First Year Experience
First Year Program Details
(13 months, including orientation month) The first-year curriculum includes the following rotations:
- Orientation — 1 month
- Inpatient oncology experience — 3 months
- Inpatient hematology experience – 3 months
- Outpatient oncology experience — 2 months
- Outpatient hematology experience - 6 weeks
- BMT unit — 1 month
- Coursework — 1 month
All new fellows participate in a month long series of subspecialty-focused orientation lectures. A wide range of topics is covered, including in-depth reviews of the diagnosis and management of the major diseases that confront the pediatric hematologist-oncologist, discussion of the principles of experimental design and clinical trial implementation, an overview of epidemiology, and topics related to clinical investigation in pediatric hematology-oncology. Also included in this month is dedicated time to shadow second year fellows in the clinical settings (both inpatient and outpatient) prior to starting your clinical rotations
The subsequent 12 months of training primarily focus on the clinical aspects of pediatric hematology-oncology. Fellows are trained in the principles of evaluation, diagnosis, and management of pediatric hematologic and oncologic disorders in both inpatient and ambulatory settings, consultations in both settings, and participation in teaching pediatric residents. It is important to highlight that the pediatric hematology-oncology fellowship emphasizes one-on-one supervision throughout the trainees’ entire educational experience. During every phase of the clinical training program, the fellows collaborate closely with faculty members to learn and deliver quality patient care.
Inpatient Services (7 months)
Oncology Service (3 months)
During the inpatient oncology service experience, the fellows will oversee the care of patients with new or established oncologic diagnoses as well as consults for possible oncologic diagnoses. Admissions may include scheduled chemotherapy as well as unscheduled admissions for disease and/or treatment complications such as fever. There are two inpatient oncology teams each with a fellow and a supervising attending physician: one team is staffed with pediatric interns, a supervising resident, and advanced practice provider; the other team is staffed with two full-time clinicians. The two teams admit patients on alternating days. Fellows and faculty determine patient distribution daily to help balance their workloads. Fellows have no other clinical responsibilities during this month so that they can devote all of their time to patient care and teaching.
Hematology Service(3 months)
During the inpatient hematology service experience, the fellow will oversee the care of patients with established hematologic diagnoses and consultations on all hematologic problems. The team consists of two first-year fellows and one supervising attending. During the week, a pediatric intern and advanced practice provider are also members of this team. A member of the Hemostasis and Thrombosis (HAT) team are available for additional support in evaluation patients with these disorders. Fellows have no other clinical responsibilities during this month so that they can devote all of their time to patient care and teaching.
Bone Marrow Transplantation (1 month)
This rotation involves the care of patients in the inpatient Bone Marrow Transplantation (BMT) Unit, with the assistance of an advanced practice provider, a bone marrow transplant fellow, and an attending physician. The fellows and attending physicians make daily patient rounds. The first-year fellow is usually paired with a senior fellow for the month.
Night call (7P-7A) is covered by a night team of a pediatric intern, pediatric hematology-oncology fellow and pediatric hematology-oncology attending (nocturnist). The intern and nocturnist are responsible for all primary hematology and oncology patients as well as any new admissions to any of those services overnight. The fellow is responsible for all inpatient BMT patients, any questions regarding hematology-oncology patients in the ICU or consult patients as well as phone calls from parent, outside facilities, and the Texas Children’s Emergency Center. The supervising physicians for all inpatient services are available 24 hours per day.
Outpatient Clinic (4 months)
During the outpatient clinic rotations, fellows are involved in evaluating new patients and following established patients in the cancer and hematology outpatient clinics. Fellows obtain the patient’s history, perform a physical examination, and formulate the initial management plan. Duties include ordering and assessing the results of laboratory and imaging studies on patients seen in the clinic. Attending physicians review each case with the fellow. Depending upon their experience, fellows are involved in or lead diagnostic and management presentations to the families and patients. The time in outpatient clinic is divided into blocks of focused learning experiences: brain tumors and solid tumors (1 month), leukemia and lymphoma (1 month), and hematology (6 weeks). The remaining two weeks are focused on learning experiences in long term survivorship, developmental therapeutics, and cancer genetics. During these clinic months, fellows also participate in the Solid Tumor Journal Club and the Hematology Journal Club.
Coursework Month (1 month)
The remaining month is spent in a rotation designated the coursework month. During this month, fellows undergo focused learning experiences in coagulation, hematopathology, blood banking, radiation oncology, immunophenotyping, cytogenetics, and DNA diagnostics. They are specific given learning objectives in each specialty area.
Continuity of Care
Longitudinal patient follow-up is an extremely important aspect of oncology training. When possible, newly diagnosed patients are seen for follow-up care by the same fellow who initially evaluated them in the outpatient or the inpatient setting. During the first-year of the program, fellows have limited opportunities to see patients they initially managed due to the requirements of the inpatient services. However, the electronic medical record system allows fellows to track their patients regardless of their current rotation. During the last quarter of their first year of training, fellows identify a group of patients to become their formal continuity patients. During the second and third years of training, fellows manage their continuity patients with appropriate faculty support. The fellows closely monitor their patients’ course of treatment. Whenever possible, the fellow is involved in major decision-making related to their primary continuity patients.
Scholarship Oversight Committee
Each first year fellow is assigned a scholarship oversight committee (SOC) of four individuals who meet with the fellow early in the first year to provide guidance in their career development and selection of a research mentor. The SOC is comprised of a clinical mentor selected by the fellow, a junior faculty member, and two senior faculty members. At the conclusion of the first year, the SOC membership is revised to include the research mentor and additional experts in the fellow’s chosen research field.
Psychosocial Aspects of Pediatric Hematology-Oncology
Fellows receive training to address psychosocial issues in the care of children and adolescents with life-threatening illnesses. Working with an experienced attending physician in the day-to-day care of patients, fellows learn how to provide optimal psychosocial support to patients and their families. In addition, the service has a full-time psychologist who directs the Psychosocial Support Program and who provides support and advice to fellows. There are also organized multidisciplinary conferences on patient and family management issues, as well as a fellows’ seminar series that focuses on recognizing and dealing with the psychosocial aspects of care (see Reflective Practice and Leadership Seminar below).
A prerequisite for success in an academic medical career is leadership ability. An academic physician is expected to guide the patient and family as they adapt to serious illness, supervise the health care team in the care of the patient, direct laboratory and clinical research efforts, teach trainees at all levels and, potentially, lead as the head of a program, department or institution. Leadership is taught implicitly, as in most programs, by a gradual increase in responsibility throughout the fellow's training, and includes the opportunity for a fourth-year fellow to function as an attending. Fellows are routinely invited to participate in formal faculty development activities (e.g., workshops on grantsmanship, career planning). In addition, the program teaches leadership through a unique Fellows’ Seminar.
Reflective Practice and Leadership Seminar
This twice-monthly seminar, required for the first-year fellows, and optional thereafter, focuses on reflective practice and leadership. Fellows are encouraged to discuss challenging circumstances they encounter in their care giving role. The diverse topics include issues such as: the difficulty of dealing with a dying patient, the complexities of leading a health care team, and the strain of balancing the family demands with the commitments of an intense academic training program. Selected senior faculty facilitate discussions and frame thought-provoking questions. They may, at times, relate their own experiences as well. This method enhances fellows’ understanding of these complex issues and broadens their experience base through input from colleagues and mentors. There is a systematic effort to help fellows develop skills in analyzing situations and translating reflection into effective action as leaders in academic medicine.