First-year hematology/oncology fellows have a primarily clinical year that is divided approximately equally between inpatient and outpatient experiences. The clinical services are located at the Hospital of the University of Pennsylvania (HUP), Perelman Center for Advanced Medicine (PCAM), Penn Presbyterian Medical Center (PPMC), and the Philadelphia VA Medical Center (VAMC).
Each rotation will last approximately 10 weeks:
- Outpatient Oncology rotation (PCAM, Outpatient)
- Classical Hematology (HUP/PCAM, Inpatient/Outpatient)
- Hematologic malignancy and hematopoietic stem cell transplant services (HUP/PCAM, Inpatient)
- Philadelphia VA Medical Center (VAMC, Inpatient/Outpatient)
- Penn Presbyterian Medical Center (PPMC, Inpatient/Outpatient)
About six months per year are dedicated to outpatient training that encompasses solid tumor oncology, hematologic malignancies and transplant, and classical hematology. The other six months include inpatient rotations in hematology and hematologic malignancy/transplant, and the Philadelphia VA Medical Center, with the latter including morning outpatient clinics and afternoon inpatient consults.
Throughout the year, fellows are entirely off duty at least one day out of seven; half of the rotations are outpatient based. Penn adheres to the ACGME requirement for an 80-hour work week. There is no in-house overnight call. Penn fellows can take four weeks of vacation per year.
Classical Hematology
This is a hybrid inpatient/outpatient rotation in classical hematology. Consult fellows see all HUP hematology consult requests, including those from the Departments of Medicine, Surgery, Surgical Subspecialties, Neurology, Obstetrics and Gynecology, and other departments. During this rotation, the outpatient fellows attend clinics and present cases at the weekly hematology case conference. The case discussions include formal literature summaries and management recommendations.
The program's goal of the program is to provide a varied and comprehensive experience in consultative hematology.
- Principal teaching methods:
Teaching rounds, bedside presentation and discussion, conferences, direct supervision of bone marrow aspiration and biopsy procedures, literature review, intensive microscopic review of case materials, participation in hematopathology rounds, and experience in the methodologies and interpretation of laboratory-based testing.
- Educational content:
Exposure to all aspects of adult hematology, including congenital and acquired coagulation disorders, transfusion medicine, diagnosis and management of cytopenias and elevated blood counts, and evaluation of patients with gammopathies. Detailed study of peripheral blood and bone marrow morphology and laboratory evaluation of coagulation disorders, flow cytometry and cytogenetics are all included.
- Mix of diseases:
The full range of congenital and acquired adult hematologic disorders.
- Patient characteristics:
Men and women, adults and adolescents, including geriatric populations.
- Types of clinical encounters:
Bedside consultations and outpatient evaluations.
- Procedures:
Bone marrow aspiration and biopsies.
- Educational resources:
Dedicated fellows' hematology-oncology library, multi-headed teaching microscope and television, American Society of Hematology Slide Collection, as well as the Medical School Library collection.
- Supervision:
All aspects of the fellows' clinical activities and training are supervised by the two inpatient attending physicians.
Hematologic Malignancy and Hematopoietic Stem Cell Transplant Service
This 10-week rotation takes place at the Hospital of the University of Pennsylvania and includes inpatient consultations, management of patients admitted to hematologic malignancy teaching services, and a two-week transplant rotation.
Hematologic malignancy inpatient teaching services consist of one fellow, an attending, a resident, a nurse practitioner, and two interns. Fellows learn to perform diagnostic and therapeutic procedures including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or Ommaya reservoir. In addition, fellows are responsible for obtaining consent for chemotherapy and writing all chemotherapy orders on the unit. The fellows continue to follow their patients when they are transferred to other units, such as the intensive care unit (ICU), physical medicine and rehabilitation or surgery.
Fellows also serve as a liaison between hematopathology and the inpatient services, reviewing new cases with the pathologists and reporting results to the team.
During a two-week transplant rotation, fellows will see patients in the outpatient stem cell transplant clinic and attend rounds on the inpatient service.
The purpose of the rotation is to provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic malignancies, the principles and practice of high dose therapies, and autologous and allogeneic hematopoietic stem cell transplantation; to provide experience in the diagnosis and management of oncology emergencies; to gain expertise in the management of pain control and patient and family-centered terminal care.
- Principal teaching methods:
Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.
- Educational content:
Explication of the pathogenesis and biology of myeloid and lymphoid malignancies and exposure to all aspects of hematologic malignancies requiring hospital-based therapies.
- Mix of diseases:
All hematologic malignancies as well as myelodysplastic syndromes and aplastic anemia.
- Patient characteristics:
Men and women, adults and adolescents, including geriatric populations.
- Types of clinical encounters:
Daily bedside encounters.
- Procedures:
Bone marrow aspiration and biopsy, chemotherapy infusion, stem cell and bone marrow infusion, intrathecal/intraventricular chemotherapy administration.
- Educational resources:
As previously described.
- Supervision:
All aspects of the fellows' clinical activities and training are supervised by the two Rhoads 7 inpatient attending physicians.
Outpatient Training in Hematology and Oncology
During the first year, fellows maintain one clinic session per week with an assigned preceptor in continuity for 6 months, without interruption for inpatient rotations. Clinics are selected with attention to fellows’ clinical interests. In addition to the continuity clinics, fellows have full-time (8 sessions per week) outpatient rotations for 5 weeks at the VAMC, 5 weeks at PPMC, and 10 weeks at HUP/PCAM. Fellows are integrated directly into individual attendings' practices. The outpatient clinical experience includes solid tumors, hematologic malignancy/transplant, or additional classical hematology as desired by the fellow.
The fellows are expected to assume primary responsibility for the patients they see, which includes a complete H&P, preparation of progress note(s), follow up on laboratory and radiographic data, presentation in conferences, and follow-up management. Fellows follow the patients as necessary, formulate treatment plans, and direct the care of the patients. Fellows continue to be the primary hematology/oncology physician for patients, are available by telephone or pager to patients during the week, and see them should an emergency arise.
The program's goal is to provide experience in performing hematology and oncology consultations and second opinions in the outpatient setting, and in devising and carrying out complex treatment plans that include long-term follow-up of the patients.
- Principal teaching methods: Outpatient teaching.
- Educational content: Exposure to a wide range of hematologic and oncologic disorders, including hematologic malignancies, leukemias and the full spectrum of solid tumors. Fellows will have the opportunity to teach patients and families about these diseases, and to counsel them, as well as to learn about the side effects of cancer therapy and the management of patients with all stages of disease, including its terminal stages.
- Mix of diseases: See above.
- Patient characteristics: Men and women of all ages and ethnic backgrounds.
- Types of clinical encounters: Interviews and examinations, review of medical records and radiographs.
- Procedures: Bone marrow aspirations and biopsies, lumbar punctures, the supervision of chemotherapy, administration of intrathecal/intraventricular chemotherapy.
- Educational resources: Multi-headed teaching microscope and television, textbooks, computer terminals, including dedicated electronic systems for viewing radiology studies.
- Supervision: Fellows are supervised by faculty in hematology/oncology in each clinic. In addition, nurse navigators and social workers are available for consultation to assist patients with psychological and social problems.
Philadelphia VA Medical Center
This is a hybrid inpatient/outpatient rotation. During outpatient blocks, first-year fellows maintain a continuity panel in which they serve as the primary hematologist/oncologist for veterans. Some fellows choose to maintain their patient panels throughout the second and third years of the fellowship program.
The clinics are staffed by Penn hematologists/oncologists and are organized such that each day has a different disease theme, including malignant hematology, GI malignancies, head and neck cancer and lung cancer. During inpatient VA rotations, the fellow and the consult attending supervise the hematology/oncology inpatient consult service and oversee the care of hematology/oncology inpatients.
Several multidisciplinary tumor boards are held at the VAMC, and the fellow and consult attending serve as the medical oncologists for these conferences.
The purpose of the program is to provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic and oncologic diseases in both inpatients and outpatients.
- Principal teaching methods:
Outpatient teaching, inpatient consults, clinical conferences and case reviews, literature reviews.
- Educational content:
Exposure to the diagnosis, treatment, and prevention of a variety of hematologic problems and liquid and solid tumors, particularly aerodigestive cancers, GI cancers, head and neck malignancies, and prostate cancer.
- Mix of diseases:
As above.
- Patient characteristics:
Largely men, including a high representation of the geriatric population.
- Types of clinical encounters:
Interviews and examinations in the outpatient office and on inpatient services.
- Procedures:
Bone marrow aspiration and biopsies, supervision of chemotherapy infusion, intrathecal/intraventricular chemotherapy administration.
- Educational resources:
As previously noted.
- Supervision:
Fellows are supervised by members of the Penn faculty who serve primarily at the VAMC or at HUP.
Penn Presbyterian Medical Center
At Penn Presbyterian Medical Center, fellows benefit from unique training opportunities and are exposed to the socioeconomically and demographically diverse patient population of an urban safety net hospital. In contrast to the tertiary care oncology clinics based at PCAM, where most patients are seeking second opinions or clinical trial enrollment, the majority of cases seen in the PPMC clinic constitute “bread and butter” hematology-oncology. In this setting, fellows learn to manage common treatment-related toxicities, chemotherapy dosing and modification, and will be better poised to own patient care in a longitudinal manner.
Clinical experiences exclusive to PPMC include a multi-disciplinary Mesothelioma and Pleural Disease Program and a novel Cancer Diagnostics clinic. The latter serves as a much-needed point of access for West Philadelphia community members who present to the emergency department with suspected malignancy.
The purpose of the rotation is to provide comprehensive training in the diagnosis and management of hematologic and oncologic diseases in an academic urban safety net setting.
- Principal teaching methods: Outpatient teaching, inpatient consults, clinical conferences and case reviews, literature reviews.
- Educational content: Exposure to the diagnosis, treatment, and prevention of a variety of hematologic problems and liquid and solid tumors, and well as classical hematology.
- Mix of diseases: As above.
- Patient characteristics: Diverse patient population reflective of West Philadelphia.
- Types of clinical encounters: Interviews and examinations in the outpatient office and on inpatient services.
- Procedures: Bone marrow aspiration and biopsies, supervision of chemotherapy infusion, intrathecal/intraventricular chemotherapy administration.
- Educational resources: As previously noted.
- Supervision: Fellows are supervised by members of the Penn faculty.