Goals and Objectives for Pediatric Hem/Onc Fellowship Elective ...

BMT INPATIENT ROTATIONPURPOSEThe BMT inpatient rotation will provide a progressive experience to the first, second, and thirdyear fellows in the management of children who are undergoing hematopoietic celltransplantation. Over the course of these rotations the fellows will be expected to assume moreindependent responsibility for the management of the inpatient service.DESCRIPTIONMonth long inpatient rotation to be integrated into the clinical component of training during the 3year fellowship program.RESPONSIBILITIES1. Daily inpatient rounds will be held with the attending physician on 4Amplatz (and5Amplatz if BMT patients): rounds will include the residents, nursepractitioners/physician assistants, pharmacist, charge nurse, nurse coordinator andsocial workers. The fellow will be in charge of conducting rounds, supervising theresidents’ management of the patients, formulating daily and long term plans for allpatients. The fellow is responsible for communicating with the rest of the medical teamincluding consultants regarding the patients’ care. The fellow is responsible forinforming the attending physician of all pertinent issues, new problems that change thestatus of the patients and admissions.2. Daily examination and assessment of all pediatric BMT patients: The fellow isresponsible for a daily physical exam on all patients, ongoing modification of eachpatient’s medical care plan as issues arise throughout the course of the admission,communicating this plan to rest of medical team, including consultants, as well as to thepatient themselves and to family members.3. Perform comprehensive history (including details of past treatment) and physical examsan newly admitted BMT patients, collect and review all results of diagnostic studies andconsultsa. Review significant H&P findingsb. Review work-up resultsc. Determine protocol eligibilityd. Determine ancillary protocol eligibilitye. Discuss patient and review plans with attending physician4. The fellow will review the protocols the patient is enrolled on and consider any specialcircumstances for individual patients. Fellows will review criteria to determine thatpatients meet the eligibility criteria to receive assigned therapy.5. Supervise admission orders and write chemotherapy for patients: The fellow willoversee all admitting orders with residents or NP/PA and the fellow is responsible forwriting all chemotherapy orders.6. The fellow will perform bone marrow aspirates and biopsies, and lumbar punctures asrequired by protocol or clinical situation for BMT inpatients.7. The fellow will evaluate children who are seen in the ER during daytime hours andselected patients who require evaluation during the evening or night.8. The fellow is responsible for evaluating BMT patients that must be seen in clinic onweekends or during the holidays. All patients must be reviewed with the attending BMTdoctor. Changes in patient’s plans must be communicated with the primary BMT doctor.9. The fellow in conjunction with the attending MD will call each referring doctor at leastweekly with an update on inpatients. More frequent calls should be made as necessary1

The schedule will be determined by the fellow and staff, however Monday through Fridayinpatient rounds will typically begin between 8-8:30am. Fellows should be on the hospital sitefrom 8 a.m. until at least 5 p.m. Monday through Friday. Weekend rounding times aredetermined by the fellow and staff. The fellow will have 2 out of every 14 days of service free ofany clinical responsibilities, typically accomplished by every other weekend covered by an offservicefellow.LEVEL OF RESPONSIBILITY AND AUTONOMYSubspecialty resident training in our program is designed to promote the professional growthand development of subspecialty residents from highly skilled pediatricians to highly skilledsubspecialists. This occurs, in part, through the care of patients with a spectrum of benign andmalignant hematologic/oncologic disorders. The philosophy of this program is that subspecialtyresident’s learn best when they are as autonomous as their knowledge, skills and attitudepermit. The matrix below details the level of responsibility/autonomy by proficiency level of thesubspecialty resident. It is expected that the fellow will progress through these levels ofresponsibility as they advance through their fellowship.Our faculty are ultimately responsible for the welfare and safety of all patients, and thus willsupervise all patient care encounters in the ambulatory and inpatient settings. Faculty are oncall and available 24 hours a day and 7 days a week for supervision and consultation.Level of responsibility/ autonomy by proficiency levelClinical Activity Beginning Developing ProficientClinical data collectionFormulation of clinicalassessments/ plansConsultant:Communication ofrecommendations toprimary care team/referringphysicianSupervisor of care teamIndependent, with staffsupplementationJointly with staffJointly with staffJointly with staff; beginsefforts at teaching otherteam members insubspecialty issuesIndependent, with staffconfirmationIndependent, with staffconfirmation; independentutilization of evidence basedmedicine resources andsharing of information withcare teamIndependent, with staffconfirmation; independentutilization of evidence basedmedicine resources andsharing of information withprimary teamIndependent, with staffconfirmation of patient careissues; increasingresponsibility for teaching ofteam membersIndependent, with staffconfirmation of selectedissuesIndependent, with staffconfirmation of selectedissues; demonstratedmastery of a large set ofsubspecialty based skills andis preparing to practiceindependently;consistently incorporatesevidence based medicine andsystem based practices intoimproving self practice ofmedicineIndependent, with staffconfirmation of selectedissues; consistentlyincorporates evidence basedmedicine and system basedpractices into improvingeffectiveness of consultationIndependent, with staffconfirmation of selectedpatient care issues; sharedresponsibility with staff forteaching of team members4

BMT OUTPATIENT ROTATIONPURPOSETo provide a more in-depth experience to our fellows in outpatient management of pediatricBMT patients: 1) to gain experience in the pre-transplant evaluation of prospective BMTcandidates, determining eligibility for transplant, donor selection; and 2) to gain experience inthe management of complications outside of the acute care setting such as chronic GVHD,immune recovery, and late effects.DESCRIPTIONMonth long outpatient rotation to be integrated into the clinical component of training during the1st year of the fellowship program.RESPONSIBILITIES1. Attend daily BMT clinics (primarily AM’s but expected to be available 8-5 M-F), primarystaff will be the BMT Work-up/outpatient attending MD.2. Management of acute outpatient care of recently discharged BMT patients3. Management of acute and or chronic GVHD on an outpatient basis.4. Perform comprehensive history (including details of past treatment) and physical examsan new BMT work-up patients, collect and review all results of diagnostic studies andconsultsa. Review significant H&P findingsb. Review work-up resultsc. Determine protocol eligibilityd. Perform diagnostic procedurese. Participate in the exit conference and consent process5. Evaluate prospective bone marrow donors, determine eligibility for donating BM vs.PBSC, assist with bone marrow harvests6. Attend long term follow-up clinic7. Participate in disease focused clinics such as Fanconi Anemia (Wagner, MacMillan),metabolic disorders (Orchard, Tolar, Miller), immunodeficiency (Smith).8. Attend weekly BMT Status meetings9. Attend mini-rotations in the stem cell processing laboratory, molecular diagnostics,apheresis center10. Other duties as assigned by the Work-up/Outpatient Attending.11. Attend weekly Leukemia Program meeting (Monday 3-4pm Mayo A532)12. Attend Late Effect/ Long-term Follow-up Clinic 2 nd & 4 th Fridays am and the weeklyMonday afternoon pre-clinic meetings (4-5pm).GOALS AND OBJECTIVES1. To understand the outpatient management of common BMT problems and complications(transfusion support, FEN issues, hypertension, CSA management, fevers, infections)2. To gain experience with the management of acute GVHD on an outpatient basisincluding diagnosis, evaluation, staging, treatment.3. To gain experience with the management of chronic GVHD on an outpatient basisincluding diagnosis, evaluation, staging, treatment.4. To be able to determine a patients eligibility for transplant and to coordinate and interpretan appropriate pre-transplant evaluation5. To gain an understanding of the donor selection process6. To become proficient in bone marrow donor harvesting1

7. To gain an appreciation for the consent process involved in counseling patients prior totransplant8. To become familiar with the issues related to long-term follow-up in BMT survivorsincluding diagnosis, management, and preventative strategiesSpecific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 1 are:• Learn the pathophysiologic principles and manifestations and complications of blood diseasesand cancer in the BMT outpatient setting. (MK)• Assess and manage patients with hematologic and/or oncologic disorders in the ambulatorycare BMT setting (PC, MK, SBLI, ICS, P, SBP)• Learn how to request and deliver effective outpatient consultation. (PC, MK, ICS, P)• Acquire a group of patients with whom the trainee can develop experience in the longitudinalcare of patients with cancer and blood diseases who received a BMT. (PC, MK, SBLI, ICS, P,SBP)• Develop effective interpersonal and communication skills with patients and health careproviders. (ICS, P)• Understand the need for development of humanistic behaviors in the practice of medicine.(MK, ICS, P)• Learn the concepts of medical ethics, including an understanding of the psychological andsocial aspects of cancer and blood diseases. (MK)• Develop competence in the performance of and interpretation of bone marrow aspiration andbiopsy and other procedures required for the practice of hematology and oncology. (PC, MK)• Develop the discipline and habits that will provide for a lifetime of self-education and clinicalimprovement. (MK, SBLI, SBP)• Develop presentation and teaching skills. (MK, SBLI, ICS, P SBP)• Become proficient in procedural skills, to include bone marrows, lumbar punctures. (PC, MK)• Demonstrate the skills of an effective consultant in pediatric blood and marrow transplantation.(PC, ICS, P)• Maintain comprehensive, timely, legible and appropriately detailed medical records as aconsultant. (PC, P)• Satisfactorily perform and interpret 2 bone marrow biopsies and aspirates incorporating theprocess of informed consent. (PC, MK)• Satisfactorily perform and interpret one lumbar puncture or Ommaya reservoir tapincorporating the process of informed consent. (PC, MK)• Actively participate in at least 3 initial consultation visit discussions. (PC, MK, ICS, P)• Understand test results within the context of a patient’s diagnosis and treatment plans. (PC,MK)• Demonstrate an appropriate therapeutic relationship with patients and families. (PC, MK, ICS,P)• Apply knowledge of health systems to use resources in providing optimal patient care (i.e. inpatientvs. out-patient consultation and testing, arranging appropriate follow-up). (PC, MK, ICS,P, SBP)• Work with the triage nurses to deliver timely and quality patient care. (PC, MK, ICS, P)• Demonstrate expertise in the diagnosis and management of patients with benign hematologic,malignant hematologic, metabolic disorders and solid tumor disorders that have received a bonemarrow transplant or are being considered for transplantation. (MK)• Maintain professional relationships with healthcare team, as a leader or member. (P)2

Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 2:• Continue to learn the scientific basis of cancer and blood diseases, including pathogenesis,diagnosis, and management in the outpatient BMT setting. (MK)• Have more exposure to a variety of BMT longitudinal care clinics. (MK)Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 3:• Develop a more mature understanding of cancer and blood diseases and clinical managementin patients that receive a BMT. (PC, MK, SBLI, SBP)• Move toward independent clinical decision making in ambulatory patient care. (PC, MK, SBLI,ICS, P, SBP)SCHEDULEMONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY8910•Clinic•New WorkupsandProcedures•Clinic•New WorkupsandProcedures•Clinic11 Administrative•MetabolicStatus MeetingDisorders121 BMTTumor ConfConference2 •Follow-up new work-up evaluations345•Clinic•ExitConferences•MetabolicDisorders,Immunodeficiencies•Review Protocols, determine eligibilityLeukemia Program Meeting•Mini Rotations in Molecular diagnostics lab, Apheresis center, stemcell processing, other division labs•NMDP Tour•Clinic•ExitConferences• Late EffectsClinicPatientConferenceLEVEL OF RESPONSIBILITY AND AUTONOMYSubspecialty resident training in our program is designed to promote the professional growthand development of subspecialty residents from highly skilled pediatricians to highly skilledsubspecialists. This occurs, in part, through the care of patients with a spectrum of benign andmalignant hematologic/oncologic disorders. The philosophy of this program is that subspecialtyresident’s learn best when they are as autonomous as their knowledge, skills and attitudepermit. The matrix below details the level of responsibility/autonomy by proficiency level of thesubspecialty resident. It is expected that the fellow will progress through these levels ofresponsibility as they advance through their fellowship.3

Our faculty are ultimately responsible for the welfare and safety of all patients, and thus willsupervise all patient care encounters in the ambulatory and inpatient settings. Faculty are oncall and available 24 hours a day and 7 days a week for supervision and consultation.Level of responsibility/ autonomy by proficiency levelClinical Activity Beginning Developing ProficientClinical datacollectionIndependent, withstaffIndependent, withstaff confirmationIndependent, withstaff confirmation ofFormulation ofclinicalassessments/ plansConsultant:Communication ofrecommendationsto primary careteam/referringphysicianSupervisor of careteamsupplementationJointly with staffJointly with staffJointly with staff;begins efforts atteaching otherteam members insubspecialtyissuesIndependent, withstaff confirmation;independentutilization ofevidence basedmedicine resourcesand sharing ofinformation withcare teamIndependent, withstaff confirmation;independentutilization ofevidence basedmedicine resourcesand sharing ofinformation withprimary teamIndependent, withstaff confirmation ofpatient care issues;increasingresponsibility forteaching of teammembersselected issuesIndependent, withstaff confirmation ofselected issues;demonstratedmastery of a large setof subspecialty basedskills and is preparingto practiceindependently;consistentlyincorporatesevidence basedmedicine and systembased practices intoimproving selfpractice of medicineIndependent, withstaff confirmation ofselected issues;consistentlyincorporatesevidence basedmedicine and systembased practices intoimprovingeffectiveness ofconsultationIndependent, withstaff confirmation ofselected patient careissues; sharedresponsibility withstaff for teaching ofteam members4

• Assess and manage patients with hematologic disorders in the ambulatory care setting.(PC, MK, ICS, P, SBP)• Learn how to request and deliver effective outpatient consultation. (PC, MK, ICS, P)• Develop effective interpersonal and communication skills with patients and health careproviders. (PC, MK, ICS, P)• Understand the need for development of humanistic behaviors in the practice ofmedicine. (MK)• Learn the concepts of medical ethics, including an understanding of the psychologicaland social aspects of blood diseases. (MK)• Develop the discipline and habits that will provide for a lifetime of self-education andclinical improvement. (P)• Develop presentation and teaching skills. (MK, PBLI, ICS, P, SBP)• Maintain comprehensive, timely, legible and appropriately detailed medical records asa consultant. (P)• Understand test results with in the context of a patient’s diagnosis and treatment plans.(MK)• Demonstrate an appropriate therapeutic relationship with patients and families. (PC,ICS, P)• Apply knowledge of health systems to use resources in providing optimal patient care(i.e. in-patient vs. out-patient consultation and testing, arranging appropriate follow-up).• Work with the triage nurses to deliver timely and quality patient care. (PC, MK, ICS, P,SBP)• Demonstrate expertise in the diagnosis and management of patients with benignhematologic disorders. (MK)• Understand test results with in the context of a patient’s diagnosis and treatment plans.(MK)• Work with the triage nurses to deliver timely and quality patient care. (PC, MK, ICS, P)Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 3 (if applicable) are:• Continue to learn the scientific basis of blood diseases, including pathogenesis,diagnosis, and management. (MK)• Have more exposure to a variety of longitudinal care clinics. (PC, MK)• Develop a more mature understanding of blood diseases and clinical management.(MK)• Move toward independent clinical decision making in a hematology ambulatory patientcare. (PC, MK, SBLI, ICS, P, SBP)

HEMATOLOGY OUTPATIENT ROTATION (SITE 2)PURPOSETo provide a more in-depth experience to the fellows in outpatient management ofpediatric hematology patients: 1) to gain experience in the evaluation of children withbleeding disorders, hemoglobinopathies, anemia, neutropenia, thrombocytopenia andthrombosis. 2) to gain experience in the routine care and management of complicationsof hemophilia, sickle cell disease, thalassemia, ITP, anemia, neutropenia, vonWillebranddisease, thrombophilia, and rare benign hematology cases.DESCRIPTIONMonth long outpatient rotation at Site 2 to be integrated into the clinical component oftraining during the 1st year of the fellowship program.RESPONSIBILITIES1. Attend daily hematology clinics (8:30-5 M,T,Th,F and 8:30-12:30 W)2. Attend daily inpatient hematology rounds at 9:00 am. (Starting inpatient vsoutpatient each morning will depend upon patient population)3. Management of acute outpatient care of benign hematology patients4. Management of acute in-patient care of benign hematology patients.5. Perform inpatient hematology consultations.6. Perform outpatient hematology consultations.7. Participate in Comprehensive Hemophilia Clinic Wednesday mornings.8. Participate in Comprehensive Sickle Cell Clinic the first and third Tuesdays, allday.9. Attend weekly Hem/Onc case review conference.10. Attend didactic lectures on Wednesday afternoons.11. Attend Hemophilia team meetings on Thursdays at 8:30 am12. Attend Sickle Cell team meetings on the 2 nd and 4 th Tuesdays at 8:30 am.GOALS AND OBJECTIVES1. To understand the outpatient management of common sickle cell problems andcomplications (transfusion support, pain, pulmonary hypertension, stroke, splenicsequestration, fevers, infections)2. To gain experience with the management of hemophilia and other bleedingdisorders on an outpatient basis including diagnosis, evaluation, treatment, and thevarious factor products.3. To gain experience with the management of inhibitor patients.4. To be able to evaluate coagulation lab results.5. To gain an understanding of venous thromboembolic disease in neonates andchildren, including incidence, etiology, evaluation, and treatment.6. To become proficient in the evaluation of anemia.7. To become proficient in the evaluation of a bleeding child.8. To gain experience in the management of ITP, including incidence, etiology,evaluation, and treatment options.

Specific Goals Educational Objectives in the Context of the ACGME Core Competenciesfor Year 1 are:• Learn the pathophysiologic principles and manifestations and complications of blooddiseases in the outpatient setting. (MK)• Assess and manage patients with hematologic disorders in the ambulatory care setting.(PC, MK, SBLI, ICS, P, SBP)• Learn how to request and deliver effective outpatient consultation. (PC, MK, ICS, P)• Develop effective interpersonal and communication skills with patients and health careproviders. (PC, MK, ICS, P)• Understand the need for development of humanistic behaviors in the practice ofmedicine. (MK)• Learn the concepts of medical ethics, including an understanding of the psychologicaland social aspects of blood diseases. (MK)• Develop the discipline and habits that will provide for a lifetime of self-education andclinical improvement. (P)• Develop presentation and teaching skills. (MK, ICS, P, SBP)• Maintain comprehensive, timely, legible and appropriately detailed medical records asa consultant. (P)• Understand test results with in the context of a patient’s diagnosis and treatment plans.(MK)• Demonstrate an appropriate therapeutic relationship with patients and families.• Apply knowledge of health systems to use resources in providing optimal patient care(i.e. in-patient vs. out-patient consultation and testing, arranging appropriate follow-up).(PC, MK, ICS, P, SBP)• Work with the triage nurses to deliver timely and quality patient care. (PC, MK, ICS, P)

HEMATOLOGY-ONCOLOGY OUTPATIENT ROTATIONPURPOSETo provide a more in-depth experience to our fellows in outpatient management of pediatriconcology and hematology patients: 1) to gain experience in the evaluation of benign hematologypatients; 2) to gain experience in the evaluation of and treatment for oncology patients 3) to gainexperience in the management of complications outside of the acute care setting such aschemotherapy toxicities, infection, immune recovery, and late effects.DESCRIPTIONWeekly outpatient clinic to be integrated into the clinical component of training during all threeyears of the fellowship program.RESPONSIBILITIES1. Attend weekly Hematology-Oncology clinic (primarily AM’s 8:30-12:30pm but can be anafternoon clinic 12:00- 4:30pm), primary staff will be the Hem-Onc attending MDs.2. Management of acute outpatient care of recently discharged oncology and hematologypatients3. Management of benign hematology in an outpatient setting.4. Management of oncology patients in an outpatient setting.5. Perform comprehensive history (including details of past treatment) and physical examsof new oncology and hematology patients, collect and review all results of diagnosticstudies and consultsa. Review significant H&P findingsb. Review work-up resultsc. Determine protocol eligibilityd. Perform diagnostic procedurese. Participate in the consent processGOALS AND OBJECTIVES1. To understand the outpatient management of oncology and hematology patients.2. To understand writing of scheduled chemotherapy in concert with the PNP in theoutpatient setting. The fellow should review the protocol, the orders, and consider anyspecial circumstances surrounding the treatment. Fellows should assure that childrenmeet the criteria to receive assigned chemotherapy.3. To gain experience with the management of previously diagnosed children with canceror hematologic disease including:a. The process of scheduled chemotherapyb. Understanding protocol chemotherapy and the needed steps for the safeadministration of chemotherapyc. Management of acute and sub acute chemotherapy complications includingfever/neutropenia, infection, nausea and vomiting in the outpatient setting.d. Understanding guidelines for inpatient or outpatient management ofcomplicationse. Appropriate outpatient management of children with hematologic diseaseincluding, but not limited to:i. Sickle cell diseaseii. Thalassemiaiii. The immune cytopeniasiv. Acute and chronic coagulopathiesv. Bone marrow failure syndromes1

f. Appropriate management of children with primary and secondaryimmunodeficiency4. To gain the procedural skills needed for hematology / oncology practice includinga. Bone marrow aspirationb. Bone marrow biopsyc. Lumbar puncture with chemotherapy administrationSpecific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 1 are:• Learn the pathophysiologic principles and manifestations and complications of blood diseasesand cancer in the outpatient setting. (MK)• Assess and manage patients with hematologic and/or oncologic disorders in the ambulatorycare setting. (PC, MK, SBLI, ICS, P, SBP)• Learn how to request and deliver effective outpatient consultation. (PC, MK, ICS, P)• Acquire a group of patients with whom the trainee can develop experience in the longitudinalcare of patients with cancer and blood diseases. (PC, MK, SBLI, ICS, P, SBP)• Develop effective interpersonal and communication skills with patients and health careproviders. (PC, ICS, P)• Understand the need for development of humanistic behaviors in the practice of medicine.(MK, ICS, P)• Learn the concepts of medical ethics, including an understanding of the psychological andsocial aspects of cancer and blood diseases. (MK)• Develop competence in the performance of and interpretation of bone marrow aspiration andbiopsy and other procedures required for the practice of hematology and oncology. (PC, MK)• Develop the discipline and habits that will provide for a lifetime of self-education and clinicalimprovement. (MK, SBLI, SBP)• Develop presentation and teaching skills. (MK, ICS, P)• Become proficient in procedural skills, to include lumbar punctures. (MK)• Maintain comprehensive, timely, legible and appropriately detailed medical records as aconsultant. (P)• Satisfactorily perform and interpret 2 bone marrow biopsies and aspirates incorporating theprocess of informed consent. (PC, MK)• Satisfactorily perform and interpret one lumbar puncture or Ommaya reservoir tapincorporating the process of informed consent. (PC, MK)• Actively participate in at least 6 new diagnoses and end of therapy discussions in theoutpatient setting. (PC, MK, ICS, P)• Understand test results within the context of a patient’s diagnosis and treatment plans. (PC,MK)• Demonstrate competence in the prescription and administration of chemotherapeutic andbiologic agents through all therapeutic routes in the outpatient setting. (PC, MK)• Demonstrate an appropriate therapeutic relationship with patients and families. (PC, MK, ICS,P)• Apply knowledge of health systems to use resources in providing optimal patient care (i.e. inpatientvs. out-patient consultation and testing, arranging appropriate follow-up). (PC, MK, ICS,P)• Work with the triage nurses to deliver timely and quality patient care. (PC, ICS, P)• Demonstrate expertise in the diagnosis and management of patients with benign hematologic,malignant hematologic and solid tumor disorders. (MK)• Maintain professional relationships with healthcare team, as a leader or member. (ICS, P)2

Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 2:• Continue to learn the scientific basis of cancer and blood diseases, including pathogenesis,diagnosis, and management. (MK)• Have more exposure to a variety of longitudinal care clinics. (PC, MK)Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 3:• Develop a more mature understanding of cancer and blood diseases and clinicalmanagement. (MK)• Move toward independent clinical decision making in ambulatory patient care. (PC, MK, SBLI,ICS, P, SBP)SCHEDULEThe fellow’s continuity clinic will be the same weekday (M,Tu,Th,F) every week for the threeyears of fellowship either in the morning (8:30- 12:30pm) or afternoon (12:00 – 4:30pm).LEVEL OF RESPONSIBILITY AND AUTONOMYSubspecialty resident training in our program is designed to promote the professional growthand development of subspecialty residents from highly skilled pediatricians to highly skilledsubspecialists. This occurs, in part, through the care of patients with a spectrum of benign andmalignant hematologic/oncologic disorders. The philosophy of this program is that subspecialtyresident’s learn best when they are as autonomous as their knowledge, skills and attitudepermit. The matrix below details the level of responsibility/autonomy by proficiency level of thesubspecialty resident. It is expected that the fellow will progress through these levels ofresponsibility as they advance through their fellowship.Our faculty are ultimately responsible for the welfare and safety of all patients, and thus willsupervise all patient care encounters in the ambulatory and inpatient settings. Faculty are oncall and available 24 hours a day and 7 days a week for supervision and consultation.Level of responsibility/ autonomy by proficiency levelClinical Activity Beginning Developing ProficientClinical data collectionFormulation of clinicalassessments/ plansIndependent, with staffsupplementationJointly with staffIndependent, with staffconfirmationIndependent, with staffconfirmation; independentutilization of evidence basedmedicine resources andsharing of information withcare teamIndependent, with staffconfirmation of selectedissuesIndependent, with staffconfirmation of selectedissues; demonstratedmastery of a large set ofsubspecialty based skills andis preparing to practiceindependently;consistently incorporates3

Consultant:Communication ofrecommendations toprimary care team/referringphysicianSupervisor of care teamJointly with staffJointly with staff; beginsefforts at teaching otherteam members insubspecialty issuesIndependent, with staffconfirmation; independentutilization of evidence basedmedicine resources andsharing of information withprimary teamIndependent, with staffconfirmation of patient careissues; increasingresponsibility for teaching ofteam membersevidence based medicine andsystem based practices intoimproving self practice ofmedicineIndependent, with staffconfirmation of selectedissues; consistentlyincorporates evidence basedmedicine and system basedpractices into improvingeffectiveness of consultationIndependent, with staffconfirmation of selectedpatient care issues; sharedresponsibility with staff forteaching of team members4

HEMATOLOGY/ONCOLOGY INPATIENT ROTATIONPURPOSEThe hematology-oncology inpatient rotation will provide a progressive experience to the firstyear fellows in the management of children and young adults with a variety of hematologic andoncologic diagnoses Fellows will rotate through the inpatient hematology/oncology serviceseveral times during their first year of fellowship training. Over the course of these rotations thefellows will be expected to assume an increasing level of responsibility for inpatient service.They will initiate the management of newly diagnosed pediatric hematology/oncology patients,manage the scheduled admissions of children for inpatient chemotherapy, and manage thecomplications of hematologic and oncologic disease. During the second and third years offellowship training, fellows again rotate on the inpatient service with the goal of solidifying theirability to more independently care for this same population of patients.DESCRIPTIONMonth long inpatient rotation to be integrated into the clinical component of training during the 3year fellowship program.RESPONSIBILITIES1. Daily inpatient rounds with the attending physician on 5B. Rounds will include theassigned housestaff and nurse practitioners.2. Daily examination and assessment of children who are either admitted to the heme/oncservice, or who are on the consult service. The fellow will be responsible for anacceptable daily progress note on all consults, and on those children who are off of 5B(i.e. PICU).3. Perform comprehensive history (including details of past treatment) and physical examsan newly admitted heme/onc patients, collect and review all results of diagnostic studiesand consultsa. Review significant H&P findingsb. Perform diagnostic proceduresc. Review work-up resultsd. Determine protocol eligibilitye. Participate in the conference and consent process4. The writing of scheduled chemotherapy in concert with the PNP. The fellow shouldreview the protocol, the orders, and consider any special circumstances surrounding theadmission. Fellows should assure that children meet the criteria to receive assignedchemotherapy.5. Fellows will evaluate children who come to the ER during daytime hours and appropriatepatients who must come during the evening or night.6. Taking first call for questions from referring physicians, parents of patients, or staff of theUniversity of Minnesota who are requesting consults7. Other duties as assigned by the Heme/Onc inpatient Attending.Updated 07/05/2011

SCHEDULEThe schedule will be determined by the fellow and staff, however Monday through Fridayinpatient rounds should begin before 9 a.m. Fellows should be on the hospital site from 8 a.m.until at least 5 p.m. Monday through Friday. Weekend rounding times are determined by thefellow and staff.LEVEL OF RESPONSIBILITY AND AUTONOMYSubspecialty resident training in our program is designed to promote the professional growthand development of subspecialty residents from highly skilled pediatricians to highly skilledsubspecialists. This occurs, in part, through the care of patients with a spectrum of benign andmalignant hematologic/oncologic disorders. The philosophy of this program is that subspecialtyresident’s learn best when they are as autonomous as their knowledge, skills and attitudepermit. The matrix below details the level of responsibility/autonomy by proficiency level of thesubspecialty resident. It is expected that the fellow will progress through these levels ofresponsibility as they advance through their fellowship.Our faculty is ultimately responsible for the welfare and safety of all patients, and thus willsupervise all patient care encounters in the ambulatory and inpatient settings. Faculty are oncall and available 24 hours a day and 7 days a week for supervision and consultation.GOALS AND OBJECTIVES1. To understand the initial clinical presentations of children with hematologic andoncologic disease.2. To gain experience with the initial management of the child with cancer or hematologicdisease including:a. The steps needed for a confirmed diagnosisb. The process of counseling the family of the newly diagnosed patientc. The process of counseling the newly diagnosed patientd. The determination of study eligibility and appropriatenesse. The process of informed consentf. Protocol directed therapy initiation3. To gain experience with the management of previously diagnosed children with canceror hematologic disease including:a. The process of scheduled chemotherapyb. Understanding protocol chemotherapy and the needed steps for the safeadministration of chemotherapyc. Management of acute and subacute chemotherapy complications includingfever/neutropenia, serious infection, nausea and vomitingd. Understanding guidelines for inpatient or outpatient management ofcomplicationse. Appropriate management of children with hematologic disease including, but notlimited to:i. Sickle cell diseaseii. Thalassemiaiii. The immune cytopeniasiv. Acute and chronic coagulopathiesv. Bone marrow failure syndromesf. Appropriate management of children with primary and secondaryimmunodeficiencyUpdated 07/05/2011

4. To gain the needed skills for the management of the child with a terminal illness5. To gain the needed skills for correct and timely consultation of children with nonhematologic/ oncologic disease, but who have a complication requiring consultation.6. To gain the procedural skills needed for hematology / oncology practice includinga. Bone marrow aspirationb. Bone marrow biopsyc. Lumbar puncture with chemotherapy administrationSpecific Goals Incorporating the Educational Objectives in the Context of the ACGME CoreCompetencies for Year 1 are:• Learn the pathophysiologic principles and manifestations and complications of blooddiseases and cancer.(MK)• Assess and manage patients with hematologic and/or oncologic disorders in the in-hospitalsetting. (PC, MK, PBLI, ICS, P SBP)• Learn how to request and deliver effective consultation. (PC, PBLI, ICS, P, SBP)• Acquire a group of patients with whom the trainee can develop experience in the longitudinalcare of patients with cancer and blood diseases. (PC)• Develop effective interpersonal and communication skills with patients and health careproviders. (PC, ICS, P)• Understand the need for development of humanistic behaviors in the practice of medicine.(MK, ICS, P)• Learn the concepts of medical ethics, including an understanding of the psychological andsocial aspects of cancer and blood diseases. (MK)• Learn the epidemiology of cancer and blood diseases and the value and role of screeningand detection in populations. (MK)• Develop competence in the performance of and interpretation of bone marrow aspirationand biopsy and other procedures required for the practice of hematology and oncology. (PC,MK)• Develop the discipline and habits that will provide for a lifetime of self-education and clinicalimprovement. (MK, SBLI, SBP)• Develop presentation and teaching skills. (MK, SBLI, ICS, P, SBP)• Learn to interpret scientific literature through journal clubs, clinical seminar presentation, andcase presentations on faculty rounds. (MK, PBLI, SBP)• Become competent in procedural skills, to include bone marrows, lumbar punctures orOmmaya reservoir tap, and administration of chemotherapy through all therapeutic routes.(PC, MK)• Plan diagnostic strategy for patients with suspected new cancer. (MK, PBLI, SBP)• Evaluate results of diagnostic tests for patients with suspected new cancer. (MK, SBP)• Implement new treatment plan for patients with new or relapsed cancer. (PC, MK, SBP)• Actively participate in at least 6 multidisciplinary health care team rounds. (MK, ICS, P)• Understand and interpret CBC and correlate with bone marrow findings. (MK, PBLI, SBP)• Understand test results within the context of a patient’s diagnosis and treatment plans. (MK,PBLI, SBP)• Demonstrate ability to lead a team in the effective delivery of health care. (PC, MK, PBLI,ICS, P, SBP)• Demonstrate competence in the prescription and administration of chemotherapeutic andbiologic agents through all therapeutic routes. (MK)• Effectively triage night and weekend patient phone calls providing medically sound andcompassionate advice. (PC, MK, SBLI, ICS, P, SBP)Updated 07/05/2011

• Manage acutely ill patients with oncologic or benign hematologic disorders. (PC, MK, PBLI,SBP)• Review open and recently closed cooperative group oncology trials appropriate to each newor relapsed oncology patient on the inpatient service. (PC, MK, SBLI, SBP)• Apply results from previous oncology clinical trials to the care of new or relapsed oncologypatients. (PC, MK, SBP)• Apply results from previous hematology clinical studies to the care of acutely ill hematologypatients. (PC, MK, SBP)• Supervise computer based core lectures; critically review at least one article per week thatpertains to a current patient problem with the resident team. (MK, SBLI, SBP)• Understand test results within the context of a patient’s diagnosis and treatment plans. (PC,MK, PBLI, SBP)• Present challenging new or relapsed oncology patients at the multidisciplinary PediatricCancer and Blood Diseases Conference, including a discussion of rationale for proposedtherapy. (MK, SBLI, ICS, P, SBP)• Lead daily education sessions for the pediatric residents rotating on the service. (MK, ICS,P, SBP)• Critically review at least one article per week that pertains to a current patient problem withthe resident team. (MK, PBLI, ICS, P, SBP)• Effectively triage night and weekend patient phone calls providing medically sound andcompassionate advice. (PC, MK, ICS, P)• Report to rounds and conferences in a timely fashion. (P)• Treat other members of the team with respect. (P)• Provide compassionate and culturally-sensitive care to patients. (P)• Demonstrate ability to lead a team in the effective delivery of health care. (ICS, P)• Provide primary care providers with updates on the clinical course of newly diagnosedhematology and oncology patients. (MK, ICS, P, SBP)• Include the primary oncologist and primary fellow in management discussions for patientsadmitted to the inpatient service. (ICS, P, SBP)• Communicate effectively with consultants from other services about the care of patientsadmitted to the inpatient service. (ICS, P, SBP)• Participate in weekly patient conference of challenging hematology-oncology patientsadmitted to the inpatient service. (MK, PBLI, ICS, P, SBP)Specific Goals Incorporating the Educational Objectives in the Context of the ACGME CoreCompetenciesfor Year 2:• Continue to learn the scientific basis of cancer and blood diseases, including pathogenesis,diagnosis, and management.(MK)• Continue to become proficient and independent in procedural skills, to include bonemarrows, lumbar punctures or Ommaya reservoir tap, and administration of chemotherapythrough all therapeutic routes. (PC, MK)• Become proficient in teaching. (MK, SBLI, ICS, P, SBP)• Apply standard of hematology-oncology/BMT care for patients with blood diseases andcancer. (PC, MK, PBLI, ICS, P, SBP)• Demonstrate expertise in the diagnosis and management of patients with benignhematologic, malignant hematologic and solid tumor disorders. (PC, MK, SBP)• Effectively manage the inpatient hematology-oncology team, including residents and nursepractitioners. (MK, SBLI, ICS, P, SBP)Updated 07/05/2011

• Explain complicated treatment plans to patients and families in easy to understandlanguage. (PC, MK, ICS, P)• Communicate empathically with patients and families around end-of-life issues. (PC, MK,ICS, P)Specific Goals Incorporating the Educational Objectives in the Context of the ACGME CoreCompetencies for Year 3:Senior fellows will serve as acting attending on the inpatient service for four to six weeks as twoweekor four-week periods. During each individual rotation, the fellow is expected to meet eachof the learning objectives described below with the supervising attending functioning as anacting consultant. At the completion of these rotations during the third year, the fellow will havesolidified the knowledge and skills necessary to manage acutely ill children and young adultswith cancer and blood diseases.• Develop a more mature understanding of cancer and blood diseases and clinicalmanagement. (MK)• Move toward independent clinical decision making in patient care. (PC, MK, SBLI, SBP)• Apply state of the art hematology-oncology/BMT care for patients with blood diseases andcancer. (PC, MK, SBLI, ICS, P, SBP)Evaluations: Fellows perform an electronic evaluation of the Inpatient Attending and the wardrotation on RMS and receive an evaluation from the inpatient attending after each ward month.360 evaluations by the nursing staff and patient families are completed quarterly for each fellow.Specialty Service Evaluations (Surgery, Pathology, PICU, Child Life, Social Work, and theHeme/Onc/BMT Inpatient Nurse Coordinators) are completed annually for each 1 st year fellow.Updated 07/05/2011Level of responsibility/ autonomy by proficiency level

Clinical Activity Beginning Developing ProficientClinical data collection Independent, with Independent, with staff Independent, with staffstaff supplementation confirmationconfirmation of selectedFormulation of clinicalassessments/ plansJointly with staffIndependent, with staffconfirmation;independent utilizationof evidence basedmedicine resourcesand sharing ofinformation with careteamissuesIndependent, with staffconfirmation of selectedissues; demonstratedmastery of a large set ofsubspecialty based skillsand is preparing topractice independently;consistently incorporatesevidence basedmedicine and systembased practices intoimproving self practice ofmedicineConsultant:Communication ofrecommendations toprimary careteam/referringphysicianJointly with staffIndependent, with staffconfirmation;independent utilizationof evidence basedmedicine resourcesand sharing ofinformation withprimary teamIndependent, with staffconfirmation of selectedissues; consistentlyincorporates evidencebased medicine andsystem based practicesinto improvingeffectiveness ofconsultationSupervisor of careteamJointly with staff;begins efforts atteaching other teammembers insubspecialty issuesIndependent, with staffconfirmation of patientcare issues; increasingresponsibility forteaching of teammembersIndependent, with staffconfirmation of selectedpatient care issues;shared responsibilitywith staff for teaching ofteam membersUpdated 07/05/2011

Neuro-Oncology RotationPURPOSETo provide a more in-depth experience to our fellows in management of pediatric brain tumorpatients: 1) to gain experience in the evaluation and management of patients with newlydiagnosed and recurrent brain tumors 2) to gain experience in neurofibromatosis evaluation andmanagement 3) to gain experience in retinoblastoma evaluation and management 4) to gainexperience in the management of complications outside of the acute care setting such asdexamethasone management, VP shunts, and late effects.DESCRIPTIONThis is a month long rotation to be integrated into the clinical component of training during the1st year of the fellowship program.RESPONSIBILITIES1. Attend neuro-oncology clinics (Tuesday and Friday). Primary staff will be Drs. Moerteland Neglia.2. Management of acute outpatient care of recently diagnosed or discharged brain tumorpatients3. Perform comprehensive history (including details of past treatment) and physical examson new brain tumor, retinoblastoma and NF patients, collect and review all results ofdiagnostic studies and consultsa. Review significant H&P findingsb. Review work-up resultsc. Determine protocol eligibilityd. Perform diagnostic procedures4. Attend long term follow-up clinic brain tumor patients5. Participate in disease-focused conferences6. Attend weekly neuro-oncology conference and coordinate patient presentations at thepediatric-specific conference.7. Attend mini-rotations in neuropathology, neurosurgery, therapeutic radiology and neuroradiology.Other duties as assigned by the attending.GOALS AND OBJECTIVES1. To understand the outpatient management of common neuro-oncology problems andcomplications (increased intracranial pressure, cranial nerve and other motor deficits, VPshunt management)2. To gain experience with the management of neurofibromatosis on an outpatient basisincluding diagnosis, evaluation, and treatment including optic pathway tumors, plexiformneurofibromas, and malignant peripheral nerve sheath tumors.3. To gain experience with the management of late effects of brain tumor treatment on anoutpatient basis including diagnosis, evaluation, and treatment.4. To be able to determine a patients eligibility for transplant and to coordinate and interpretan appropriate pre-transplant evaluation5. To gain an understanding of the neurosurgical treatment of brain tumors6. To gain an appreciation for the consent process involved in counseling patients prior totreatment7. To become familiar with the issues related to long-term follow-up in brain tumor survivorsincluding diagnosis, management, and preventative strategies1

Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for Year 1- 1 st Rotation:• Learn the pathophysiologic principles and manifestations and complications of neuro-oncologyin the outpatient setting. (MK)• Assess and manage patients with neuro-oncologic disorders in the ambulatory care setting.(PC, MK, P)• Learn how to request and deliver effective outpatient consultation. (PC, MK< ICS, P)• Acquire a group of patients with whom the trainee can develop experience in the longitudinalcare of patients with brain/spine tumors. (PC, MK)• Develop effective interpersonal and communication skills with patients and health careproviders. (ICS, P)• Understand the need for development of humanistic behaviors in the practice of medicine.(MK)• Learn the concepts of medical ethics, including an understanding of the psychological andsocial aspects of neuro-oncology. (MK)• Develop the discipline and habits that will provide for a lifetime of self-education and clinicalimprovement. (MK, P)• Develop presentation and teaching skills. (MK, ICS, P, SBP)• Become proficient in lumbar punctures. (MK)• Maintain comprehensive, timely, legible and appropriately detailed medical records in theoutpatient setting. (P)• Actively participate in at least 3 new diagnoses and end of therapy discussions in the inpatientor outpatient setting. (PC, MK, ICS, P)• Understand test results within the context of a patient’s diagnosis and treatment plans. (MK)• Demonstrate competence in the prescription and administration of chemotherapeutic andbiologic agents through all therapeutic routes in the outpatient setting. (PC, MK)• Demonstrate an appropriate therapeutic relationship with patients and families. (PC, MK, ICS,P)• Apply knowledge of health systems to use resources in providing optimal patient care (i.e. inpatientvs. out-patient consultation and testing, arranging appropriate follow-up). (PC, MK, ICS,P, SBP)• Work with the triage nurses to deliver timely and quality patient care. (PC, ICS, P)• Demonstrate expertise in the diagnosis and management of patients with brain/spinal cordtumors. (PC, MK, SBLI, ICS, P, SBP)• Maintain professional relationships with healthcare team, as a leader or member. (P)Specific Goals Incorporating Educational Objectives in the Context of the ACGME CoreCompetencies for 2 nd Rotation:• Continue to learn the scientific basis of neuro-oncology, including pathogenesis, diagnosis,and management. (MK)• Have more exposure to a variety of longitudinal care clinics. (PC, MK)Evaluations: Fellows perform an electronic evaluation of the Neuro-oncology Attendings andthe outpatient rotation on RMS and receive an evaluation from the Neuro-oncology Rotationattending (Dr. Moertel) after each elective month.2

SCHEDULEMONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY89WeeklyNeuroradiology• Neurooncology• Nasseff Clinic •Therapeuticradiology10ClinicMonthly neurooncology(Moertel)1112 Monthly neuro-research dataconference1 Neurooncologyconference2 •Follow-up new work-up evaluations345oncology clinicwithneurosurgeryteam –Children’s, St.PaulTumor Conf•Review Protocols, determine eligibility•Mini Rotations in neurosurgery, neuropathology, other divisionlabs• NeurooncologyClinic(Moertel/Neglia)• Late EffectsClinicPatientConferenceLEVEL OF RESPONSIBILITY AND AUTONOMYSubspecialty resident training in our program is designed to promote the professional growthand development of subspecialty residents from highly skilled pediatricians to highly skilledsubspecialists. This occurs, in part, through the care of patients with a spectrum of benign andmalignant hematologic/oncologic disorders. The philosophy of this program is that subspecialtyresident’s learn best when they are as autonomous as their knowledge, skills and attitudepermit. The matrix below details the level of responsibility/autonomy by proficiency level of thesubspecialty resident. It is expected that the fellow will progress through these levels ofresponsibility as they advance through their fellowship.Our faculty are ultimately responsible for the welfare and safety of all patients, and thus willsupervise all patient care encounters in the ambulatory and inpatient settings. Faculty are oncall and available 24 hours a day and 7 days a week for supervision and consultation.Level of responsibility/ autonomy by proficiency levelClinical Activity Beginning Developing ProficientClinical data collectionFormulation of clinicalassessments/ plansIndependent, with staffsupplementationJointly with staffIndependent, with staffconfirmationIndependent, with staffconfirmation; independentutilization of evidence basedIndependent, with staffconfirmation of selectedissuesIndependent, with staffconfirmation of selectedissues; demonstrated3

Consultant:Communication ofrecommendations toprimary care team/referringphysicianSupervisor of care teamJointly with staffJointly with staff; beginsefforts at teaching otherteam members insubspecialty issuesmedicine resources andsharing of information withcare teamIndependent, with staffconfirmation; independentutilization of evidence basedmedicine resources andsharing of information withprimary teamIndependent, with staffconfirmation of patient careissues; increasingresponsibility for teaching ofteam membersmastery of a large set ofsubspecialty based skills andis preparing to practiceindependently;consistently incorporatesevidence based medicine andsystem based practices intoimproving self practice ofmedicineIndependent, with staffconfirmation of selectedissues; consistentlyincorporates evidence basedmedicine and system basedpractices into improvingeffectiveness of consultationIndependent, with staffconfirmation of selectedpatient care issues; sharedresponsibility with staff forteaching of team members4

RESEARCH EXPERIENCEPURPOSEOne of the guiding principals of the Pediatric Hematology/Oncology and Marrow Transplantationprogram at the University of Minnesota is to improve the lives of children with hematological andmalignant diseases through basic, translational and clinical research. The purpose of theresearch experience is for the fellow to acquire the ability to plan and carry out meaningful,hypothesis-driven research in pediatric hematology, oncology and marrow transplantation.DESCRIPTIONWorking with a faculty member, fellows will perform clinical, translational or basic scienceresearch.RESPONSIBILITIESYear 1:• Journal club.• Submit a case report/case series for publication.• Identify a research mentor and project.• With the aid of your faculty advisor, identify a research mentor, compile a researchcommittee (containing two members within the division and one outside of the division).• With the aid of this research mentor, define the project’s rationale and research plan andpresent this at the weekly pediatric cancer and blood diseases meeting.Years 2 and 3:• To spend the majority of time (~75%) performing research.• If on clinical research tract, to successfully complete the Master’s degree program inclinical research or epidemiology.• Present preliminary data at the weekly pediatric cancer and blood diseases meeting (year2)• Prepare a publication reporting research findings (year 3).• 4 th and 5 th years of research training are potentially available and will be reviewed on acase-by-case basis. Areas considered will include research commitment, trajectory,external funding sources and publication success.GOALS AND OBJECTIVES• To provide protected/dedicated time to spend on a concentrated focused researchproject.• To learn how data is acquired, analyzed and reported.• To acquire the ability to critically review the current literature in the chosen subject areafor strengths and weaknesses.• To gain an improved understanding of the most up to date research techniques in theirchosen area of study.• To gain exposure to research as a potential career path.• To prepare the fellow to successfully compete for an academic faculty position.1

Specific Goals for Year 1:Work with the assigned first year advisor to identify a career path, complete a careerdevelopment training plan, identify an area of research interest, and select a mentor forresearch activities in years 2 and 3. (MK, ICS, P)Specific Goals for Year 2:• Identify a research area of interest and begin a research project with a designated mentor.(MK, ICS, P)• Learn academic writing skills (MK)Specific Goals for Year 3:• Further develop research skills (MK)• Focus career plans and research goals (MK, ICS)• Begin to write applications for career development awards (MK)Evaluations: Fellows perform an electronic evaluation of their research time twice annually onRMS and receive an evaluation from their research mentor twice a year during fellowship years2 and 3.2