Benign Hematology and Malignant Hematology Clinics

Educational Purpose

The objective of this rotation is to provide an experience for fellows in providing new patient consultative services plus ongoing care to individuals who are being seen in the out patient Arizona Cancer Center Clinics located at the UMC-North facility because of benign blood disorders or because of malignant hematologic disorders including lymphomas and multiple myeloma. The clinics are run by and supervised by specific attending physicians who specialize in these conditions.

Teaching Methods

  1. Provide, under attending physician supervision with critiquing and feedback from the attending physician, clinical care including the initial assessment and follow-up care of patients admitted to the Hematology and Medical Oncology in-patient service and consultative assessment and recommendation on patients on whom subspecialty consultations have been requested.
  2. Perform under attending supervision the following procedures and deductive services:
    1. Bone marrow aspiration and biopsy
    2. Performance of LPs with the administration of chemotherapy
    3. Oral and intravenous ordering and administration of chemotherapy
    4. Management of central venous access devices
    5. Measurement to tumor masses on physical exam and imaging studies
    6. Correlating clinical findings with pathologic information.
    7. Palliation of malignancy related accumulation of fluids within the body.
    8. Performing therapeutic phlebotomies and pheresis
    9. Preparation and interpretation of blood and bone marrow smears
  3. Present findings to attending physicians for critique and feedback.
  4. Communicate under attending supervision with patients and their families medical information, therapeutic recommendations, and prognosis discussions.
  5. Perform medical literature reviews on the diagnoses and conditions of patients seen and review a summary to the review with the attending physician.
  6. Present cases of interest for education purposes to multi-disciplinary conferences.

Mix of Diseases Seen

Patients seen in these clinics represent the entire spectrum of individuals who suffer with benign blood disorders or malignant hematologic disorders including lymphomas and multiple myeloma. Typical of this group of malignancies would be benign blood disorders which result in either blood cell levels that are either too high or too low, benign disorders of blood cell function, blood coagulation disorders, malignancies of blood cells (leukemias) and malignancies of plasma cells or lymph nodes (multiple myeloma or lymphomas). The patients seen represent a broad spectrum of social, cultural and economic circumstances thus providing and excellent teaching experience for trainees to enhance their communication skills.

Types of Clinical Encounters

Patients managed in the benign hematology or malignant hematology clinics under attending physician supervision, represent the spectrum of individuals who are afflicted with benign blood disorders or malignant hematologic disorders. As part of providing initial new patient evaluations together with ongoing care to these patients, a fellow obtains experience and expertise in performing definitive diagnostic services, assessment of extent of disease and determining all management options, and in managing the disease and treatment related complications. In addition to seeing, assessing, and managing patients under attending supervision, fellows will interact and provide didactic support for other health care providers involved in the care of these patients and patients. Procedures will be done under supervision as deemed necessary for optimal care under attending physician supervision.

Procedures Anticipated

  1. Bone marrow aspiration and biopsy
  2. Performance of LPs with the administration of chemotherapy
  3. Oral and intravenous ordering and administration of chemotherapy
  4. Management of central venous access devices
  5. Measurement to tumor masses on physical exam and imaging studies
  6. Correlating clinical findings with pathologic information.
  7. Palliation of malignancy related accumulation of fluids within the body utilizing removal or injecting of palliative therapies
  8. Performing therapeutic phlebotomies and pheresis
  9. Preparation and interpretation of blood and bone marrow smears


Rotation Specific Competency Based Goals and Objectives

  1. Patient Care
    1. With the completion of each rotation in the benign blood disorder and malignant hematology clinics, a fellow will gain increasing skill, precision, efficiency and accuracy in performing initial new patient evaluations which includes collecting historical information, performing, physical exams with emphasis on those aspects of the physical exam which related to benign blood disorder and malignant hematology clinics, formulating assessment and formulating management plans. This will include formulating differential diagnoses.
    2. With the completion of each rotation in the benign blood disorder and malignant hematology clinics, a fellow will gain increasing skill in producing accurate and succinct written subspecialty evaluations and management plan formulations.
    3. With the completion of each rotation in the benign blood disorder and malignant hematology clinics, a fellow will gain increasing skill, precision, efficiency and accuracy in providing ongoing care to individuals with these diseases. This will include the writing of chemotherapy orders, administration of treatments, performing procedures, managing disease side effects and managing treatment related side effects plus providing supportive care to patients and their families that will include end of life care.
  2. Medical Knowledge
    1. With the completion of each rotation the fellow will gain an ever increasing knowledge base about benign blood disorder and malignant hematology clinics.
    2. With the completion of each rotation the fellow will gain an increasing knowledge about the risk benefit of each therapy provided to individuals with benign blood disorder and malignant hematology clinics.
    3. With the completion of each rotation the fellow will gain an increasing knowledge about the spectrum of palliative intervention and their risk benefit issues.
  3. Interpersonal and Communication Skills
    1. With the completion of each rotation the fellow will gain an increased experience and skill in multidisciplinary treatment planning and how to relate and communicate effectively with the multidisciplinary care team
    2. With the completion of each rotation the fellow will gain an increased experience and skill in supervising and teaching medical trainees and lower levels and in communicating diagnostic conclusions and management recommendations to referring physicians of all disciplines.
    3. With the completion of each rotation the fellow will gain an increased experience in creating written documentation of historical details, findings of physical exam, results of diagnostic studies, and describing differential diagnoses, conclusions and management recommendations.
    4. With the completion of each rotation, the fellow will gain an increased experience in communication with patients and their families particularly in discussing clinical assessment and management recommendations.
    5. With the completion of each rotation, the fellow will gain an increased experience and skill in providing emotional support to patient and family with an emphasis on compassion and respectful, professional behavior.
  4. Professionalism
    1. With the completion of each rotation, the fellow will gain an increased experience and serving as a resource to the family for clarifying questions and developing a management plan in which each family member and the patient understands their role.
    2. With the completion of each rotation and with attending physician supervision and feedback a fellow will demonstrate respect, honesty, compassion and integrity in all aspects of the relations with the health care team and the patient and their family.
    3. With the completion of each rotation the fellow will gain an increased understanding of the importance of maintaining strict confidentially and ethics.
  5. Practice Based Learning and Improvement
    1. The fellow will engage in self-directed reading/learning on daily patient assessment and management issues.
    2. With the completion of each rotation in the benign blood disorder and malignant hematology clinics, a fellow will increasingly be able to find and apply information from the medical literature to the diagnostic plan and management plan.
    3. The fellow with the completion of each rotation will increasing become skilled in the utilization of electronic records, on line medical information resources and be able to provide educational materials to patients and their families.
  6. Competency Goals Based on Year of Training
    1. At the end of the first year of fellowship training, a fellow should have obtained a general knowledge of benign blood disorders and malignant hematology clinics. The disorders seen will include benign blood disorders which result in either blood cell levels that are either too high or too low, benign disorders of blood cell function, blood coagulation disorders, malignancies of blood cells (leukemias) and malignancies of plasma cells or lymph nodes (multiple myeloma or lymphomas
    2.  Each year the knowledge should increase so by the end of the third year, the knowledge obtained should be adequate to allow a fellow to successfully pass the written certification exams.
    3. By the end of the first year fellows should be experienced in the performance and interpretation of the procedures associated with the initial evaluation of individuals and the ongoing management of individuals with GI cancers (esophageal, pancreatic, liver, gastric, colon, rectum and anus), Head and Neck cancers, lung cancers, sarcomas, melanomas, and others but excluding breast cancer, prostate cancer, bladder cancer, kidney cancer, testicular cancer and penile cancer without supervision.
    4. By the end of the first year of fellowship, a fellow should be able to complete chemotherapy orders with therapy ordered with the correct dosages, routes of administration and premedications to minimize the risk of treatment related toxicity without supervision.
    5. By the end of the 2nd and 3rd year of fellowships a fellow should be able to correctly translate a chemotherapy management plan as it relates to an unusual condition or circumstance from the medical literature to the ordering and administration of such a treatment to a specific patient.
    6. By the end of the 3rd year, a fellow should have acquired the knowledge, skills, and communication abilities to function independently as a subspecialist in the fields of Hematology and Medical Oncology in this case specifically the management of individuals with benign blood disorders as well as hematologic malignancies. Typical disorders include benign blood disorders which result in either blood cell levels that are either too high or too low, benign disorders of blood cell function, blood coagulation disorders, malignancies of blood cells (leukemias) and malignancies of plasma cells or lymph nodes (multiple myeloma or lymphomas

Reading List

Please reference the ASCO and ASH national recommended reading lists provided in a separate section in this curriculum.

Pathologic Materials


On all patients who undergoing biopsies, especially bone marrow aspirations and biopsies, a fellow is expected to review the pathologic materials microscopically with the pathology team be it histologies or cytologies.

Educational Resources


Computerized internet access to the Medical Library at the University of Arizona/College of Medicine is available to all trainees both within the facility and at home. In addition the library itself is open 24 hours per day 7 days per week and has an excellent collection of books and journals relating the Hematology and Medical Oncology. In addition the library provides on line internet access to the National Library of Medicine and other subscription medical information services such as “Up to Date” at no charge to trainees.

Competency Emphasis During Rotation (Low, Intermediate or High Emphasis)
Patient Care High
Medical Knowledge High
Practice Based Learning and Improvements High
Interpersonal and Communication Skills High
Professionalism High
System Based Practice  High
 
Evaluation Process Tools (Used, Yes or No)
Attending Written Evaluation Yes
360 degree coworker evaluation Yes
Cognitive Testing/In Service Exam Yes
Focused Observation (Mini CEX) No
Certification Examination No
Procedures Yes
Morbidity and Mortality Presentations Yes

Level of Fellow Supervision

Fellows are supervised directly by Hematology and Medical Oncology attending physicians. During all clinics in this rotation the attending physician sees the patient and confirms findings both historical and on physical examination. The attending also supervises and participates in all discussions with the patient and their family including any discussion of prognosis, management options and the development of a management plan. As the fellow’s knowledge, skills and experience improve, they will be take an ever increasing role in the diagnosis, formulation of management plans, and communication with patients and family so that by the end of the fellowship they are able to function independently. However, throughout all three years of the fellowship, an attending physician is always present and supervision and providing education and critique of a fellow’s performance.