The first year of training is dedicated to an intensive clinical exposure in hematology, oncology, immunology and stem cell transplantation. All clinical training is based at Children's National.
Oncology Inpatient Service
Three months of the first year are spent on the oncology inpatient service, which includes caring for both acute and chronic patients.
During the inpatient rotation, the trainee is responsible for:
- Conducting daily work rounds with the house staff along with a senior resident
- Providing immediate support and supervision to the house staff and nursing staff
- Writing all chemotherapy orders
- Performing all procedures (bone marrow aspirates, bone marrow biopsies, and lumbar punctures with intrathecal chemotherapy)
- Educating patients and their families on their illness
- Communicating with patients and their families on the plan of care
- Communicating with the patient’s primary care physician
- Obtaining consent for treatment protocols for newly diagnosed oncology patients
Routine daily orders are handled by the house staff. All activities are performed under the direct supervision of an attending physician in oncology. Oncology consults are seen by the inpatient oncology team.
Hematology Inpatient Service
Three months of the first year are spent on the hematology inpatient service.
During these three inpatient months, the trainee is responsible for:
- Conducting daily work rounds with the house staff
- Providing immediate support and supervision to the house staff and nursing staff
- Educating patients and their families on their illness
- Communicating with patients and their families on the plan of care
- Communicating with the patient’s primary care physician and coordinating care for the patient
All activities are performed under the direct supervision of an attending physician in hematology oncology. Hematology consultations are performed by the inpatient hematology team. Occasionally, immunology consultations also will be done by the hematology fellow.
Stem Cell Transplantation Service
Two months of the first year are spent on the stem cell transplantation service.
The trainee is responsible for:
- Conducting morning rounds
- Supervising all aspects of the patient's care
- Communicating with patients and their families
- Performing all procedures (lumbar punctures, bone marrow aspirates and biopsies, bone marrow harvest, and skin biopsies)
All activities are performed under the direct supervision of an attending in stem cell transplantation. Immunology consults are seen by the BMT/Immunology team.
Consultations
For consultations, the trainee is responsible for:
- The initial evaluation
- Formulation of a diagnostic approach and therapeutic plan of action
- Review of the literature
- Communicating recommendations with the referring team
- Providing follow up on further evaluation and management
All activities are reviewed and directly supervised by either an attending physician in hematology, oncology or immunology.
Fellow Continuity Clinic
Fellows will have a one-half day continuity clinic throughout their three years of training. Fellows identify new patients with leukemia/lymphoma, solid tumors and complex hematologic disorders, which will be their patients to follow longitudinally. The fellows will have the responsibility of managing all aspects of their patients’ care from diagnosis to completion of therapy to follow up and management of relapse if necessary. One new hematology patient will be filtered into the fellows’ continuity clinics each week in order to get exposure to the hematology new patient consultation. Fellows in their third year will participate in our multidisciplinary subspecialty clinics including neuro-oncology, thrombosis, hemophilia, stem cell transplant alternating with their continuity clinic. Other opportunities exist in late effects, sarcoma, infant sickle cell clinics as examples. Fellows also will rotate into the procedure room schedule performing five to six procedures under attending supervision in the second and third year to maintain their procedural skills.
Outpatient Clinic
Fellows will attend the outpatient oncology clinic for one block month and the outpatient hematology schedule for one block month.
Fellows are expected to:
- Evaluate the patient
- Develop a diagnostic and therapeutic plan
- Follow up on outstanding laboratory, radiology or pathology tests
The fellow is also responsible to perform any procedures required at the visit. All activities are under the direct supervision on an attending in hematology oncology, stem cell transplantation or immunology.
Laboratory Medicine
One month of the first year is spent on an elective rotating through transfusion medicine, hematology, special hematology and coagulation laboratory, flow cytometry and cytogenetics. During this month, the trainee learns:
- The principles of transfusion medicine
- The principles of radiation oncology
- How to perform and interpret testing in the special hematology and coagulation laboratory
- Review of peripheral smears
- How to interpret flow cytometric results
- Exposure to the technical areas in medical cytogenetics
Radiation Oncology
Children’s National Hospital and Johns Hopkins have partnered to create the first dedicated program in Washington, D.C., which focuses on advancing pediatric clinical care and pediatric radiation oncology research. Our radiation oncology team members are on site to evaluate patients, attend oncology tumor boards and provide education for trainees. Our fellows spend a week following their first year with our radiation oncology team at the radiation treatment center.
