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Hematology/Medical Oncology Fellowship: Program Curriculum |
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Residency & Fellowship Programs > Internal Medicine > Hematology/Medical Oncology Fellowship: Program Curriculum |
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- Program Structure General Training Environment The Hematology/Medical Oncology Fellowship is a small (total of 6 Fellows, 2 per year) collegial program with a wide variety of clinical, educational, and scholarly opportunities. Because of the small size of the program, all 6 Fellows and all faculty attending physicians have frequent opportunities to work closely with each other and become familiar with each other’s interests and expertise. A responsible attending physician is readily available at all times to support a Fellow during rotations, and when on call duty which is taken from home. The curricular goals of the Fellowship are accomplished through a variety of inpatient and outpatient experiences and a variety of electives:
In addition, many lectures are given on campus by both visiting speakers and University of Vermont faculty on topics related to Hematology or Medical Oncology in the Departments of Pathology, Biochemistry, Microbiology, Surgery, Molecular Genetics, and Pharmacology. Continuity Clinics Each Fellow sees at least 200 hematology and 200 oncology consultations annually covering a broad array of diseases and presentations. Fellows attend two half day continuity clinics weekly in Hematology and Medical Oncology respectively during the entire 3 years of training. Continuity is assured by working with the same faculty Attending physician in the same clinic, for a minimum period of 6 months evaluating and managing a particular set of conditions seen in the specialized practice of that Attending physician. The outpatient experience is supplemented by a specific outpatient clinic elective which allows a Fellow to learn about other disorders that they have not been exposed to during the continuity clinics.
The principal rotations are:
More time is available for research in the second and third years. Month long electives:
A one month allogeneic bone marrow transplant rotation is usually taken at another center and is supported with extra funds to defray additional costs. The educational experience is further enhanced by mentored participation in one of four structured senior year specialized training tracks in supportive care, hemostasis and thrombosis research, cancer genetics, and breast oncology for each of which extensive and sophisticated resources are available.
In addition to a high level of scholarship, Fellows gain proficiency in the modern ACGME competencies including:
. Fellows also develop competence and technical expertise in relevant procedures such as:
As the major tertiary care hospital serving Vermont and northeastern New York and the primary teaching hospital for the College of Medicine, Fletcher Allen Health Care provides access to a range of patients with rare and complicated diseases as well as those with conditions that are prevalent in any community, although disorders specific to ethnic minorities (e.g. sickle cell anemia) and HIV related malignancies are under-represented . However, because there is no county or veteran’s hospital in the area, Fellows sees patients from the full socio-economic spectrum. In addition, the vast majority of patients admitted to Fletcher Allen Health Care are available for teaching. The outpatient services are located in the Vermont Cancer Center clinics on the 2nd Floor of the Ambulatory Care Center immediately adjacent to the Breast Care Center, Radiation Oncology and clinical laboratories.
The faculty practice comprising the Fletcher Allen Health Care (FAHC) Hematology-Oncology Division consists of 11 board certified subspecialists with specific disease site expertise or fields of interests. All faculty physicians are also members of the Vermont Cancer Center, and serve on a variety of FAHC committees pertaining to clinical practice, teaching and research such as the Cancer, Pharmacy and Therapeutics, and Education committees, thus providing many opportunities for Fellows to gain professional experiences or freely access research resources such as statistical consulting or the Cancer Registry which publishes the annual FAHC Cancer Program Annual Report on its website. Fellows, like faculty, are supported by clinical research nurses and associates, a nutritionist, social worker, massage therapist, and licensed doctorate clinical psychologists (from the Cancer Patient Support Program) who are available on site to provide free services including participation in clinical trials. Fellows also get limited but valuable exposure to private practice oncology Attending physicians on weekends and during inpatient teaching rounds for several weeks each year.
Each faculty physician's clinical and research specialization covers the areas of
In concert with interested and specifically skilled members of other Departments such as Surgery Radiation Oncology, and Pathology, faculty lead or participate in multidisciplinary services or programs for breast cancer, lymphoma, high-dose chemotherapy/stem cell transplant program, thrombosis and hemostasis, gastrointestinal cancers, pancreatic cancer, genitourinary/urologic cancer, and familial cancers. Some of these activities are manifested in the wide variety of teaching and research conferences.
The principal monthly rotations are
There are substantially fewer hospital based rotations in the second and third Fellowship years when electives and research months predominate. Beyond an ACGME mandated 18 months of clinical rotations, Fellows have the opportunity to tailor their second and third year experiences with the assistance of their mentor towards an individualized training track. Specialized Training Tracks are also available. Throughout the 3 years of training, regardless of rotation, Fellows maintain responsibility to their continuity clinics.
Fellows present a half hour seminar every 6 weeks in rotation, on a current topic of interest. Fellows also present at Vermont Cancer Center Grand Rounds once in the second and third years, and lead journal club discussion twice a year. A weekly meeting led by the hospital-based Fellows, and attended by faculty, inpatient and outpatient nurses, pathology and research personnel optimizes communication between inpatient and outpatient care givers and serves as a quality assurance forum for all hospitalized hematology and oncology patients. The inpatient service Fellow also leads the inpatient unit weekly multidisciplinary discharge planning meeting attended by internal medicine residents, a case manager, social worker, nutritionist, nurse manager, palliative care nurse, chaplain and other ancillary personnel.
The individual Fellow’s progress through a graded set of educational, professional and scholarly experiences commensurate with a rising level of responsibility assigned to each year of training, is evaluated and guided by the Program Director every 6 months. Examples of advanced activities include:
Fellows maintain a portfolio binder that documents a personal program of self study and professional growth, and supports achievement of the standard competencies necessary for graduation. The Chief Fellow is a third year fellow who serves on the Division's Education Committee, manages rotations, call, back-up and vacation schedules, assists in developing a core lecture series and MKSAP review schedule, and assists the Program Director at the Fellow’s monthly curriculum review meeting.
Fellows are strongly urged and supported to go to at least one major national professional meeting (American Society of Clinical Oncology or American Society of Hematology) each year but often also attend updates or research conferences and join special courses. Each year Fellows attend the Annual Northeast Regional Hematology/Oncology Fellows Conference which serves as an excellent forum for Fellow level presentations, networking, education and camaraderie among New England based Fellows amidst the best winter recreation in the Northeast.
Hematology and Oncology faculty pursue basic, epidemiologic, and clinical research. Areas of active clinical investigation on the local and national levels include breast cancer, lung cancer, genitourinary cancer, symptom management, cancer genetics, and developmental therapeutics. A research training program in hemostasis and thrombosis is available which can include a wide variety of topic areas including study of the epidemiology of venous and arterial thrombosis in large US populations, translational studies of hemostatic function in relation to myeloproliferative disease, cancer and vascular disease, and basic biochemistry of blood coagulation Mechanisms of carcinogenesis (leukemogenesis) and determination of individual and familial risk are studied in ongoing translational programs in Hematology and gastrointestinal malignancy. Collaborations with researchers in other departments including Pathology, Biochemistry, and Health Promotion are available and increase the available clinical and basic science projects.
As a member of the Cancer and Leukemia Group B (CALGB), the National Surgical Adjuvant Breast and Bowel Project (NSABP), Gynecologic Oncology Group (GOG), Radiation Therapy Oncology Group (RTOG), and Pediatric Oncology Group (POG) (via the Vermont Cancer Center), the Hematology/Oncology Division actively participates in the design and implementation of treatment trials in all phases, employing a variety of immunologic, anti-angiogenic, receptor targeting and other investigational agents. Fellows are exposed to clinical trials as an integral part of high quality, modern cancer care. Each year, funding is available for a Fellow to attend a general meeting of the Cancer and Leukemia Group B meeting in the second or third year.
Research activities carried out within the program by the unit faculty are supported by grants from the National Cancer Institute, the Department of Defense, the American Cancer Society, the American Health Association, the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, the Vermont Cancer Center/Lake Champlain Cancer Research Organization, and pharmaceutical sources. Research opportunities for fellows also are offered by faculty with adjunct appointments in the Department of Medicine. Biostatistical support is available through the Vermont Cancer Center and the Department of Medical Biostatistics of the University of Vermont. The philanthropically supported DeGroot Fund is available to trainees interested in Hematology projects.
Fellows are offered 12 to 18 months of research time and may participate in basic or clinical research with faculty mentoring. Fellows are expected to participate in at least one research project during the fellowship and a Fellow’s initially assigned general mentor is often helpful in matching a Fellow’s interest to the general categories of research opportunities available. A research project is typically embedded in any one of the specialized training tracks in:
Throughout the first year the fellow should become familiar with the research interests of the faculty through conferences and individual exploration and discussions leading to the choice of a research mentor and begin project planning and design. The project should be initiated early in the second year and completed in the third year. Under the supervision of a research mentor, Fellows are expected to write grant proposals for ASCO, ASH, or CALGB and other locally available grants as well as to make the principal effort in conducting and analyzing the research. Our Fellows play an important and integral role in the life of the Hematology/Oncology Division and enrich the clinical, educational and research missions by their individual contributions and participation in divisional activities.
Although run by a Program Director and Associate Program Director, all faculty are closely involved with Fellowship training. The program is in full compliance with ACGME duty hour policies and aspires to strike a healthy balance between career development and personal freedom in the lives of our Fellows. Fellows are given a great deal of flexibility in tailoring their supervised program experiences, developing a mentored strategy of professional growth, and optimizing their readiness for successful placement.
Fellows have considerable resources available to support their educational goals and to facilitate functioning as physicians, trainees and researchers. Fellows receive laptop access and LCD projector use, free parking permits, business cards, white coats with embossed name, free cell phone when on call, free library copy card use. They have access to Division secretarial resources for academic and educational activities as well as primary nurse support in the clinic for assistance with patient care issues.
Fellows from a wide variety of demographic (age, gender, marital status) and educational (MD, MD/PhD, DO, IMG) and ethnic backgrounds, coexist very comfortably in this program embedded in a university campus within a college town. We adhere in letter and spirit to the policy of Fletcher Allen Health Care to “provide employment, training, compensation, promotion, and other conditions of employment without regard to race, color, sex, age, religion, national origin, sexual orientation, ancestry, place of birth, or disability” both in our recruitment process and during the training program.
The greater Burlington area offers many fine opportunities for children, families and individuals with respect to residential options, education, all-season recreation, community fellowship, and entertainment. An annual Fellows’ Welcome party, Holiday Season party, and Farewell celebration are important social hallmarks of the life of the Hematology/Oncology unit. Faculty, Fellows and alumni routinely meet for dinner annually at the American Society of Clinical Oncology meeting and the American Society of Hematology meeting. Additional information regarding the Hematology/ Oncology Fellowship Training Program can be obtained from the program coordinator Gail Berry (802-847-5971 or Gail.Berry@vtmednet.org) or the program director (George.Philips@vtmednet.org).. |
 George Philips, M.D.
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