Pediatric Hematology-Oncology Fellowship 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

Orientation Month

During the first month of fellowship, new fellows attend a series of subspecialty-focused orientation lectures.

The topics covered in-depth reviews of the diagnosis and management of the common diseases in Pediatric Hematology-Oncology, introduction to experimental design and clinical trial implementation, hands-on procedural practice, and shadowing on the inpatient and outpatient services prior to starting clinical rotations. This time also allow fellows to acclimate to Houston and Texas Children’s Hospital.

Clinical Rotations

Following orientation, the subsequent 12 months are focused on clinical training in Pediatric Hematology-Oncology. Fellows develop competence in the evaluation, diagnosis, management of Pediatric Hematology-Oncology disorders in both inpatient and outpatient settings. Fellows provide consultations in both settings and participate in teaching and supervising pediatric residents and medical students. During every phase of the clinical training program, the fellows collaborate closely with faculty members to learn and deliver quality patient care. While our fellowship program provides one-on-one supervision by clinical faculty throughout the trainees’ educational experience, fellows are given graduated responsibility and are expected to progressively lead the clinical team.

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 consultations for possible oncologic diagnoses. Admissions may include scheduled chemotherapy as well as unscheduled admissions for disease and/or treatment complications. There are two inpatient oncology teams (Blue team and Yellow team) each with a fellow and a supervising attending physician. The Blue team, staffed with an advanced practice provider and upper-level pediatric residents, admits patients with new oncologic diagnoses, disease related complications, and patients requiring chemotherapy. The Yellow team oversees oncology patients in the critical care units and inpatient consultations. An additional team, the Green team, is staffed exclusively by faculty and accepts admissions for lower acuity oncologic conditions.

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 inpatient care and teaching.

Hematology Service (3 months)

During the inpatient hematology rotations, the fellow oversees the care of patients with established hematologic diagnoses and consultations on all hematologic problems. There are two inpatient Hematology teams (Purple team and Red team) each with a fellow and a supervising attending physician. The Purple team is staffed with an advanced practice provider and an upper-level pediatric resident to provide consultations for hematologic conditions throughout the hospital. The Red team admits primary patients with known hematologic diagnoses. A member of the Hemostasis and Thrombosis (HAT) team is always 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 inpatient care and teaching.

Bone Marrow Transplantation (1 month)

This rotation involves the care of patients on 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

Night call (7P-7A) is covered by a night team of a pediatric resident, 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 a day.

Outpatient Clinic (4 months)

During the outpatient clinic rotations, fellows are involved in evaluating new patients and following established patients in the Hematology, Leukemia/Lymphoma/Histiocytosis, and Solid Tumor/Neuro-Oncology outpatient clinics. Fellows obtain the patient’s history, perform a physical examination, and formulate the initial management plan. After reviewing each case with the specific subspecialty attending, fellows order and assess laboratory and imaging studies on each patient. Fellows are expected to be involved in or lead diagnostic and therapeutic discussions with patients and families. The outpatient rotations are divided into blocks of focused learning experiences with approximately 1 month of Leukemia/Lymphoma/Histiocytosis, 1 month of Solid Tumor/Neuro-Oncology and 1.5 months of Hematology. The outpatient Hematology experience includes a 1-week rotation with the Transfusion Medicine service. The remaining two weeks are focused on learning experiences in Long-Term Survivorship, Vascular Anomalies, 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)

During the Coursework month, fellows participate in focused learning experiences including hematopathology, blood banking, radiation oncology, developmental therapeutics immunophenotyping, cytogenetics, flow cytometry, and palliative care.

Throughout Coursework and the outpatient clinic months, fellows also take time to explore opportunities for research and meet with potential research mentors for the following year.

Continuity of Care

Longitudinal patient care is an extremely important aspect of Hematology and 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 latter part 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 in their half-day per week continuity clinic. The fellows are expected to follow a variety of oncologic and hematologic diagnoses and be involved major decision-making related to their primary continuity clinic patients.

Scholarship Oversight Committee

At the start of fellowship, the scholarship oversight committee (SOC) is initially comprised of the fellowship directors, research director, and the section chief who provide ongoing and individualized support to each fellow in identifying a research mentor. At the start of their second year, the fellow develops a personalized SOC of at least four individuals to provide guidance in their research progress and career development. This SOC is composed of a clinical mentor (selected by the fellow at the start of first year of fellowship), the research mentor (selected by the fellow by the end of the first year of fellowship), a mentor outside the section, and any additional faculty with expertise in the fellow’s area of research. All fellows are required to have at least 3 formal SOC meetings during their research years. A meeting summary and detailed research progress report are submitted to the program director, research director, and section chief after each meeting.

First Year Fellows’ Retreat

In January of the first year of fellowship, the first year fellows spend a day off campus participating in a class retreat. Activities are centered on reflection, team building, role modeling, and mentorship. After the retreat, the faculty and all the fellows gather for an annual dinner to show appreciation for fellows and their families.

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 Division and provides support and advice to the 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).

Leadership Training

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 by a gradual increase in responsibility throughout the fellow's training and through role-modeling by faculty, and also formally as fellows are routinely invited to participate in faculty development activities (e.g., workshops on grantsmanship, career planning, professionalism, and communication). The fellows also have a monthly meeting with the section chief, clinical leadership, and program directors to discuss leadership topics chosen by the fellows. In addition, the program teaches leadership through a unique Fellows’ Seminar.

Modules on Leadership and Academic Career Development are also offered through Fellows College, a core curriculum for all pediatric subspecialty fellows.