Hematology/Medical Oncology Fellowship Program

Required 2-4 Months

The consult fellow(s) manages inpatient Hematology Consults, including consults from medical and nonmedical services. During this rotation, the fellow will organize and present at the Friday AM Clinico-Pathologic Conference (aka Slide Conference) and at one case management conference during Hematology/Hematologic Malignancies Didactics (Tuesdays, noon - 1 p.m.).

Educational Purpose: To provide a varied and comprehensive experience in general and consultative hematology so that fellows are able to practice independently in all areas of classical 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.

It is expected that the fellow will provide brief lectures to the Hematology team, at least weekly, on topics in general hematology (e.g., cytopenias, evaluations of prolonged PT or aPTT, hypercoaguable states, hemolytic anemias).

Educational Content: Exposure to all aspects of adult hematology, including hereditary and acquired anemias, congenital and acquired coagulation disorders, transfusion medicine, the diagnosis and management of cytopenias and elevated blood counts, and the evaluation of patients with gammopathies. Detailed study of peripheral blood and bone marrow morphology, the 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.

Procedures: Bone marrow aspiration and biopsies.

Educational Resources: Multiheaded teaching microscope and television, American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: All Consults are supervised by the Hematology Consult Attending.

Required 2-4 Weeks

Most fellows will spend 2-4 weeks on the hematopathology rotation. This is an in-depth exposure to all aspects of hematopathology and the laboratory medicine related to hematology and hematologic malignancies. The fellow also serves as liaison between hematopathology and clinical teams – hematologic malignancies, BMT, and general hematology. It includes active participation in hematopathology rounds and experience in the methodologies and interpretation of laboratory-based testing.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis of hematologic malignancies, including microscopy, flow cytometry and molecular analysis.

Principal Teaching Methods: Microscopy sessions, half-day or full-day sessions in the hematology, flow cytometry, molecular biology, and special hemostasis laboratories.

Educational Content: Pathologic review of bone marrow aspirations and biopsies, and lymph node biopsies; observation of laboratory analysis of special hemostasis lab tests; observation of flow cytometry and molecular assays with focus on interpretation of results in consultation with attending pathologist/hematologist.

Mix of Diseases: All diseases/evaluations, which would include marrow or lymph node biopsies (including hematologic malignancies and general hematology), bleeding, and clotting disorders. The primary focus is on bone marrow and lymph node biopsies.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Clinical correlation of laboratory findings will usually be done at conferences or via phone consultation.

Procedures: Not applicable.

Educational Resources: American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the attending physicians in Pathology/Hematolopathology.

Required for Most Fellows - 1 Month

The outpatient hemophilia experience provides an exposure to patients with bleeding disorders. This will include patients with inherited Factor 8 and Factor 9 deficiency, but will also include those with von Willebrand disease and acquired factor deficiencies.

The fellow will see outpatients with the Hemophilia Center Director or his/her designee, and Hemophilia Center nursing staff.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of bleeding disorders and the long-term sequelae of these diseases.

Principal Teaching Methods: This is primarily an outpatient rotation, including outpatient management, fellows’ presentations of patients and discussion, literature review, and teaching conferences.

Educational Content: Bleeding and thrombotic disorders, including new patient consults and management of chronic diseases..

Mix of Diseases: All bleeding and thrombotic disorders, but with primary focus on Factor 8 and Factor 9 deficiencies.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Outpatient office visits.

Procedures: Not applicable.

Educational Resources: American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellow's clinical activities and training are supervised by the Hemophilia Center Director and Hematology faculty.

Required – 1-2 Months

Fellows will coordinate patient care on this inpatient service. The daily schedule consists of morning walk rounds with the attending and residents, including discharge planning (case management) rounds. The fellow is responsible for diagnostic and therapeutic procedures, including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or ommaya reservoir tap. In addition, the fellow is responsible for obtaining consent for chemotherapy (with attending supervision and attending signature) and writing draft chemotherapy orders. Fellows will continue to follow their patients when they are transferred to other units, such as the ICU or Surgery.

Fellows will perform consultation for patients with new diagnoses of acute myeloid leukemia, acute lymphoid leukemia, myelodysplastic syndrome, chronic leukemias, etc. Patients will be transferred to the Oncology Service as appropriate for patient management.

The fellow also serves as liaison between hematopathology and the Blue Medicine service, reviewing the new cases with the pathologists and reporting results to the team. The fellow is expected to round with the attending and the Advanced Practice Providers on the Elective Chemotherapy Service, but generally does not have primary responsibility for these patients.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic malignancies; to provide experience in the diagnosis and management of oncologic emergencies; to gain expertise in the management of pain control and family-centered terminal care.

Principal Teaching Methods: Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

It is expected that the fellow will provide brief lectures to the Blue Medicine team, at least weekly, on topics in hematologic malignancies (e.g., leukemias, tumor lysis syndrome, febrile neutropenia).

Educational Content: Exposure to the pathogenesis and biology of myeloid and lymphoid malignancies, with a focus on acute lymphoid leukemia and acute myeloid leukemia.

Mix of Diseases: Acute lymphoid leukemia, acute myeloid leukemia, chronic lymphoid leukemia, chronic myeloid leukemia, myelodysplastic syndrome, myeloproliferative diseases.

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, intrathecal chemotherapy administration.

Educational Resources: Multiheaded teaching microscope and television, American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the inpatient attending physicians.

Required – 1-2 Months

Fellows will coordinate patient care on this inpatient service. The daily schedule consists of morning walk rounds with the attending and residents, including discharge planning (case management) rounds. The fellow is responsible for diagnostic and therapeutic procedures, including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or ommaya reservoir tap. In addition, the fellow is responsible for obtaining consent for chemotherapy (with attending supervision and attending signature) and writing draft chemotherapy orders. Fellows will continue to follow their patients when they are transferred to other units, such as the ICU or Surgery.

Fellows will perform consultation for patients with new diagnoses of Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, other plasma cell dyscrasias, etc. Patients will be transferred to the Oncology Service as appropriate for patient management.

The fellow also serves as liaison between hematopathology and the Blue Medicine service, reviewing the new cases with the pathologists and reporting results to the team. The fellow is expected to round with the attending and the Advanced Practice Providers on the Elective Chemotherapy Service, but generally does not have primary responsibility for these patients.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic malignancies; to provide experience in the diagnosis and management of oncologic emergencies; to gain expertise in the management of pain control and family-centered terminal care.

Principal Teaching Methods: Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

It is expected that the fellow will provide brief lectures to the Blue Medicine team, at least weekly, on topics in hematologic malignancies (e.g., multiple myeloma, lymphomas, tumor lysis syndrome, febrile neutropenia).

Educational Content: Exposure to the pathogenesis and biology of lymphoid malignancies – focusing on lymphomas and myeloma,  and exposure to all aspects of hematologic malignancies requiring hospital-based therapies.

Mix of Diseases: Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, and other plasma cell dyscrasias

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, intrathecal chemotherapy administration.

Educational Resources: Multiheaded teaching microscope and television, American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the inpatient attending physicians.

Required – 36 Months

Fellows are required to have outpatient clinical experiences for the duration of the fellowship. This includes:

• Longitudinal Clinics: At least six months in duration but may be 12-24 months if appropriate. Fellows follow patients as the primary provider, with support from the attending of record and office staff (nurses, medical assistants, etc.). This includes options in classical hematology, general hematology-oncology, solid tumor oncology, and hematologic malignancies.
• Six-Month Outpatient Blocks: These are six-month blocks during the first two years of training. During the PGY4 and PGY5 year, fellows will have a six-month block devoted to GU oncology, thoracic oncology, and head and neck oncology, and another six-month block devoted to GYN oncology, GI oncology, sarcoma and breast oncology. During these six-month blocks, fellows will usually have one session/week in hematology or hematologic malignancies. Sessions in palliative care, neuro-oncology, melanoma, etc., can be added in, based on fellow preference.
• Multidisciplinary Clinics: These are incorporated into the six-month blocks noted above, but can also be an assigned clinic for fellows with career goals related to a specific tumor type. These include thoracic, melanoma, head and neck, GI, GU, breast, and GYN.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and outpatient management of patients with classical hematologic diseases, hematologic malignancies, and solid tumors; to provide experience in the use of antineoplastic therapies; to gain expertise in the management of pain control and family-centered terminal care.

Principal Teaching Methods: Patient visits and presentations in the outpatient setting. There are often medical students in the outpatient setting as well, although every effort is made to have medical residents see patients in clinics that do not have fellows. Fellows are expected to mentor other trainees in this setting, both in history and physical exam, but also in specific topics in hematology and oncology.

Educational Content: All areas of classical hematology, hematologic malignancies, and solid tumors

Mix of Diseases: All areas of classical hematology, hematologic malignancies, and solid tumors

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Outpatient clinic setting, including multidisciplinary clinics.

Procedures: Bone marrow aspiration and biopsy, chemotherapy infusion, and intrathecal chemotherapy administration.

Educational Resources: American Society of Hematology online resources (ASH Essentials), American Society of Clinical Oncology online resources (ASCO University), NCCN guidelines, as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the attending physicians.

Required for Most Fellows – Schedule Varies

Fellows have several options for clinical experience in Palliative/Supportive Care. There is an inpatient consult service, as well as an outpatient clinic, as part of the Sidney Kimmel Comprehensive Cancer Center - Neu Center. In the outpatient setting, this includes an experience in the Medical Marijuana Clinic.

It is understood that the best clinical experience for a fellow may be inpatient, outpatient, or a combination of these. It is further understood that fellows with significant prior experience in Palliative/Supportive Care may not benefit from a prolonged experience.

Fellows may choose to do:

• 2-4 week elective with the Palliative Care/Supportive Care service, including inpatient consultation, outpatient visits, or both.
• Longitudinal Clinic – 6-12 months in the outpatient setting, one session/week.

Educational Purpose: To provide a comprehensive experience in the management of pain and other side effects of cancers and associated therapies; to gain expertise in the management of pain control and family-centered terminal care.

Principal Teaching Methods: Patient visits, presentations in the outpatient and/or inpatient setting.

Educational Content: Symptom management, including pain, neuropathy, nausea, anxiety, advanced care planning, medical marijuana use.

Mix of Diseases: All areas of hematologic malignancies and solid tumors.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Outpatient and/or inpatient setting.

Procedures: Not applicable.

Educational Resources: Online resources as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the attending physicians in the Palliative/Supportive Care Program.

Elective – Schedule Varies

Jefferson’s Senior Adult Oncology Clinic was established several years ago. Patients who are 65 years or older, who are or will be receiving chemotherapy, are seen in consultation by a multidisciplinary team, including geriatrician, oncologist, pharmacist, dietician, and social worker. The team evaluates the patient and family, and provides a summative statement about the patient’s fitness for therapy and makes recommendations related to therapy and/or supportive care.

Fellows have two options for clinical experience in Senior Adult Oncology:  

• 2-4 week elective with the Senior Adult Oncology service in the outpatient setting.
• Longitudinal Clinic – 6-12 months in the outpatient setting, one session/week.

Educational Purpose: To provide a comprehensive experience in the management of older patients with cancer.

Principal Teaching Methods: Patient visits, presentations in the outpatient setting.

Educational Content: Management of older patients with cancer, including general medical issues that effect the older adult, polypharmacy, and supportive care.

Mix of Diseases: All areas of hematologic malignancies and solid tumors.

Patient Characteristics: Men and women – geriatric population.

Types of Clinical Encounters: Outpatient setting.

Procedures: Not applicable.

Educational Resources: Online resources as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellows' clinical activities and training are supervised by the attending physicians in the Senior Adult Oncology Program.

Elective – 2-4 Weeks

Educational Purpose: To provide an in-depth experience in the treatment of sickle cell anemia, related hemolytic processes, and their long-term sequelae.

Principal Teaching Methods: Outpatient office visits, sickle cell day center visits, teaching rounds, bedside presentation and discussion, conferences, inpatient consultation.

Educational Content: Exposure to all aspects of the care of patients with sickle cell anemia, SC disease, sickle beta thalassemia, and related hemolytic disorders. This includes an in-depth experience looking at the management of pain crisis, renal crisis, neurological sequelae, and other end-organ damage related to these entities.

Mix of Diseases: Sickle cell anemia, SC disease, sickle beta thalassemia, and related hemolytic disorders.

Patient Characteristics: Men and women, adults and adolescents.

Types of Clinical Encounters: This will be mostly an outpatient rotation, including the sickle cell day center and outpatient office visits. There will be rounds on the inpatients with sickle cell anemia and inpatient consultations as necessary.

Procedures: Not applicable.

Educational Resources: American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: Fellows are supervised by the attending physicians in Hematology and General Internal Medicine, who care for patients with these diseases.

Required – 1-3 Months

On this rotation, the fellows will concentrate on the evaluation and management of patients with new oncologic diagnoses or patients with unknown diagnoses for whom a malignancy is part of the differential diagnosis, as well as provide support to the oncology inpatients by writing chemotherapy orders on solid tumor oncology inpatients. The aims are for the fellow to gain an understanding of disease processes, the past histories, and the choices of chemotherapy regimens. Consults will be staffed by the solid tumor inpatient attendings on-service. (Consults that are requested of and staffed by attendings who are not on service will not be seen by the fellow.)

The fellow will also facilitate transfers to the solid tumor inpatient oncology service from other hospitals or other services at Jefferson, and follow those patients as above.

The consult service is a collaborative effort between the fellows and advanced practice providers, with an effort to provide fellows with the consultation experience that best suits both the individual fellow’s educational needs and results in optimal patient care.

Fellows may do two-week blocks of consults on this service or four-week blocks, depending on individual fellows’ schedules and patient care needs.

Educational Purpose: To provide a sophisticated and comprehensive experience in the diagnosis and management of oncologic diseases, under the direct supervision of attending physicians.

Principal Teaching Methods: Inpatient patient management, consultation, teaching, clinical conferences and case reviews, literature reviews.

It is expected that the fellow will provide brief lectures to the Blue Medicine team, at least weekly, on topics in oncology (e.g., lung cancer, colon cancer, breast cancer, prostate cancer, cancer screening, management of nausea and emesis).

Educational Content: Exposure to the biology and pathogenesis of a variety of solid tumors, and participation in the diagnosis and treatment of a variety of solid tumors and their complications, including breast cancer, aero-digestive cancer, melanoma and sarcoma, lymphomas, brain tumors, and genitourinary cancers.

Mix of Diseases: A wide array of solid tumor oncologic problems, as well as hypercalcemia, workup of new masses or lytic bony lesions.

Patient Characteristics: Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters: Interviews and examinations in the inpatient setting.

Procedures: Bone marrow aspiration and biopsies, chemotherapy infusion, intrathecal chemotherapy administration.

Educational Resources: Online resources, including ASCO University and NCCN Guidelines, the Sidney Kimmel Medical College Library.

Required for Most Fellows – 2-4 Weeks

Fellows will become proficient in the evaluation, diagnosis, and management of patients in transfusion and apheresis medicine. They will work with the transfusion medicine attendings and fellows to see patients requiring consultation for red cell exchange and apheresis procedures, and to deal with patients with difficult transfusion issues.

Educational Purpose: To provide a sophisticated and comprehensive experience in blood banking, including cross matching, and the use of plasma and cellular products. To provide an experience in the use of apheresis procedures for multiple indications.

Principal Teaching Methods: Rounds with the transfusion medicine team, inpatient consultation, literature review, and teaching conferences, including the Transfusion Medicine Journal Club.

Educational Content: Exposure to the standard transfusion medicine procedures and to the most current guidelines for transfusion. This will include the risk of transfusion reaction and viral transmission, the use of apheresis, and the evaluation and management of patients who are refractory to red cell or platelet products.

Mix of Diseases: All patient who require transfusion support and/or apheresis.

Patient Characteristics: The entire TJUH population, including children and adults, male and female.

Types of Clinical Encounters: Occasional inpatient consultation, some evaluation of patients who will be undergoing phlebotomy or apheresis in the TJUH Donor Center.

Procedures: Not applicable.

Educational Resources: American Society of Hematology online resources (ASH Essentials), as well as the Sidney Kimmel Medical College Library collection.

Supervision: All aspects of the fellow's activities and training are supervised by the Transfusion Medicine attending physicians.