Rotation Descriptions

Rotation Descriptions



TEACHING/INPATIENT SERVICE:

2 faculty, 1 fellow, 3 resident-intern pairs, + 1 float-1 MS

  • Serve as a consultant to the residents taking care of patients on the hem/onc teaching service.
  • Attend "Morning attending rounds" as consultant/educator.
  • Manage/supervise specialized hematology/oncology care and write chemo orders/obtain consent for service patients.
  • Look ahead at pre-admits scheduled for the following day and arrange to have all chemotherapy orders and consents completed in order to avoid delays in patient care.
  • Perform all bone marrow aspirations/biopsies on service patients.
  • Share "on-call" duty with the fellow on the hematology consult service. Every other night and every other weekend - See On Call Responsibilities and Duty Hours policies.
  • Attend "check-out" rounds daily with residents to address problems if they arise.
  • Teach on rounds and during scheduled fellow teaching sessions (at least 2/wk).
  • Accept transfers from other services or hospitals, facilitate admission of patients from clinic and arrange follow up for patients seen in the ER during duty hours.
  • Help arrange for follow-up on patients discharge from the impatient service.
  • Responsible for overseeing the daily care of all patients on the hem/onc service by serving as consultant to house officers and liaison with faculty and staff.

ONCOLOGY CONSULTS:

1 fellow, +/- resident, +/- student, 1 faculty

  • Inpatient fellow is responsible for all inpatient oncology consults during work hours (8-5).
  • Inpatient consults will be staffed with disease-specific attending (ie, lung cancer attending if patient has lung cancer) or the attending assigned to oncology consults for that 2 week block.
  • All consults will be seen the same day if called before 4 PM or next day if not urgent.
  • A fellow may choose to follow an inpatient or outpatient consult in their continuity clinic. If they choose NOT to follow the patient after discharge from the hospital, they must assure that adequate follow-up for the patient has been established.
  • All initial consultations are done on an "Initial Inpatient Consultation" form. This form should be placed in the patient's chart and eventually co-signed by the staffing attending.
  • Inpatient consult dictations should be completed the day of the consult (See inpatient consult dictating policy). They must be signed within 24 hours.
  • Follow-up notes should not be dictated, but should be performed on the "Concurrent Care Note" form.
  • Review all pathology, scans and laboratories on all consults.
  • Provide follow-up care, arrange disposition to appropriate oncologist, or indicate release of patient from oncology care for all consults.
  • Supervise residents working on the oncology consult - assign patients, teach, and review.
  • Dictate letter at conclusion of consultation to outpatient oncologist/physician with review of findings/laboratories and final recommendations if appropriate. 1 Fellow, at most 1-3 faculty.

AMBULATORY CLINICS:

  • Fellows choose 1-3 faculty / disease states per month rotation.
  • Fellows must spend a MINIMUM of 2 clinic sessions/wk (1 day/wk) with 1 faculty member for the entire month, but spending every clinic session with that faculty is preferred.
  • Fellows should not "drop in" on clinics during this rotation but plan to spend an extended time (at least 2 sessions per wk) in each of the 1-3 clinics they choose. How many clinic sessions the fellow attends with each faculty member will determine how many faculty (s)he works with during the month but NO MORE THAN 3.
  • Fellows will spend a minimum of 6 clinic sessions (3.0 days/wk) in disease specific clinics.
  • Fellows will be responsible for seeing new and return patients during each clinic session as determined by the faculty.
  • Each faculty will provide the fellow with specific rules of operation for the clinic in regards to which patients to see, how to present, dictation expectations, etc.
  • Fellows are expected to learn basic diagnostic and chemotherapy regimens for each disease state as a first year and expand treatment options for refractory disease by the second/third year of fellowship.
  • Fellows will work with faculty, physician extenders and nurse coordinators to write orders, schedule tests and follow-up results for clinic patients.
  • Fellows will be expected to present at disease-specific tumor boards weekly during the rotation and to attend all tumor boards for clinics they attend.
  • Fellows will spend one clinic session / week in Fellows' Continuity Clinic and one clinic session a week in their 4 month disease specific clinic.
  • Except for absences to attend a tumor board or required conference, the fellow will be expected to be in clinic all day Mon-Fri, 8-5 until clinic patients'/chemotherapy patients' needs have been addressed for the day.  
  • Fellows must attend all mandatory conferences during the week/month - on average one hour of didactic / clinical review a day, journal club monthly, grand rounds/Cancer Center seminar weekly.
  • Fellows have no on-call responsibilities during this rotation EXCEPT as the DESIGNATED backup fellow who will cover the inpatient service/pager call after hours IF the inpatient ward coverage fellow is unable to take call.
  • Emergent outpatient non-directed oncology consultations fall within the responsibility of the ambulatory care fellow.  They should be staffed with the disease-specific attending, one of the ambulatory care attendings, or the oncology consult attending (by default). The fellow will also see unassigned urgent/emergent outpatient consults that cannot be seen by another faculty clinic in a timely manner.
  • Outpatient consults should be staffed with disease-specific attending if available, clinic attending if possible OR oncologist assigned to inpatient consults as default.

HEMATOLOGY CONSULTS:

1 fellow, +/- resident, +/- student, 1 faculty

  • Responsible for all inpatient and undirected urgent/emergent outpatient hematology consults during work hours.
  • Staff outpatient consults with disease specific attending if possible-default attending is the hematologist assigned to the consult rotation.
  • A faculty member will be assigned to staff hematology consults every day and will staff all inpatient consults UNLESS this faculty member personally calls another hematologist to see the patient.
  • See all consults and staff within 24 hours, less for emergent / urgent consults.
  • All initial consult notes to be stat dictated day of consult with preliminary note in chart. (See inpatient consult dictating policy). Must be signed within 24 hours.
  • Review all pathology, scans and laboratories on all consults.
  • Provide follow-up care, arrange disposition to appropriate physician for hematologic problem, or indicate release of patient from hematology care for all consults.
  • Perform, interpret and sign-off all bone marrow aspirations on heme consult patients.
  • Coordinate residents / students on elective and provide short teaching sessions during work rounds.
  • Fellow will see all patients active on the consult service daily and decide which established patients need an attending visit.

ELECTIVES:

  • Required electives MUST be completed during the fellowship. Fellows choose when to do the electives. See list of required electives on the Overview page.
  • Fellow designed electives require "Goals and Objectives" form.
  • No "on-call" scheduled during the elective unless covering for the inpatient/heme fellow.
  • Must be available 8AM-5PM M-F OR appropriately signed out.

CONTINUITY CLINIC:

Friday morning 8-12 

  • Fellows' Clinic is scheduled every Friday morning except for official clinic holidays.
  • Weekly attendance is mandatory if not away on vacation or professional leave.
  • A clinic must consist of 4-8 scheduled patients. A "fellow" patient seen in "swing" clinic due to problem that could not wait until Friday's clinic will count as part of 4-8 "continuity patients" scheduled per week IF staffed by faculty.
  • Only follow-up patients are scheduled while on inpatient service.
  • While on inpatient service, clinic will start at 10 am.
  • All patients will be scheduled as "fellow" patients for Friday clinic with staffing faculty added at the end of clinic for billing/documentation purposes.
  • All fellows' patients must have the fellow as the ordering physician for laboratory and scans-fellows must fill out laboratory request signing as ordering physician.
  • For infusion patients, the fellow MUST provide orders co-signed by attending for chemotherapy, laboratory slips with their name as ordering physician, and a brief clinical summary for the infusion staff. Review infusion policy and "Fellow Patient Infusion" form.
  • IF a patient is seen without being staffed by faculty, ie, lab only visit or limited problem not requiring faculty input, the chart will not have a faculty name added. All orders for labs or radiology MUST indicate fellow as ordering physician. The patient must be dictated as "fellow only" using 57 code and note must be signed within one to two weeks.
  • All clinic patients must be included in clinic log including diagnosis and transition of care plan at time the fellow leaves the institution. Every 6 months, 4-6 patients must be selected for self-assessment of practice and reviewed for appropriate care with faculty. See "Practice Self-Assessment" form.
  • Clinic will be reviewed at least semi-annually for timeliness of medical record completion, attention to required documentation for level of care, and appropriate "cc" to primary care or other physicians of record. At least 50% of clinic notes MUST be reviewed/edited by fellow within 7 days and 75% must be reviewed within two weeks. Attendings will be asked to not cosign for 7 days. For fellow only notes, 75% must be reviewed in 7 days and 90% reviewed in 2 weeks and all reviewed within 3 weeks (will allow for vacation/away time).
  • All bone marrow biopsies on clinic patients performed by fellow.
  • Coverage must be arranged for clinic patients during absences.

DISEASE SPECIFIC CLINICS: 

4 month block:

  • Morning clinics are scheduled from 8am-12pm and afternoon clinics are scheduled 1pm-5pm EXCEPTIONS to start times:
  • Inpatient service fellow will report at 10 after completing inpatient rounds and may stay until mid afternoon as long as released for noon conference.
  • Required meetings/lectures/programs may require shifting of clinic times.
  • The clinic fellow is responsible for bone marrows on patients whom they have seen or will see with the faculty.
  • Fellow is "first call" for nurse coordinators working with clinic for patient calls/needs.
  • Notify in writing (email) the clinic faculty, nurse coordinator and secretary one-month in advance for planned absences. See vacation and leave policies.
  • Medical record timeliness and completeness will be evaluated by faculty at end of rotation.
  • Must be available 8AM-5PM for coverage. See Work Hours, Vacation, Leave policies.
  • Fellows must take an active role in clinic patient management by meeting with preceptor to discuss scans, labs, and clinical course of patients between clinic visits.

CONFERENCES:

  • Fellows must attend all required conferences (core/didactic lectures, Introduction to Clinical Investigation - Fall series, Journal Club, Grand Rounds, etc) unless an emergent patient issue interferes.
  • Attendance at scheduled conferences will be taken and absences addressed at 6 month evaluation with PD.
  • Must attend one tumor board a week, preferably for preceptor's specialty unless schedule conflicts with primary service obligation. Fellows are encouraged to attend other tumor boards, especially while on elective.
  • Required to prepare 1-2 Journal clubs and at least 1 Grand Rounds and 1 Morbidity/Mortality conference each year.
  • Administrative fellows (usually second years) are responsible for scheduling Grand Rounds, Journal Club, and didactic lectures.