Hematology/Oncology Curriculum

Department: Internal Medicine

Faculty Coordinators: Jaya Juturi, M.D./ Lalan Wilfong, M.D.

Hospital: Texas Health Presbyterian Hospital Dallas

Periods offered: All

Length: 4 weeks

Max no. of residents: 1

First Day Contact: Hematology/Oncology faculty member you have chosen to rotate with

First Day Time: Contact faculty member a week prior to rotation

First Day Place: Contact faculty member a week prior to rotation

Requirements: 7:30 a.m. to 6:00 p.m. Monday thru Friday

Weekends: 2 weekends a month

Vacation: 1 week either the first week or last week of the month

I. Course Description:

Resident will be working one-on-one with a Hematologist/Oncologist with a busy inpatient and outpatient practice. At the most there will be one resident rotating with the team. The resident will be exposed to a wide variety of hematological and oncological disease. He/she will participate in seeing patients in consultation, following patients on the oncology floor and attending the faculty member's outpatient practice.

II. Course Goals and Objectives: (based on ACGME competencies for resident education.)

Patient Care:

Residents are expected to provide care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

Objectives:

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples: One must be able to perform and write a thorough history and physical on a patient presenting with lymphadenopathy, a woman presenting with a breast mass, a patient with pancytopenia, etc.
  
  
• Make informed recommendations about preventives, diagnostic and therapeutic options and interventions that are based on clinical judgement, scientific evidence, and patient preference. Examples: One must demonstrate his/her ability to evaluate and treat patients with such problems as a solitary lung mass, a coagulopathy, splenomegaly. He/she must have a firm knowledge of 1° and 2 ° cancer prevention practices.
  
  
• Develop, negotiate and implement effective patient management plans and integration of patient care. Examples: A resident should be able to arrange for collaberation between surgeon, radiation oncologist and oncolgist in the care of a woman with breast cancer.
  
  
• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: Resident should gain experience in performing bone marrow exams, reviewing bone marrow slides and peripheral blood smears.

Medical Knowledge:

Objectives:

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: Learning the genetics of oncology; understanding of chemotherapy; the indications and complications of commonly used agents.
  
  
• Access and critically evaluate current medical information and scientific evidence. Examples: Resident should demonstrate skills in accessing medical information regarding current treatment recommendations for specific malignancies.
  
  
• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine. Examples: Resident should understand the biology and genetics of oncology.
  
  
• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: Apply understanding of genetics to targeted therapy.

Practice-Based Learning and Improvement:

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.

Objectives:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: Resident when lacking knowledge should demonstrate an active pursuit of the literature to obtain the knowledge needed to evaluate and treat a patient.
  
  
• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: Demonstrate knowledge regarding the importance of assessing pain control and continuing to try and improve pain control.
  
  
• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: See above.
  
  
• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: See above.

Interpersonal and Communication Skills:

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

Objectives:

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues. Examples: Resident should demonstrate ability to communicate with the consulting physician in a clear and effective manner regarding their patient.
  
  
• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: Resident should demonstrate above skills in all circumstances surrounding the care of a patient with malignancy.
  
  
• Interact with consultants in a respectful, appropriate manner.
  
  
• Maintain comprehensive, timely, and legible medical records.

Professionalism:

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

Objectives:

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues.
  
  
• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.
  
  
• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
  
  
• Recognize and identify deficiencies in peer performance.

Systems-Based Practice:

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

Objectives:

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples: Demonstrate timely consulting for psychological support, spiritual support, dietary support, and social support in the patients with malignancy.
  
  
• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. Examples: Resident should be able to organize all of the consultants involved in the patient's care and deliver an efficient and effective treatment plan.
  
  
• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: Resident should demonstrate use of evidence-based medicine in screening patients for cancer.
  
  
• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care.

III.                Methods of instruction:

A)     Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room
Monday Noon Tumor conference 12:00-1:00 p.m. - Haggar Hall
(Resident must attend 2 per month)
Wednesday mornings 7:30-8:00 a.m. - Clinical Grand Rounds - IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall
Thursday Multidisciplinary Breast Care Conference 12:00-1:00 p.m. - Haggar Hall
(1st and 3rd Thursday of each month)

B)     Clinical

Evaluate and treat patients with oncological disease in the inpatient and outpatient setting. Perform histories and physicals. Formulate and carrying out a diagnostic and therapeutic plan and communicate that plan verbally and/or in writing to the patient, the supporting medical team and the consulting physician.