Hematology – Oncology Consult Curriculum

Rotation Coordinator:  Victoria M. Villaflor, M.D.
Ext:  2-6613, Michelle Scheuer
Pager: 8956
Email:  vvillafl@medicine.bsd.uchicago.edu

Expectations:

There are many competent physicians who spend their entire life trying to learn everything about just one small area of hematology or oncology.  It would be impossible to try to learn everything in a 2-4 week rotation. The purpose of this rotation is to develop your preexisting knowledge and skills to make you more comfortable as part of a medical team caring for patients with malignancies or benign hematologic disorders.  No matter which subspecialty of medicine is chosen, you will encounter cancer patients and will often be asked questions by the patient, family or even be involved in the management; likewise for benign hematologic issues.  The goal of this rotation is to prepare you to evaluate the cancer or benign hematology patients and be comfortable with treatments for more common malignancies and benign hematologic disorders.  Additionally, clinical indications, complications, and limitations will be taught.  End of life discussion and goals of care are an integral part of oncology which can be carried to other areas of medicine.

The best way to achieve these goals is to be an active participant on the rotation.  The purpose of these goals is to define active participation.

  1. Attendance to clinics is mandatory. (exceptions: personal/family medical illnesses or alternative clinical responsibilities)
  2. Residents are allowed to take maximum one personal day for fellowship interviews, job interviews, board exams etc.
  3. Residents are expected to see at least 4-5 patients during a half day clinic.  After evaluation of the patient, the H&P will be presented to the attending.  Both the resident and the attending will see the patient.

Evaluations will be completed by all the attendings you work with and a summary will be provided to the chief medical residents.  You will evaluate the attendings you work with and also evaluate the rotation with emphasis on your experiences and what improvements could be made.

 

Hem/Onc Ambulatory Service Curriculum

Overview:

The Hem/Onc Ambulatory Clinical Rotation provides house officers exposure to the diagnosis and treatment of malignancies and benign hematological disorders encountered in the out patient setting.  The team consists of you and a supervising attending physician.  The rotation lasts 2-4 weeks.


Educational Purpose and Goals:

Active participation in hem/onc clinics while achieving the following goals:

Develop the ability to diagnose stage and understand goals of treatment, complications and management as well as discussions on end of life issues.

 

  1. Malignancies

Breast Cancer

  • Understand genetic abnormalities and other high risk features
  • Understand diagnosis and staging
  • Understand treatments and complications of those treatments
  • Understand targeted therapies such as PARP inhibitors, tamoxifen, aromatase inhibitors, HER2 and the criteria for their use in specific subsets of disease.
  • Understand complications associated with progressive disease
  • Obtain history and physical with emphasis on symptoms and physical manifestations of breast cancer and complications of treatment
  • Obtain and interpret pathology data and radiology data
  • Obtain and interpret lab data on therapy
  • Review high risk features of breast cancer for prognosis and for familial risk
  • Understand appropriate use of hormonal therapies
  • Understand screening recommendations
  • Understand survivorship issues including risk for recurrence, lymphedema risks, osteoporosis and other long term side effects of treatment of breast cancer
  • Understand indications for radiation, surgery and reconstruction

 

Lung Cancer

  • Understand the risk factors for developing lung cancer
  • Understand diagnosis and staging
  • Understand treatments and complications of treatment
  • Understand complications of tumor progression
  • Understand how to manage multiple comorbidities while on treatment
  • Obtain history and physical with emphasis on symptoms and physical manifestations of lung cancer and complications of treatment
  • Obtain and interpret pathology data and radiology data
  • Obtain and interpret lab data on therapy
  • Be able to understand goals of treatment and feel comfortable with end of life discussions
  • Understand survivorship issues including risk for recurrence
  • Understand indications for radiation and surgery


Colorectal Cancer/GI Malignancies

  • Understand screening recommendations
  • Understand diagnosis and staging
  • Understand treatment and complications of both treatment and tumor progression
  • Obtain history and physical with emphasis on symptoms and physical manifestations of colorectal cancer (GI Malignancies)
  • Obtain and interpret pathology data, radiology data, colonoscopy/endoscopy/ERCP/EUS data
  • Obtain and interpret laboratory data while on treatment
  • Understand familial risk syndromes
  • Understand the role of KRAS in CRC
  • Understand survivorship issues
  • Understand indications for radiation and surgery


Head and Neck Malignancies

  • Understand diagnosis and staging
  • Understand the role of HPV in head and neck cancer
  • Understand treatment and complications of treatment and tumor progression
  • Obtain history and physical with emphasis on symptoms and physical manifestations of head and neck cancer
  • Obtain and interpret pathology data panendoscopy data and radiology data
  • Obtain and interpret laboratory while on treatment
  • Management of toxicities of treatment
  • Understand survivorship issues including risk for recurrence and other long term side effects of treatment of head and neck cancer
  • Understand indications for radiation, surgery and reconstruction


Lymphoma/Leukemia and Other Hematologic Malignancies

  • Understand genetic abnormalities and prognostic/treatment implications
  • Understand diagnosis and staging
  • Understand treatment recommendations
  • Understand complications of both treatment and progression of disease
  • Understand bone marrow biopsy interpretation, flow cytometry and genetic interpretation
  • Understand and interpret radiology data
  • Obtain and interpret laboratory data
  • Obtain history and physical with emphasis on symptoms and physical manifestations of hematologic malignancies
  • Understand “survivorship” goals in diseases such as leukemia, lymphoma, transplant.
  • Understand late and under-recognized side effects from treatment
  • Understand the immunocompromised state of patients with active hematologic malignancies


GU Malignancies (prostate, renal, testicular, ovarian/GYN)

  • Understand screening recommendations for prostate cancer
  • Understand diagnosis and staging
  • Understand treatment
  • Understand complications of treatment and tumor progression
  • Obtain history and physical with emphasis on symptoms and clinical manifestations of GU malignancies
  • Obtain and interpret pathology data, cystoscopy data and radiologic data
  • Obtain and interpret laboratory data while on treatment
  • Management of toxicities of treatment
  • Understand survivorship issues including risk for recurrence and other long term side effects of treatment
  • Understand indications for radiation and surgery

Other malignancies such as sarcomas, thyroid cancer, salivary gland cancer and other rare malignancies may be other topics of interest time permitting.

 

  1. Benign Hematology

Anemias and Pancytopenias

  • Understand differential diagnosis
  • Understand workup including laboratory testing, bone marrow biopsy interpretation
  • Understand treatments and complications of treatment

Transfusion Medicine

  • Indications for transfusion
  • Appropriate use of transfusion products
  • Risks for transfusion

Coagulation and Hemostasis (Bleeding) Disorders

  • Understand differential diagnosis
  • Understand laboratory evaluation, and interpretation of results
  • Understand treatments and complications of treatment

Dysplastic and Proliferative Disorders

  • Understand differential diagnosis
  • Understand pathophysiology of myeloproliferative syndromes and myelodysplastic syndromes
  • Understand genetic defects
  • Understand laboratory analysis
  • Understand treatment recommendations and potential complications

 

Suggested Reading:

  • Harrison’s Internal Medicine
  • Up to Date
  • Medstudy Internal medicine review core curriculum (not adequate primary source but does provide some good information and questions)