialties and
overseen by Dr. Michael Deleo who is boarded in both areas. The goals and objectives are
broken down by competency below for each specialty.
Types of Clinical Encounters: (PLEASE SPECIFY)
This rotation is designed to expose residents to primarily outpatient Hematology & Oncology
issues as all residents rotate through the inpatient services during their residencies, where they
receive inpatient and acute management skills in caring for this population. Residents will work
in both the clinic as well as in the infusion center. They will attend multidisciplinary Cancer
Conference on a weekly basis.
Types of Patients: (PLEASE SPECIFY)
[X]
[X]
[X]
[X]
[ ]
Adults of all ages
Male
Female
Children < 18 years old
Other (please specify)
Mix of Diseases: (PLEASE SPECIFY ANY ADDITIONAL DISEASES
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See below under patient care.
Types of Procedures: (PLEASE SPECIFY)
 Bone marrow aspirate and biopsy.
 Perform needle aspiration of cutaneous lesions and lymph nodes.
Describe the level of supervision by faculty:
[X]
[X]
[X]
[ ]
Attending staff will supervise and precept all patient care activity directly or indirectly.
Attending staff will provide mid rotation feedback
Attending staff will provide end-of-rotation feedback
Other (please specify)
Competency Based Objectives/Expectations. Please see Roman Numeral II
with additional items specific to this rotation as below:
Patient Care
Hematology
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Appropriately evaluate anemia, thrombocytopenia, and leukopenia.
Appropriately evaluate patients with myeloproliferative diseases and leukemoid
reactions.
Perform a complete physical exam, especially evaluating lymphadenopathy and
splenomegaly.
Perform appropriate history, physical, documentation and presentation on new consults
and follow up visits in patients with hematologic disorders.
Perform bone marrow aspirate and biopsy.
Oncology
Appropriately evaluate patients with solid tumors, including breast, lung, prostate, GI,
and hematologic malignancies.
Be able to explain to patients the differing roles for chemotherapy and treating cancer,
palliation versus a hoped-for long-term remission, and some of the goals that can be
obtained through a so-called “palliative” treatment.
Evaluate pain, isolate its causes through physical exam and history-taking, and
recommend appropriate therapy.
Examine and evaluate patients with breast complaints, including breast pain, masses, and
discharge.
Perform a cancer-based physical exam on patients with solid tumors to assess cancer
burden, to take a cancer-based history, and to ask questions to elicit cancer risks,
including an examination to uncover paraneoplastic syndromes, new tumor areas, and the
examination and treatment of hematology/oncology emergencies.
Perform appropriate history and physicals in patients receiving chemotherapy and
radiation looking for complications of treatment.
Perform appropriate history, physical, documentation and presentation on new consults
and follow up visits in patients with oncologic disorders.
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Recognize the importance of screening in the general population regarding how often to
perform routine cancer screens and at what age.
Understand how hospice can be an option for terminally ill patients, and residents will
gain some understanding of how differing religions deal with death and mourning &
learn to perform
Medical Knowledge
Hematology
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Have knowledge in the appropriate use of blood products.
Indications for bone marrow biopsy and aspirate.
Initiate evaluation of common hematologic problems.
Interpret hematology lab tests including the peripheral smear.
Obtain adequate bleeding history.
Treat uncomplicated hematologic problems.
Understand the “coagulopathies” and how to assessing both the bleeding and the hypercoaguable patient.
Oncology
Learn complications associated with the common chemotherapeutic agents
Learn the major complications which may be associated with malignancies
Recognize and have knowledge to treat oncologic emergencies including: hypercalcemia,
pericardial complications, tumor lysis, cord compression, CNS metastases.
The basic principles of radiation therapy, simulations, and treatment.
The importance of nutrition in cancer, and how to modify diet to maximize health.
The multiple causes of pain, including depression, anxiety, paraneoplastic syndromes,
and referred pain.
Understanding of natural history, pathology, staging, and therapeutic options of solid
tumors, including breast, lung, prostate, GI, and hematologic malignancies.
Practice-Based Learning
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See Roman numeral II
Projects; Review topic for conference
Tour of bone marrow processing lab to learn some of the fundamentals of peripheral
stem cell collection and storage, and to learn when this therapy is appropriate
Interpersonal and Communication Skills
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See Roman numeral II
Professionalism
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See Roman numeral II
System-Based Practice
3
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Understand how Hematologists and Oncologists function as part of a health care team of
primary care providers, nurses, social workers, extended family, nutritionists and the
patient.
Check Any Methods Used For Teaching and Assessment:
[ ] Ambulatory Clinic (feedback written & verbal)
[ ] Annual In-service Exam (feedback written)
[ ] Attending Rounds (feedback written & verbal)
[ ] Board Review (feedback written examination)
[X] Cancer Conference
[ ] Case Management Evaluation (360 degree written evaluation)
[X] Chart Stimulated Recall & Feedback (feedback verbal)
[X] Direct Observation and Feedback (feedback written & verbal)
[ ] GME Core Curriculum
[ ] Interns Report (feedback written & verbal)
[ ] Journal Club (feedback written & verbal)
[X] Medical Record Review (feedback written & verbal)
[ ] Mentor Feedback (feedback written & verbal)
[X] Monthly End of Elective Exam (feedback written)
[X] Monthly Mini CEX (feedback written & verbal)
[X] Monthly Competency Based Written Evaluation
[ ] Morning Report (feedback written & verbal)
[ ] Multidisciplinary Rounds Feedback (feedback verbal)
[ ] Nursing Evaluation (360 degree written evaluation)
[ ] Patient Evaluation (360 degree written evaluation)
[ ] Patient Management Discussions (feedback written & verbal)
[X] Procedure Logs
[ ] Performance improvement Multidisciplinary Morbidity and Mortality
(feedback written & verbal)
[ ] Semi Annual Program Director Feedback (feedback written &
verbal)
[ ] Student Evaluation (feedback written & verbal)
[ ] Supervised Sign-In Rounds (feedback written & verbal)
[ ] Supervised Sign-Out Rounds (feedback verbal)
Other Policies:
The Course Director recognizes that the trainee is accountable to all BMC Residency and GME
Personnel Policies and Procedures. The Course Director recognizes that the residents are
expected to attend all continuity clinics and mandatory educational conferences unless excused
by the Program Director or Chief Medical Resident with advanced notice.
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Check The Educational Materials Used (beyond direct patient care):
[X] Reading List:
Articles to be given as cases discussed. In addition,
1.
2.
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4.
5.
6.
7.
Williams, Hematology.*
Wintrobe, Hematology.
Jandl, Blood.*
Ratnoff, Disorders of Hemostasis.
Journals: Blood, Seminars in Hematology.
Devita, Principles and Practice of Oncology
Selected articles in journals: Cancer Journal of Clinical Oncology Seminars in
Oncology
*Suggested texts
[X] Review of Appropriate Radiology Images
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Resident will gain familiarity with reviewing CT, MRI, Plain films, and PET scan results
to stage and work up malignancies
[X] Review of Appropriate Pathology
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Resident will gain familiarity in reviewing peripheral smears as well as bone marrow
aspirates & biopsies as well as reviewing tissue biopsies & histopathology both in person
with the Oncologist & Pathologists as well as in a group setting at Cancer Conference.
[X] Review of Appropriate Laboratory Data
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Resident will gain familiarity with indications and interpretation of tumor markers as well
as interpretation of any other routine lab work done on patients under their care.
[X] Articles from the Literature
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Resident will gain familiarity with using appropriate search engines to find information
about chemotherapy and treatment protocols.
[ ] Other (Please Specify):
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