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Hematology, Oncology and
Bone Marrow Transplantation
Fellowship
The pediatric hematology, oncology and bone marrow transplantation fellowship program is designed to promote the training of fellows in the scientific and clinical aspects of the field, preparing them for an academic career. Paramount throughout the training of the subspecialty fellow is the emphasis on excellence of clinical care for children with hematologic or malignant disorders and those requiring BMT. It is emphasized that the fellows develop in the physician scientist model, for which there are numerous role models among the faculty. During the fellowship, each fellow is expected to acquire the clinical expertise and the procedural skills required for the diagnosis and therapy of pediatric Hematology, Oncology and Bone Marrow Transplantation patients. Of equal importance, each fellow is expected to select a research mentor, and then, under the guidance of that individual, to develop research skills, specifically learning the methods of careful, controlled scientific inquiry. Our fellowship is designed as a three-year training program, with the emphasis in the latter two years being on research. The fellowship is accredited by the Accreditation Council of Graduate Medical Education.
Note: Fellowship application information is provided at the end of this document.
Fellowship Curriculum
YEAR ONE
Goals:
- Development of clinical skills in Hem/Onc/BMT.
- Acquisition of fundamental Hem/Onc/BMT knowledge base.
- Introduction to basic laboratory and clinical skills.
- Experience in preparing clinical presentations, discussions of cases and case reports.
- Initiation of some research interests.
Rotations:
- Four months hematology/ two weeks hemophilia;
Three months oncology;
One month neuro-oncology;
Three months BMT (inpatient/outpatient);
One month supportive services elective covering processes vital to more than one of the disciplines.
- Vacation - three weeks; meeting - one week.
- Half-day per week in clinic throughout fellowship;
Clinic - half-day per week
- 1st 18 mo. - Oncology Continuity Clinic
2nd 18 mo. - Oncology Continuity Clinic
2 weeks (3 in 5 week month)
- Fellow-focused Hem/Onc/BMT Clinic
- may change/rotate
- contact responsible attending
- keep log and turn in every six months
- Upper-level fellows will serve as "Doctor of the Day" for walk-in sick oncology patients.
Clinics:
There are several clinics held in the Hem/Onc/BMT Department. All fellows are asked to do a half-day of Oncology Continuity Clinic weekly for 18 months, then two to three times per month. As upper-level fellows, they are part of the Doctor of the Day (DOD) schedule during Oncology Continuity Clinic. During hematology rotations, they are asked to attend the general Hematology Clinic (two days per week), one consultation clinic (half-day per week), Sickle Cell Clinic (every other week) and Hemophilia Clinic (every week). Note, Hemophilia Clinics are held the first three Wednesdays of the month at Fitzsimons and fellows will be expected to attend. While on the BMT clinical rotation, the fellow will be asked to attend one week per month (dependent on the inpatient BMT service commitment, but must arrange 10 half-days each month).
Inpatient:
There is an 18-bed oncology unit and a 6-bed BMT unit.
Oncology:
Every fellow now spends four months on the oncology/neuro-oncology inpatient unit supervising as well as managing oncology cases.
Hematology:
Every fellow will spend four months on hematology. A small portion of the hematology/oncology unit has hematology inpatients and most of the hematology service patients are consults and hence are scattered all over the hospital. Experience in hemophilia will be by a two-week rotation at the Hemophilia Center and 15-16 half-day clinics over the year.
BMT:
Every fellow will spend three months on BMT, primarily managing patients during their inpatient BMT phase of treatment. The fellows will also gain experience in the other phases of BMT, specifically the pre-BMT consultative and evaluation phase and the post-BMT recovery and management of complications phases during their clinic time (3 of 12 weeks).
Call:
The first-year fellows are on call two week nights per week and one weekend every three weeks. During their weeknight call, they cover the inpatient and outpatient calls for Hem/Onc/BMT services, with the respective inpatient attending for that service as their backup coverage.
Weekend call is split between one or two fellows and two or three attendings. Other faculty may be called for advice or help at the discretion of the on call team.
It is highly encouraged and is good professional courtesy (and the desire of most of the attendings and fellows) that the primary team (fellow, attending, RN) following the patient be contacted in the event of imminently life-threatening changes or deaths (this can often be reviewed on sign-outs).
Most of us would like to know that one of our primary patients has been admitted overnight or over the weekend (notified the next day or on Monday).
Academic Requirements:
- Preparation of four (per fellow) tumor board didactic handouts over the year (one per month on oncology inpatient rotation total).
- Present "Professor Rounds" discussion monthly and write-up ("minutes" of the meeting) four times per year.
- First year fellows must attend the Friday morning conference and the Tuesday didactic conference and are strongly encouraged to attend:
Leukemia Conference*
Tumor Board*
Morphology Conference**
Hemoglobinopathy Conference**
Neuro-Oncology Conference*
Coagulation Conference**
* Mandatory while on oncology
** Mandatory while on hematology
- By April 1st, the first year fellow will present background and research plan for following year at research conference. Subsequently, one presentation per year.
- Preparation of one case report or participate in clinical research data collection, independent of primary research project.
Meetings:
- Tumor Board or Tumor Conference at 12:30 every other Tuesday (mandatory).
- Fellows Teaching Conference at 7:30 on the first and third Tuesday (mandatory).
- Morphology Session 8:00-9:00 every Thursday morning. It is strongly advised that the first year fellows attend.
- Coag-Conference at noon on the first and third Thursday at the University of Colorado Denver. Fellows rotating on hematology are strongly urged to attend.
- Professor Rounds/Research Conference 8:00 Friday mornings (mandatory). A case discussion in Hem/Onc/BMT or research presentation by faculty or visiting faculty.
- Encouraged to attend the General Pediatrics Conference, especially the Grand Rounds and 7:30 Residents Report on the 1st and 3rd Thursday each month (a Hem/Onc case).
- Neuro-Oncology Conference on the 2nd and 4th Wednesday at 7:00 a.m. in Torrey's Peak at The Children's Hospital (while on oncology).
Research:
- Involvement in the CRC protocols.
- Involvement in the clinical Hem/Onc/BMT protocols.
- Planning for abstract in some clinical topics in Hem/Onc/BMT.
- Strongly encouraged to submit at least one abstract at the national or regional meeting.
YEAR TWO
Major focus is research
Goals:
- Development of understanding the investigative approach and attaining the laboratory skills to conduct independent research projects under guidance of research mentor.
- Development of in-depth scientific knowledge in Hem/Onc/BMT.
- Development of independence in clinical abilities.
- Development of in-depth pathophysiology and knowledge of Hem/Onc/BMT disorders.
Clinics:
Although it is strictly a research year as far as majority of time commitment, fellows do have some clinical responsibilities.
- Oncology Continuity Clinic - half-day per week, at which time fellow is Doctor of the Day.
- Specialty clinics, such as HOPE Clinic, Neuro-Oncology Clinic, Hemophilia Clinic, Sickle Cell Clinic, if time permits.
Call:
Usually only on weekend call, averaging one weekend call per month. However, if there are less than three first-year fellows, upper-level fellows (along with faculty) may be asked to cover a set number of weekday call.
Meetings:
- One national meeting per year.
- The Research Conference/Professor Rounds.
- Any of the other meetings as time permits. Leukemia Conference and Fellows Teaching Conference are strongly encouraged, as is presenting one of these didactic sessions.
- Section Aspen Retreat (mandatory).
Research:
These are your research years and therefore you should focus on project development, research interactions, presentations, abstract, article submissions and grant preparation. In second and third years, four lectures/year to housestaff/ first year fellows on basic topics in Hem/Onc/BMT. One to two Prof Rounds/year.
Courses:
To be arranged dependent upon your research needs. All fellows are required to take the Cellular and Molecular Biology course offered at UCD at the beginning of the summer of your second year (fellows with extensive research experience or a PhD may discuss 'placing out' of this with the director of the fellowship).
YEAR THREE
Major focus is research
Goals:
Focus on more advanced research development - completing the knowledge base.
Clinical:
Continuation of clinic involvement with half-day two times per week, two to three times per month, in Oncology Continuity Clinic, with DOD duty. Third-year fellows will be offered the opportunity to be the 'junior or co-attending' on the service of their choice (minimum time commitment is two weeks and maximum is four weeks). If this occurs during a time when the first-year fellow is on vacation, the attending will assume some of the first-year fellow's responsibilities.
Call:
Weekend call, averaging one weekend call per month. However, if there are less than three first-year fellows, upper-level fellows (along with faculty) may be asked to cover a set number of weekday call. Some granting agencies demand that there be no call (if you get such a grant, discuss with the fellowship director).
Meetings:
- One national meeting per year.
- One mandatory meeting, Research Conference/Professor Rounds (Friday morning).
- Any of the other meetings as time permits. Fellows Teaching Conference is strongly encouraged, as is presenting one of these didactic sessions.
- Section Aspen Retreat (mandatory).
Fellowship Application
We are participating in the ERAS match for the 2010 academic year. The match begins on November 15, 2008, with a deadline for applications of December 19, 2008. We will begin reviewing applications December 22 and will schedule interviews from January through the end of March 2009.
If you require further information about our fellowship program, please contact our fellowship coordinator.
Diane Frelund
Fellowship Coordinator
Hematology, Oncology and Bone Marrow Transplantation
The Children's Hospital
13123 East 16th Avenue, B115
Aurora, Colorado 80045
Tel: (720) 777-6672
E-mail: frelund.diane@tchden.org
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