• Overview
• Fellowship Program
  • Fellowship Applications
  • Curriculum for First Year
  • Curriculum for Upper Years
  • Current Fellows
• Benign Hematology Program
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First year fellows will rotate between seven services, with each block running for three to four weeks. Of the seven services, six are at the Hospital of the University of Pennsylvania (HUP): the Hematology Consult Service, the Leukemia/Lymphoma/Transplant Service (Rhoads 7), the Oncology Consult Service and the Outpatient Blocks. Additional services are at the Veterans Administration Medical Center (VAMC).

Additionally, there are two elective rotations which include one week of palliative care and hospice, three weeks of vacation, and the remainder dedicated to an elective. First year fellows will also have two continuity clinics per week: one dedicated to Hematology and one to solid tumor Oncology. Throughout the year, fellows will be entirely off duty at least one day out of seven; half of the rotations are outpatient based and have no weekend responsibilities. We adhere to the ACGME requirement for an 80-hour work week. There is no in-house overnight call.

1. Hematology Consults
2. Hematologic Malignancy and Hematopoietic Stem Cell Transplant Service
3. Oncology Consults
4. Veterans Administration Medical Center (VAMC)
5. Outpatient Clinics
6. Palliative Care (HUP)
7. Continuity Practice (HUP, VAMC)

1) Hematology Consults

The consult fellow handles Hematology Consults at HUP, including consults from medical and non-medical services. There are also occasional inpatients who are primarily managed by the fellow and consult attending with a team of housestaff. During this rotation, the fellow will organize and present at the Friday afternoon Hematology Conference (1:30-2:30 pm). The fellow will present and discuss cases including formal literature summaries and management recommendations.

Educational Purpose:
To provide a varied and comprehensive experience in consultative hematology.

Principal Teaching Methods:
Teaching rounds, bedside presentation and discussion, conferences, direct supervision of bone marrow aspiration and biopsy procedures, literature review, intensive microscopic review of case materials, participation in hematopathology rounds, and experience in the methodologies and interpretation of laboratory-based testing.

Educational Content:
Exposure to all aspects of adult hematology, including congenital and acquired coagulation disorders, transfusion medicine, the diagnosis and management of cytopenias and elevated blood counts, and the evaluation of patients with gammopathies. Detailed study of peripheral blood and bone marrow morphology, the laboratory evaluation of coagulation disorders, flow cytometry and cytogenetics are all included.

Mix of Diseases:
The full range of congenital and acquired adult hematologic disorders.

Patient Characteristics:
Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters:
Bedside consultations.

Procedures:
Bone Marrow Aspiration and Biopsies.

Educational Resources:
Dedicated Fellows' hematology-oncology library, multi-headed teaching microscope and television, American Society of Hematology Slide Collection, as well as the Medical School Library collection.

Supervision:
All Consults are supervised by the Hematology Consult Attending.

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2) Hematologic Malignancy and Hematopoietic Stem Cell Transplant Service

The two Rhoads 7 fellows will coordinate patient care on this inpatient Hematology/Oncology Unit. Each fellow will round with one attending. The daily schedule consists of morning walk rounds with the attending and housestaff followed by discharge planning rounds, conducted by the fellow. Allogeneic transplant rounds are then held during which transplant patients are discussed in further detail. The fellow is responsible for diagnostic and therapeutic procedures including bone marrow biopsies and intrathecal chemotherapy administration via lumbar puncture and/or Ommaya reservoir tap. In addition, the fellow is responsible for obtaining consent for chemotherapy and writing all chemotherapy orders on the unit. The Rhoads 7 fellows will continue to follow their patients when they are transferred to other units, such as the ICU, Physical Medicine and Rehabilitation, or Surgery.

Finally, the fellow also serves as liaison between hematopathology and the Rhoads 7 service, reviewing the new cases with the pathologists and reporting results to the team. The fellow is responsible for dictating discharge summaries for any patient whose length of stay is greater than 2 days.

Educational Purpose:
To provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic malignancies, the principles and practice of high dose therapies, and autologous and allogeneic hematopoietic stem cell transplantation; to provide experience in the diagnosis and management of oncology emergencies; to gain expertise in the management of pain control and family-centered terminal care.

Principal Teaching Methods:
Teaching rounds, bedside presentation and discussion, literature review, and teaching conferences.

Educational Content:
Explication of the pathogenesis and biology of myeloid and lymphoid malignancies and exposure to all aspects of hematologic malignancies requiring hospital-based therapies.

Mix of Diseases:
All hematologic malignancies as well as myelodysplastic syndrome and aplastic anemia.

Patient Characteristics:
Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters:
Daily bedside encounters.

Procedures:
Bone marrow aspiration and biopsy, chemotherapy infusion, stem cell and bone marrow infusion, intrathecal/intraventricular chemotherapy administration.

Educational Resources:
As previously described.

Supervision:
All aspects of the fellows' clinical activities and training are supervised by the two Rhoads 7 inpatient attending physicians.

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3) Oncology Consults

On this rotation, the fellows will concentrate on the evaluation and management of patients with new oncologic diagnoses (or patients with unknown diagnoses for whom a malignancy is part of the differential diagnosis) as well as provide support to the oncology inpatients by writing chemotherapy orders on solid tumor oncology inpatients. The aims are for the fellow to gain an understanding of disease processes, the past histories and the choices of chemotherapy regimens. Consults will be staffed by the solid tumor inpatient on-service attendings.

The fellow will also facilitate transfers to the solid tumor inpatient oncology service from other hospitals or other services at HUP, and follow those patients as above.

During the first half of the academic year, this rotation is performed by upper year fellows; the responsibility for oncology consultations belongs to the first year fellows from January through June. They will also be responsible for managing all Oncology consults at HUP.

Educational Purpose:
To provide a sophisticated and comprehensive experience in the diagnosis and management of oncologic diseases, under the direct supervision of attending physicians.

Principal Teaching Methods:
Inpatient patient management, consultation, teaching, clinical conferences and case reviews, literature reviews.

Educational Content:
Explication of the biology and pathogenesis of a variety of solid tumors and participation in the diagnosis and treatment of a variety of solid tumors and their complications, including breast cancer, aero-digestive cancer, melanoma and sarcoma, lymphomas, brain tumors, and genitourinary cancers.

Mix of Diseases:
A wide array of solid tumor oncologic problems, as well as new lymphadenopathy, hypercalcemia, workup of new masses or lytic bony lesions.

Patient Characteristics:
Men and women, adults and adolescents, including geriatric populations.

Types of Clinical Encounters:
Interviews and examinations in the inpatient setting.

Procedures:
Bone Marrow Aspiration and Biopsies, chemotherapy infusion, stem cell and bone marrow infusion, intrathecal/intraventricular chemotherapy administration.

Educational Resources:
As previously described.

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4) Veterans Administration Medical Center (VAMC)

Fellows will see patients at the VAMC under the general supervision of Dr. Kenneth Algazy, Director of Hematology-Oncology at that institution, and under the direct supervision of an attending physician in Hematology/Oncology. The Hematology/Oncology Division at the VAMC provides outpatient care to all patients at the VA with active hematologic or oncologic problems and both inpatient and outpatient consultative services.

The outpatient clinical practice consists of morning clinics that take place on successive mornings, Monday through Friday and are staffed by Penn hematologists/oncologists. The clinics are organized such that each day has a different theme, including malignant hematology, GI malignancies, head and neck cancer, and lung cancer. During the mornings, fellows work in these various outpatient clinics. In the afternoon, the fellow and the consult attending supervise the hematology/oncology inpatient consult service and oversee the care of hematology/oncology inpatients.

A multi-disciplinary tumor board is held Fridays from 8:00 to 9:00 am, and the fellow and consult attending serve as the medical oncologists for this exercise. Fellows give one case presentation during each of their rotations at the Friday morning tumor board conference. Additionally, there is a lung cancer multidisciplinary conference each Wednesday afternoon.

Educational Purpose:
To provide a sophisticated and comprehensive experience in the diagnosis and management of hematologic and oncologic diseases in both inpatients and outpatients.

Principal Teaching Methods:
Outpatient teaching, inpatient consults, clinical conferences and case reviews, literature reviews.

Educational Content:
Exposure to the diagnosis, treatment, and prevention of a variety of hematologic problems and liquid and solid tumors, particularly intrathoracic neoplasms, aero-digestive cancer, head and neck malignancies, and prostate cancer.

Mix of Diseases:
As above.

Patient Characteristics:
Largely men, including a high representation of the geriatric population.

Types of Clinical Encounters:
Interviews and examinations in the outpatient office and on inpatient services.

Procedures:
Bone marrow aspiration and biopsies, supervision of chemotherapy infusion, intrathecal/intraventricular chemotherapy administration.

Educational Resources:
As previously noted.

Supervision:
Fellows are supervised by members of the Penn faculty who serve primarily at the VAMC or at HUP.

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5) Outpatient Clinics

First year fellows spend five blocks rotating through a variety of clinical practices representing common solid malignancies: breast, lung, head and neck, GI, GU, and melanoma.

Educational Purpose:
To expose the first year fellow to a broad array of tumor types as well as a variety of management styles in the outpatient setting.

Principal teaching methods:
Outpatient teaching, lectures, clinical conferences and case reviews, literature reviews, and journal club arranged by fellow during each block.

Educational Content:
Participation in the diagnosis, treatment, and long-term management of major oncologic diagnoses, particularly breast malignancy, intrathoracic neoplasms, aero-digestive cancer, head and neck malignancies, melanoma, lymphoma and genitourinary disease.

Mix of Diseases:
As above.

Patient Characteristics:
Men and women, adults and adolescents, including geriatric patients.

Types of Clinical Encounters:
Interviews and examinations in the outpatient office.

Procedures:
Bone marrow aspiration and biopsies, supervision of chemotherapy infusion, intrathecal/intraventricular chemotherapy administration.

Educational Resources:
As previously described.

Supervision:
Fellows are supervised by Penn Faculty at HUP.

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6) Palliative Care (HUP)

The fellows will rotate on the palliative care service for one week during their first academic year. During this week, they will work with the inpatient symptom management group and the hospice teams, including both inpatient and outpatient experiences.

Educational Purpose:
To learn how to manage end of life care, and symptom management including: pain, nausea, vomiting, breathlessness, anxiety, and fear.

Principal teaching methods:
In-patient consults, clinical conferences, home hospice visits, case management sessions and literature reviews.

Educational Content:
Participation in the end of life treatment and symptom management.

Mix of Diseases:
As above.

Patient Characteristics:
Men and women, adults and adolescents including geriatric patients.

Types of Clinical Encounters:
Interviews and examinations in the inpatient and outpatient setting.

Procedures:
As necessary.

Educational Resources:
As previously described.

Supervision:
Fellows are supervised by Penn Faculty in Oncology, Anesthesia, Primary Care and Geriatrics.

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7) Continuity Practice (HUP, VAMC)

The fellows' continuity clinic will consist of two half-days of clinic per week, one dedicated to benign and malignant hematology and the other to solid tumor Oncology. Each fellow is assigned an attending expert in an Oncologic sub-specialty and will work in conjunction with that attending seeing new and follow-up patients. The fellow should assume primary responsibility for the patients they see which includes, a complete H&P, dictation, follow up on laboratory and radiographic data, presentation in conferences, and follow-up management. They will be responsible to follow at least 10 patients in continuity for each half of the year, seeing these patients in follow-up and at their chemotherapy sessions. Each fellow will keep a log of these continuity patients to review with the Fellowship Director at the semiannual meeting. To ensure breadth of exposure, the fellows will rotate sub-specialty attendings through the academic year. For the Hematology experience, the fellows will spend six months in a general Hematology practice located on 15 Penn Tower on Tuesday afternoons or the VA, and then rotate to work with an attending in his/her practice.

For both Hematology and Oncology clinics, each week the fellow will be assigned two or three new patients. The fellow will follow the patient as necessary, formulate treatment plans, and direct the care of the patients. The fellow continues to be the primary Hematology/Oncology physician for the patient, and will thus be available by telephone or pager to the patients during the week and see them if an emergency should arise.

Educational Purpose:
To provide experience in performing Hematology and Oncology consultations and second opinions in the outpatient setting, and in devising and carrying out treatment plans, with long-term follow-up of the patients.

Principal Teaching Methods:
Outpatient teaching.

Educational Content:
Exposure to a full range of hematologic and oncologic disorders, including hematologic malignancies and leukemias. Fellows will have the opportunity to teach patients and families about these diseases, and to counsel them, as well as to learn about the side effects of cancer therapy and the management of patients with all stages of disease, including its terminal stage.

Mix of Diseases:
See above.

Patient Characteristics:
Men and women of all ages and ethnic backgrounds.

Types of Clinical Encounters:
Interviews and examinations, review of medical records and radiographs.

Procedures:
Bone marrow aspirations and biopsies, lumbar punctures, the supervision of chemotherapy, administration of intrathecal/intraventricular chemotherapy.

Educational Resources:
Multi-headed teaching microscope and television, textbooks, X-ray view boxes, computer terminals.

Supervision:
Fellows are be supervised by faculty in Hematology/Oncology in each clinic. Patient Care Coordinators are available for consultation to help with psychosocial problems.

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