The Division of Hematology/Oncology offers a three-year combined Hematology and Medical Oncology (Hem/Onc) training program. Trainees must complete the American Board of Internal Medicine requirements for specialty training in Internal Medicine before they will be allowed to begin subspecialty training in Hem/Onc. A trainee must be board certified in Internal Medicine AND complete training in Hem/Onc before they will be eligible for certification by the American Board of Internal Medicine in the subspecialties of Hematology and Medical Oncology.

The University of Virginia Health System is a referral center providing primary and tertiary care for large portions of Virginia and West Virginia. All inpatient and outpatient services in Hem/Onc are provided in Charlottesville. The Hem/Onc inpatient service consists of 26 ward beds. Two attendings are assigned to the inpatient service. The attending directs a fellow, residents, interns, and medical students, and provides primary coverage for the ward service. Outpatient facilities include the Cancer Center clinics and Infusion Center, a multi-headed microscope room for review of pathology and bone marrow specimens, and multiple conference rooms.

The University of Virginia is the recipient of a NCI Cancer Center Support Grant with basic research programs in: cell-signaling; endocrinology and cancer; immunology of cancer; metastases, invasion and cell surfaces; and clinical research focusing on drug discovery, including phase I and II clinical trials and phase III trials in cooperation with the ECOG, GOG and NSABP. To learn more please visit the  Cancer Center's Research Programs page.

Clinical Experience

A fellow in the combined Hematology / Oncology training program is required by The American Board of Internal Medicine to complete a minimum of 18 months of full time clinical training with patient care responsibility and 36 months of an outpatient continuity clinic. Full-time clinical training is defined as at least 80% of the fellow's professional time during a working week dedicated to clinical (patient care or educational) activities. The 18 months of clinical activity must include 6 months of benign hematology, and 12 months of neoplastic diseases including malignant hematology. In addition, the board requires training in a number of associated disciplines and procedures. These requirements are met by rotations on the inpatient ward, hematology consult service, ambulatory oncology block, "disease specific" clinics, and selected clinical electives.

Outpatient Clinics:

The continuity clinic provides a major portion of a fellow's education in the natural history and management of hematologic and oncologic disorders. Continuity clinic is one-half day a week for the entire three years of the fellowship. Each fellow accumulates a panel of patients with various hem/onc disorders for whom they provide longitudinal care. The fellow is expected to assume the primary hem/onc caretaker role for their patients. Faculty staff fellows' clinic to fulfill teaching, supervisory, regulatory and billing requirements, but the fellow assumes full responsibility with guidance from faculty for management of the patients. Incoming fellows assume the care of patients from departing fellows' clinic roster.

Effective July 1, 2005, ACGME requires in addition to continuity clinic, that at least 10% of the required 18 months of clinical training must be spent in an ambulatory setting (i.e., the equivalent of 72 half-day sessions). The fellow works directly with one faculty member in a "disease specific" clinic for a 4 month block before rotating to another clinic. The fellow will participate in 5-9 blocks during the 3 years depending on whether they follow a clinical or a basic research track. Disease-specific clinics include breast, prostate/GU, lung, GI, head/neck, sarcoma, malignant hematology, and benign hematology and hemostasis. Most cancer clinics are multidisciplinary, thus fostering a team approach inclusive of surgeons, pathologists, medical oncologists and radiation therapists. Additional ambulatory experience is obtained during ambulatory oncology blocks and as electives in the second and third years. Both a variety of attending management styles and a mix of patient disorders will be encountered. During a clinic rotation, the fellow evaluates new patients, reviews progress of established patients, and participates in multidisciplinary aspects of the disease-specific clinic by participating in post-clinic conferences and tumor boards.

Consultation Services:

The Hematology consultation service operates separately and independently providing inpatient consultations as well as undirected outpatient consultations. One fellow is assigned to the Hematology consult service and residents or medical students may also participate. The oncology consult service is covered by the ward fellow assigned to the inpatient rotation. The consult fellow coordinates the service's activities working closely with the consult attending, medical residents and medical students (if present). The on call ward fellow assumes responsibility for all consultations, hematology and oncology, at night, on weekends and holidays. Consultation in hematology and oncology are provided 24 hours a day, 7 days a week. The consult fellows supervise and teach the residents and students rotating on the service.

Inpatient Service:

The ward attending and fellow work closely with residents to provide optimal care to patients with a variety of hematologic or oncologic problems. One fellow is assigned to the inpatient ward. The ward fellow shares night and weekend on call responsibilities with the hematology consult fellow adhering to duty hour limitations. The ward fellow's responsibilities include: overseeing hem/onc specific care of all patients on the service; providing didactic and clinical teaching in hem/onc to the residents and medical students; participating in morning rounds and evening check-out rounds; writing chemotherapy orders; administering intrathecal chemotherapy; and performing bone marrow biopsies and interpreting bone marrow aspirates for inpatients on their service. The general medical care for each patient is the primary responsibility of the resident not the fellow but the fellow may serve as a general medical consultant to the resident as needed. The inpatient fellow also covers oncology inpatient consults.

Electives:

Formal electives are required in stem cell transplantation, radiation therapy, blood banking, hematopathology, specialty diagnostic laboratories (immunology, flow cytometry, cytogenetics, molecular genetics), coagulation, gynecologic oncology, palliative care and pain control, and infusion center with chemotherapy administration. Remaining elective time may be self-designed but requires approval of curriculum, goals and evaluation method by the program director.

Research

Participation in a research project during the fellowship is required. A fellow must choose a research track before the end of the first year of fellowship. The design of the last two years of training differs depending on whether a fellow elects a basic or clinical research track. The basic research track requires completion of preferably all but the continuity clinic portion of the clinical requirements by the end of the second year so that a full year may be spent in the research laboratory with few interruptions for clinical rotations. Fewer electives are available as the basic research fellow concentrates on the core clinical components to allow additional time in the research laboratory. Several basic research areas are available through the Cancer Center. The clinical research track begins at the end of the first year. Clinical research requires continued involvement of the fellow for at least two full years although only isolated months will be reserved for research only activities. Patient accrual into trials and intermittent study activity occur continuously and therefore fellows will frequently be participating simultaneously in research activities and other clinical rotations. Clinical research protocols are available within the context of ECOG and other collaborative groups and as investigator-generated protocols in cancer and hemostasis.

Educational Experience

In addition to the clinical experience, didactic lectures and conferences are a vital part of the fellowship. ACGME requires Conferences to be conducted regularly as scheduled and must be attended by faculty and fellows. The fellowship complies with the minimum requirements of at least one clinical conference weekly (Grand Rounds/tumor boards); one journal club monthly; one research conference monthly(Cancer Center Seminar); and at least one core curriculum conference weekly, (averaged over 1 year).

The core curriculum conference series includes the basic sciences relevant to hematology and oncology and the clinical topics in the subspecialties. A core curriculum conference series is in place and will be repeated on an annual basis so that fellows will have several opportunities to attend the core conference topics. Additional conferences include weekly hematopathology, bone marrow sign out conferences, biweekly cancer center symposia, clinical coagulation conference and tumor boards that occur several times a week. Fellows are required to document in their portfolio that they have attended the required conferences averaging one clinical conference a week, 1 tumor board a week, attendance at one didactic lecture a week, and attendance at monthly journal club and research conference. Sign-in sheets for faculty and fellows are required.

A board review lecture series designed and implemented by the fellows provides an opportunity to teach peers and concentrate on specific topics over the three-year fellowship. Fellows are required to teach residents and medical students on rotations. Over the course of the 3 years the fellow prepares at least 3 grand rounds presentations, 3 Morbidity and Mortality conferences, and 4-6 journal club presentations. Presentations at tumor boards should occur at least monthly and preferably weekly. During the fellowship, each fellow will present either a talk or poster session at a regional, state or national meeting.

Committee/Administrative Experience

Fellows must serve on committees to learn administrative responsibility and to foster professional development in a healthcare system. Trainees are required to participate in the planning and conducting of conferences. Every fellow will participate in the Educational Committee in their 2^nd or 3^rd year to review, revise, and schedule the core didactic and grand rounds conferences. Every fellow will participate in the Clinical Committee in their 2^nd or 3^rd year to review, revise, and schedule the clinical rotations and electives. All fellows are encouraged to join practice committees to review and revise clinic procedures and policies. Fellows have recently served on the Infusion Center committee and the Practice Committee to implement a new electronic medical record. One fellow a year serves on the fellowship admissions committee.