Ascension Providence Hospital Hematology/Oncology Rotation Schedule

Consult Service & Floor- Hematology/Oncology Teaching Floor

The fellow spends 6 months of the first year of the fellowship in 2-month block periods.  The fellow will supervise house staff of two rotating internal medicine fellows and one to two medical students a month.  Work rounds will begin at 8:30 a.m. although it is expected that the fellow will have seen the patient prior to work rounds.  The fellow will be responsible for writing orders and coordinating care with the supervising attending.   Review of pathology and x-rays will be done on a daily basis.  Sign out rounds will be conducted at 4:30 p.m. daily.  The fellow will be involved in supervising the house staff and assisting with their evaluations.  The senior fellow will also supervise the first-year fellow..  The overall evaluations will be in accordance with the ACGME guidelines by assessment of attending physicians and input from the clinical nurse specialist and head nurse.  The fellows will have sole responsibility for chemotherapy patients.  They will also perform bone marrow examination, paracenthesis and lumbar puncture on paracenthesis.  The fellows will participate in teaching conferences.  Consultation will be 5 months during the first year in 2-month time blocks.

Radiation Oncology

Radiation therapy will be under the guidance of Ascension Providence Hospital by the University of Michigan teaching faculty.  This is done at the Novi Cancer Center.  The fellow will learn the principles of radiation therapy.    The differences of radiation fundamentals with brachytherapy, electron beam and linear accelerator will be addressed.  The fellow will perform consultation in the hospital and outpatient setting and attend conferences.  The fellow should be confident in the indications of radiation therapy, the maximum tolerated dose and combined modality therapy with radiation sensitizeus such as chemotherapy or thiols, which enhance radiation therapy.  The fellow will be assessed by the ACGME guidelines for evaluation.  The fellow will be assessed by ACGME guidelines for evaluation of the radiation elective during the first year.  Each week the fellow will be assigned to a different attending. 

The fellows will do a maximum of four consults a day in hematology/oncology.  They will evaluate the patient, perform a history and physical, and provide diagnostic and treatment plan.  The fellow will be responsible for presenting cases at general tumor board and leukemia/lymphoma and breast cancer conferences.  The fellow will follow all patients on the consult service.  Patients seen in the outpatient setting will be followed in the outpatient environment where they may be assessed to determine the correct treatment plan.  The treatment plan will then be implemented. 

Senior Fellow

At times the senior fellow may fill in for a fellow that is away on conference or vacation.  The senior fellow will also work in the laboratory or complete clinical research projects.  The senior fellow will be responsible for rotations and schedules to be coordinated with the Director of the Hematology/Oncology program. 

Karmanos Cancer Institute

This rotation is located at the Karmanos Cancer Institute and is a six month rotation.  The fellow will attend disciplinary conferences, attend to subspecialty disciplines within the field of Breast Cancer, lymphomas, pharmacology, head and neck cancer, and GI cancer.  Each rotation will be critically addressed by ACGME guidelines for the fellow input.  The fellow will see the patients who will be seen for a new consultation.  The fellow will be expected to provide a diagnostic and treatment plan with the attending physician.  The fellow will spend four full days a week at the Karmanos Cancer Institute and be expected to start at 7:00am to a minimum of 5:00pm.  He will return to Ascension Providence Hospital one day per week for continuity clinic responsibilities.  Research studies can be performed during any free time the fellow may have during this rotation.  The fellow will also supervise the first year fellow by performing teaching rounds twice a week.  These teaching rounds will deal with the basic fundamentals of hematology/oncology.  The fellow will also be in charge of providing the teaching schedule for the attending physician’s for the hematology/oncology fellows. 

Hematology Rotations

Coagulation
The fellow will rotate at Henry Ford Hospital for one month and learn to work with the Laboratory Specimens in performing clotting studies.  They will learn the principles of clotting when doing consultations with the Coagulation specialist at Henry Ford Hospital.  The principles for the diagnostic and treatment options for patients with hemophilia, prior factor deficiencies, and congenital problems along with platelet disorders will be addressed.

Bone Marrow Transplantation
Fellows will rotate at the Karmanos Cancer Institute for 2 months were they will see patients both in the inpatient/outpatient service.  They will attend the multi-disciplinary bone marrow transplant patient conferences where patients will be presented for consideration for transplants.  They will provide the outpatient consultation they will also spend time directly on the floor-managing patients for cell harvesting, chemotherapy adminisistration, total body radiation therapy administration, and management of the patients with pancytopenia.  They will become expert in antibiotic prophylaxis along with management malignant hemological disease and they will learn and understand the principles of allogeneic and autologous transplantation and the different indications for these therapies patients with multiple myleoma, acute leukemia, lymphoma’s, Hodgkin’s disease, aplastic anemia and solid tumors will all be assessed. Patients will also be seen in the outpatient setting for follow up to determine there response and quality of life and tolerance of transplant.

Hematopathology
The fellow will spend one month at Ascension Providence Hospital under the guidance of hamatopatholoy where they will review histopathology, bone marrows, lymph node biopsies, and cytology and review the pathology tissue slides with a manapathologist it will be expected of the fellow to be confident in peripheral smears and bone marrow examinations issuing reports that are accurate and meaningful for patients undergoing bone marrow examinations.  The fellow also will become expert in the revised European/American lymphoma classification (REAL) and attend conferences in leukemia lymphoma and discuss the pathology findings under direction of the hamanapathologists.

Blood Banking
Principles of blood banking including ABO histocompatability, principles of platelet, red cell transfusion patients with hemolytic anemias will have special emphasis