Faculty Chair:

William Adler, MD

Contacts:

William Adler, MD

Required Experiences:

Memorial Medical Center

Optional Experience:

Elective rotations

Weekly Schedule PGY3:

Requirements:

AOA

Internal Medicine

The program must provide at least thirty-two weeks of clinical training in internal medicine disciplines, including at least eight weeks of general internal medicine experiences during the OGME-1 year. This requirement can be met by either inpatient internal medicine or inpatient family medicine service.

At a minimum internal medicine training must include:

• Twenty-four weeks of inpatient experience.
• Four weeks of training in critical care medicine.
• Didactic and clinical training.

Internal medicine training shall include exposure to the following disciplines, in either inpatient or outpatient settings:

• Allergy and immunology.
• Cardiology.
• Dermatology.
• Endocrinology.
• Gastroenterology.
• Hematology.
• Infectious diseases.
• Nephrology.
• Neurology.
• Oncology.
• Pulmonology.
• Rheumatology.

ACGME

There must be specific subspecialty curricula to address the breadth of patients seen in family medicine. (Core)

The program must ensure that every resident has exposure to a variety of medical and surgical subspecialties throughout the educational program. (Detail)

Description of Rotation or Educational Experience:

Residents work closely with Hematology/ Oncology faculty. The range of blood diseases and malignancies encountered is wide, and affords the resident the opportunity to see these problems at every stage of their natural history and treatment. The service utilizes both established treatment modalities and a large number of collaborative research protocols in the management of patients. Residents are thereby exposed to cutting-edge concepts of treatment

Expectations:

Residents

Residents are expected to arrive to Hematology/ Oncology and continuity clinics on time and to dress and act in a professional manner. They are expected to contact the Hematology/ Oncology preceptors’ office prior to their first day on the rotation in order to arrange the initial meeting time and location of the rotation. It is expected that while at the preceptors’ office the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty:

Family medicine faculty will provide precepting of Hematology/ Oncology cases and procedures as seen in resident continuity clinics. Dr. Adler, and possibly other physicians in his practice, will provide precepting during the focused rotation. The faculty and preceptors are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of Heme/Onc conditions and their treatments.

Call:

There is no call specific to this rotation.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Be able to perform standardized comprehensive assessments, obtain necessary further investigation and develop acute and long-term comprehensive treatment plans based on the basis of presenting and progression of hematologic or oncologic processes.

Objectives

In the appropriate setting, the resident should demonstrate the ability to independently

perform or appropriately refer:

• Develop a thorough and reliable database for patients with a variety of hematologic and oncologic problems. Depending on the database, residents will develop a complete and accurate problems list for each patient, including relevant psychosocial problems.
• Construct a complete differential diagnosis for a wide variety of medical
  problems encountered by patients in the hematology/oncology practice.
• Select appropriate hematologic/oncologic diagnostic studies and
  understand the significance of their results.
• Perform common diagnostic studies and, as appropriate, appreciate their
  difficulty, the impact on patients, and advantages and shortcomings of the studies.
• Correctly interpret peripheral blood smears demonstrating normal findings and common abnormalities.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Be able to understand normal and abnormal hematologic physiology. Describe the pathophysiology of common malignacies.

Objectives

In the appropriate setting, the resident should demonstrate the ability to apply

knowledge of:

• Reflect satisfactory understanding of the common hematologic and oncologic conditions:
  • Mix of diseases:
    • The resident will learn the pathophysiology, prevention, evaluation and management of common hematology problems including: anemia and abnormalities of peripheral blood smear, hemoglobinopathies, bleeding, bruising, petechiae, family history of anemia or bleeding disorder, lymphadenopathy, pallor or fatigue, recurrent infections, fever/neutropenia, splenomegaly, venous or arterial thrombosis, polycythemia, neutropenia, leukocytosis, thrombocytopenia, thrombocytosis, coagulopathy, and common hematologic malignancies.
    • The resident will learn the pathophysiology, prevention, evaluation and management of common oncology problems including: ascites, bleeding, bowel obstruction, cough, hoarseness, hemoptysis, lymphadenopathy, soft tissue mass, organ enlargement, pleural or peritoneal effusion of unknown cause, sensory polyneuropathy, superior vena cava syndrome, weight loss, lung cancer, breast cancer, colorectal cancer, prostate cancer, pancreatic cancer, urinary tract malignancies, uterine (including cervical) cancer, lymphoma, gastric cancer, ovarian cancer, skin cancer (including melanoma), head and neck cancers, and esophageal cancer.

• Understand the indications and limitations as well as technical aspects of common diagnostic procedures including:
  • Bronchoscopy and mediastinoscopy
  • Open lung biopsy and mediastinotomy
  • Mammography
  • Needle aspiration (breast and others)
  • Breast biopsy and axillary node dissection
  • Bone marrow aspiration and biopsy
  • Upper and lower GI endoscopy
  • Prostatic ultrasound and biopsy (transrectal and TUR)
  • Nuclear imaging studies, including PET
  • Understand the indications, limitations, and technical aspects (lab and clinical) of transfusion of blood products
• Understand the basic principles of major modalities of cancer treatment including:
  • Chemotherapy
  • Surgical treatment
  • Radiation therapy
  • Immunotherapy
• Understand the importance of adequate symptom management and demonstrate knowledge of specific techniques for control of pain, nausea, and anxiety.
• Medical decision making and medical management: By completion of the rotation, residents should:
  • Integrate history, physical exam, and diagnostic studies to formulate a differential diagnosis, diagnostic plan, and initial management plan for common hematologic and oncologic syndromes:
    • anemia and other cytopenias
    • disorders of homeostasis and clotting
    • newly diagnosed common tumors (breast, colon, prostate, lung, and hematologic malignancies)
  • Under supervision, properly order transfusion of blood products
  • Under supervision, provide appropriate palliative care

Practice Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

• Be able to recognize his or her own practice limitations and seek consultation with other health care providers to provide optimal care.

Objectives

• Complete assigned reading topics and apply learned material in the clinical setting
• Demonstrate ability to identify limitations in own knowledge and take steps to fill these gaps.

System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Be able to optimize treatment plans based on knowledge of local resources that include local, state and federal agencies.
• Coordinate ambulatory, in-patient and institutional care across health care providers, institutions and governmental agencies.

Objectives

• Make appropriate referrals to and coordinate care with oncologists for those conditions that fall out of the scope of family medicine or do not respond to that treatment which family physicians can provide
• Demonstrate cost effective care and diagnostic testing
• Understand the design of oncologic trials and the implications for clinical practice.
• Demonstrate a commitment to continuous improvement, both in personal development and in a constructive approach to the clinical curriculum and
  clinical operations.
• Demonstrate critical appraisal of literature relating to hematology-oncology care, and constructively participate in small group discussion
• Demonstrate active case-based reading.

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

The list below reflects competencies that fall under Professionalism. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy

Objectives

• Display sensitivity for patient privacy and autonomy during exams and procedures
• Engage in interviewing techniques which demonstrate cultural and social sensitivity

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

The list below reflects competencies that fall under Interpersonal and Communication Skills. Which of the following competencies are relevant for the rotation or educational experience you have chosen? (Pick one or two)

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Act in a consultative role to other physicians and health professionals

Objectives

Communicate with patients and their families in a respectful, and concise manner that facilitates understanding with minimal jargon.

Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed. They will participate in weekly conferences. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

Direct observation with a ongoing global assessment based on the REDI system. All procedures will be recorded on New Innovations and independence for each procedure assessed using the REDI system. Evaluation from each of the community preceptors to be completed at the end of the rotation. Review of documentation by family medicine preceptors as part of continuity clinic supervision.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.

Educational Resources

Readings:

Week 1

FP Comprehensive #381 “Hematalogic Malignancies”

Iron Deficiency Anemia

Week 2

Week 3

Week 4

Text Books

Web Sites