Hematology-Oncology Fellowship

Curriculum

    Program Goals and Objectives

    The Hematology-Oncology fellowship is a 3-year training program designed to satisfy the ABIM requirements for both the hematology and medical oncology subspecialty board examinations. 

    The curriculum is designed to provide the new, first-year fellow with an opportunity to acquire foundational knowledge prior to being assigned to the inpatient hematology and oncology services. This structure has been purposely created to provide the new fellow with some essential tools before being put in a position that directly supervises and educates dependent learners. It is our belief that this creates a more educational and satisfying work environment for all learners across the spectrum of training.

    Also be sure to explore these other pages outlining curriculum and opportunities within the Program:
    Conferences | Scholarship

    Typical Schedule
    Typical 1st Year Rotation Schedule Location Length
    Inpatient Hematology Service VCUHS 4-6 weeks
    Inpatient Oncology Service VCUHS 4-6 weeks
    Inpatient Hematology/Oncology Consult Service VCUHS/VA 8 weeks
    Inpatient Bone Marrow/Stem Cell Transplantation VCUHS 4 weeks
    Outpatient Bone Marrow/Stem Cell Transplantation VCUHS 4 weeks
    Ambulatory Clinics VCUHS 8 weeks
    Gynecologic and Neurologic Oncology VCUHS 2-4 weeks
    Palliative Care VCUHS 4 weeks
    Hematopathology VCUHS 2-4 weeks
    Transfusion Medicine/Apheresis VCUHS 2-4 weeks
    Elective VCUHS/VA 2 weeks
    Core 2nd Year fellow Rotation Schedule Location Length
    Inpatient Hematology Service VCUHS 4 weeks
    Inpatient Oncology Service VCUHS 4 weeks
    Inpatient Hematology/Oncology Consult Service VCUHS/VA 10 weeks
    Electives, dedicated research time, subspecialty ambulatory clinics,* and/or bone marrow transplantation electives (dependent upon track) VCUHS/VA 34 weeks
    Core 3rd Year fellow Rotation Schedule Location Length
    Inpatient Hematology Service VCUHS 4 weeks
    Inpatient Oncology Service VCUHS 4 weeks
    Inpatient Hematology/Oncology Consult Service VCUHS/VA 8 weeks
    Outpatient Bone Marrow/Stem Cell Transplantation VCUHS 4 weeks
    Electives, dedicated research time, subspecialty ambulatory clinics,* and/or bone marrow transplantation electives (dependent upon track) VCUHS/VA 32 weeks

    *Annual vacation time is allocated during electives, neuro-gyn oncology, hematopathology, or transfusion medicine/apheresis rotations.

    Tracks

    Individualization: Going Beyond the Core
    Aside from the core requirements, the remainder of the second and third year fellowship training allows for educational individualization based on the interests and needs of the fellow. In consultation with the program director, fellows will complete their training though one of the three tracks with suggested composition as outlined below.

      • Basic Scientist Track
      • 12 weeks Elective
      • 40 weeks dedicated research blocks
      • Maintain half-day continuity clinics
      • Attendance at the cancer center scientific conferences and laboratory meetings

      Fellows' Perspectives on the Program

      "Having continuity clinics (at both VCUHS and Mcguire VA hospital) allows the fellow to take ownership of management decisions in a supportive atmosphere."

      Masey Ross, MD
      Class of 2017

      • Clinical or Educational Research Track
      • 2-4 Elective blocks
      • 4-5 Eight-week blocks rotating through core subspecialty assigned attending clinics and related multi-disciplinary clinics.
        • (Examples of available ambulatory subspecialty blocks include: breast oncology, thoracic oncology, gastrointestinal oncology, hematologic malignancies, and benign hematology.)
      • 3 Dedicated research blocks
      • Maintain half-day continuity clinics
      • Attendance at research-related/relevant conferences.
          • Examples:
          • Phase I/II conference and clinic if doing translational research
          • Performance Improvement/Quality Health type conferences

      • Clinical Research Track with additional clinical focus on stem cell transplantation
      • 3 Electives (NOT associated with bone marrow/stem cell transplant)
      • 3 Inpatient bone marrow/stem cell transplant blocks
      • 3 Outpatient bone marrow/stem cell transplant blocks
      • 3 Additional BMT electives (i.e. apheresis and product collection/processing, transplant ID, etc.)
      • 3 Dedicated research months
      • Maintain half day continuity clinics
      • Attendance at BMT and Donor selection conference

    Rotations

      [See Typical Rotation Schedules Above]

      Inpatient Hematology Service
      The MCV Hospital Inpatient Hematology service provides an opportunity for fellows to participate in the care and management of adult patients admitted to the hospital with acute benign and malignant hematologic medical needs.

      The fellow operates within the context of a multi‐disciplinary team, managing conditions that include, but are not limited to, acute oncologic emergencies, symptoms of advanced malignancy, acute leukemia, inpatient administered chemotherapy regimens, complications of oncologic therapies, immune‐mediated cytopenia, bone marrow failure states, and hemophilia.

      Additionally, the rotation affords the opportunity for the fellow to engage directly in the subspecialty-specific oversight and education of internal medicine housestaff and medical student learners rotating on the service. All of this occurs under the supervision of the responsible ward attending faculty members from the Division of Hematology, Oncology, and Palliative Care.

      Fellows' Perspectives on the Program

      “Our program gives you exposure to a wide variety of clinical situations, while still tailoring the curriculum to your individual aspirations whether it may be to become a bone marrow transplant doctor or a basic researcher.”

      Priya Gopie, MD
      Class of 2017

      Inpatient Oncology Service
      The MCV Hospital Inpatient Oncology rotation is designed to provide the fellow the opportunity to participate in the care and management of adult oncology patients admitted to the hospital with acute medical needs associated with solid neoplasms and hematologic malignancies. The fellow operates within the context of a multi‐disciplinary team managing conditions that include, but are not limited to, acute oncologic emergencies, symptoms of advanced malignancy, acute leukemia, inpatient administered chemotherapy regimens, complications of oncologic therapies, and end‐of‐life management.

      Additionally, the rotation affords the opportunity for the fellow to engage directly in the subspecialty specific oversight and education of internal medicine housestaff and medical student learners rotating on the service. All of this occurs under the supervision of the responsible ward attending faculty members from the Division of Hematology, Oncology, and Palliative Care.

      Inpatient Hematology-Oncology Consult Service at VCUHS and VAMC
      The MCV Hospital and VA Medical Center inpatient hematology-oncology consultation rotations are designed to allow the fellow to become proficient and independent in the provision of inpatient consultation services. The fellow is expected to participate in the care and management of adult patients admitted to the hospital for any variety of medical conditions in which the primary team has an acute hematologic and/or oncologic question.

      The fellow is responsible for efficiently synthesizing the available data from a variety of modalities and for augmenting the existing data with targeted, specialty/consult question-specific collection of additional primary information from the patient, family, outside providers, and additional diagnostics as necessary.   

      The fellow is responsible for the development of the assessment and recommendations through their synthesis of the data and through their review of the literature and other resources. As the fellow functions as a specialty consultant to the primary admitting team, this rotation provides the opportunity for the fellow to develop skills necessary for the effective and timely evaluation of the patient and for the communication of the recommendations back to the consulting team.

      In addition, the rotation emphasizes the role of consultant as an educator to both the patient and the consulting provider. The fellow will be challenged to focus their clinical care and educational efforts on the specialty specific aspects of the patient’s care but put into context as they relate and interact with the patient’s other systemic illnesses and needs.   

      All of this occurs under the supervision of the responsible faculty from the Division of Hematology, Oncology, and Palliative Care consult attending faculty members at the two facilities.

      Inpatient Bone Marrow/Stem Cell Transplantation
      The inpatient bone marrow transplant rotation is an experience designed to educate the fellows on the management of the patient referred for stem cell transplantation immediately prior to, during and following the transplant inclusive of the myeloablation, stem cell infusion, acute post-transplant complications and marrow recovery. During the first year of fellowship, this rotation is done as part of an eight-week continuous block alternating every two weeks between the inpatien and outpatient setting.

      Outpatient Bone Marrow/Stem Cell Transplantation
      The outpatient bone marrow transplant rotation is an experience designed to educate the fellows on the evaluation and management of the patient referred for stem cell transplantation during the pre-transplant evaluation and post-transplant follow-up phases. During the first year of fellowship, this rotation is done as a part of an eight-week continuous block alternating every two weeks between inpatient and outpatient setting.

      First Year Fellows’ Ambulatory Block

      The Hematology/Oncology Subspecialty Ambulatory Rotation is a combination of experiences in various subspecialty and general faculty Hematology/Oncology clinics designed to supplement the outpatient experience provided by the Hematology/Oncology Continuity Clinic Rotation. This rotation occurs at the beginning of the fellowship to introduce fellows to the various multi-disciplinary clinic providers. Additionally, time is set aside to provide procedural training experience under direct supervision.

      • Clinics in this rotation include:
      • Thoracic Oncology clinic
        This clinic is a multidisciplinary clinic comprised of interventional pulmonologists, thoracic surgeons, radiation oncologists, medical oncologists, social workers, and clinical research coordinators.
      • Breast Oncology Clinic
        This clinic is a multidisciplinary clinic comprised of medical oncologists, radiation oncologists, surgical oncologists, radiologists, pathologists, social workers, and clinical research coordinators.
      • Hematologic Malignancy Clinic
        This clinic is a multidisciplinary clinic comprised of medical oncologists, hematologists, radiation oncologists, social workers, and clinical research coordinators.
      • Gastrointestinal Oncology Clinic.
        This clinic is a multidisciplinary clinic comprised of medical oncologists, radiation oncologists, surgical oncologists; radiologists; pathologists; social workers; and clinical research coordinators.
      • Genitourinary and Soft Tissue/Melanoma Clinics
        This clinic is a faculty practice clinic.
      • Interventional/Procedural Clinics
        Occurring at both the VA medical center and at VCUHS, these clinics are comprised of attending physicians and/or advanced practice providers trained in specialized procedures. The fellows perform and become proficient in intrathecal chemotherapy administration both through lumbar puncture and Omaya reservoir and in the performance of bone marrow aspiration and biopsy.

      Second- and Third-year Fellows’ Ambulatory Block

      The Second- and Third-year Fellow Hematology/Oncology Subspecialty Ambulatory Rotations provide experiences in benign hematology and oncologywithin a single oncologic sub-discipline focus.

      These blocks are generally four to ten weeks in duration. They provide an opportunity for the fellow to work with faculty in disease-focused clinics. This focused time allows fellows to work alongside experts in their field of study to gain insight into their management and decision-making processes. Educationally, this compliments the experience of the fellow’s continuity clinic. The clinic assignments during these blocks are designed to provide sufficient protected time for the fellow to dedicate toward their ongoing scholarly project(s) concurrent with the clinical duties.

      The fellow, in conjunction with the program director, will select the areas of focus for these assignments based on a balance of factors including the fellow’s academic interests; areas of need identified on the fellow’s in-service training examinations; and prior clinical rotation experiences. Areas of focus can be selected among the following sub-disciplines: breast oncology; gastrointestinal oncology; genitourinary oncology; hematologic malignancies; thoracic oncology; and benign hematology. Other oncologic sub-disciplines outside of these core areas of focus can be considered based on the individual fellow's learning goals.. Ambulatory clinic assignments consist of a combination of multi-disciplinary and faculty practice clinics within the area of focus for the rotation.

      • Core Clinics included in this rotation include:
      • Thoracic Oncology
      • Breast Oncology
      • Heme Malignancy
      • Gastrointestinal Oncology
      • Genitourinary and Soft Tissue
      • Benign Hematology

      Neurologic-Gynecologic Oncology
      The Neuro-Gyn Onc rotation is a combination of experiences in the neuro-oncology and the gynecological oncology clinics designed to expose and educate the fellows regarding these subspecialties of cancer care.

       

      Clinics included in this rotation:

      • Gyn/Onc Faculty Practice Clinics (Massey Cancer Center and Stony Point)
      • Neuro-Oncology Faculty Practice Clinics (Massey Cancer Center)

      Palliative Care
      The palliative care rotation provides the fellow with the opportunity to participate in the care and management of patients admitted to the hospital in the acute setting who require palliative acute symptom relief and/or end-of-life management as well as outpatients with cancer and chronic pain or palliative needs. The fellow operates in the context of the multidisciplinary team of physicians, mid-level providers, nurses, chaplains, social workers, and therapists trained in hospice and palliative care medicine. The fellow is exposed to the use of care sets developed for palliative care and hospice management. This rotation provides a unique opportunity for exposure to routine and advanced pain management techniques and organ-based and systemic symptom management techniques when disease-specific therapy alone has been insufficient. The rotation provides training for the fellow in the establishment and communication of goals-of-care with the patient, the family, and a multi-disciplinary team. Additionally, the rotation provides the fellow the opportunity to participate in hospice/palliative house-calls and, thus, to gain additional insights to the barriers and needs confronting the patient. All of this occurs under the supervision of the specially trained faculty in hospice and palliative care within the Division of Hematology, Oncology, and Palliative Care.

      Hematopathology
      The rotation in the hematopathology laboratory is designed to help fellows gain a basic understanding of the preparation and interpretation of the CBC/peripheral blood smear, bone marrow aspirate/biopsy and lymph node, flow cytometry and molecular pathology. This rotation is completed in the VCUHS Clinical Laboratories on the second, fifth, and sixth floors of the Clinical Support Building.:


      Transfusion Medicine/Apheresis
      The Hematology-Oncology fellowship transfusion rotation is designed to provide the fellow with an overview of topics pertinent to the hematologist regarding transfusion medicine and cellular therapies. Fellows are afforded the opportunity to participate in the clinical activities and patient care pertaining to transfusion medicine, including direct experience in both the blood donor service and transfusion medicine service aspect of the discipline. It is expected that the fellow will have hands-on experience with the process of blood typing and crossing, including the evaluation and identification of both allo and auto antibodies directed against blood components.

      The fellow is given opportunities to observe blood product preparation and an expectation of gaining an understanding of the various blood products and the indications for their use. Additionally, the fellow should become familiar with the complications of blood product administration and participate in the investigation of possible transfusion reactions and other related complications. The fellow is expected to gain an understanding of the clinical uses of apheresis therapy and the procedures involved in such. All of this activity occurs under the supervision of the transfusion medicine trained attending physicians, the blood bank/apheresis technologists/staff, and the residents within the Department of Pathology.

      Research
      The VCU Hematology-Oncology fellowship program research curriculum is designed to foster the scholarly interests of the individual fellow and to provide a basic skill set by which to appreciate the scientific process and the regulatory aspects of conducting clinical investigation. All of this occurs under the supervision of the responsible faculty from the Massey Cancer Center; the Division of Hematology, Oncology, and Palliative Care; and other suitable mentor is determined based on the needs of a fellow’s specific project(s). (Additional information may be found under the Scholarship tab).

    Additional Learning Opportunities

      Fellows’ Continuity Clinic
      Each fellow maintains an outpatient continuity clinic at VCUHS and at the McGuire VA Medical Center. The patients in the fellows’ continuity clinic are evaluated and managed by the fellow under the supervision of an attending hematology-oncology physician throughout the course of their training. Fellows work with their primary nurse who assists in coordinating the care of the patient. This degree of ownership provides the fellow with invaluable first-hand experience critical for practice-based learning. Prior to the start of each clinic, the fellow meets with the attending , the nurse, and team members including, social workers, research staff, and others to review their cases and develop a multi-disciplinary plan in a collaborative environment. This pre-clinic conference affords an opportunity for dedicated teaching time and direction from the attending related to the patients’ management, which compliments the independent efforts of the fellow in preparing for the clinic.

      Communication Curriculum
      The program works in conjunction with the VCU palliative care fellowship program; the VCU SOM simulation center; and the VCU Department of Theatre to provide simulation-based training in effective communication with patents. The program focuses on challenging patient communication encounters such as breaking bad news, goals of care, end-of-life decision making, informed consent, and treatment plan counseling. The communication training employs a combination of didactics, role-play, reflective writings, professional actor simulation, and directly-observed patient encounters. This curriculum is consistent throughout the three years of training to provide longitudinal, formative feedback to the fellow as their skills develop and mature.

      Becoming a Reflective Practitioner Curriculum
      Throughout the academic year, prompts for reflection guide the fellows as they become reflective practitioners of the art and science of hematology-oncology. The curriculum guides the learner as they examine their personal biases and assumptions; cultural influences that effect their clinical practice of medicine.  The prompts additionally challenge the fellows to examine their knowledge, skills, and attitudes that potential lead to medical errors and inform their approach to situations of uncertainty.  A diverse selction of speakers offering diverse persectives of health systems and health care supplement the written reflections.

      Supplemental Self-Paced Educational Curriculum
      The program enrolls the fellow in ASCO University and uses this web-based educational resource as part of the formal curriculum.  Assigned modules vary by year of training and are completed throughout the academic year at a pace determined by the needs of the fellow. Topics covered include: symptom-management, fertility preservation, business-practice of oncology, disease-specific tumor boards, and more. Additionally, the training program provides enrolls each fellow in the ASH Essentials program.

      Research and Scholarship
      See Scholarship Section.