Pediatric Hematology/Oncology Rotation Specific Objectives Department of Pediatrics McMaster University

Transcription

1 Pediatric Hematology/Oncology Rotation Specific Objectives Department of Pediatrics McMaster University MEDICAL EXPERT 1. Demonstrate diagnostic and therapeutic skills for ethical and effective patient care. 2. Access and apply relevant information to clinical practice. 3. Demonstrate effective consultation services with respect to patient care, education and legal opinions. The hematology resident must demonstrate in-depth knowledge of: 1. The development, structure and function of the hemopoietic system in infancy, childhood and adolescence, including changes in normal values with age. 2. The physiology of factors responsible for hemostasis and thrombosis in infancy, childhood and adolescence. 3. The pathophysiology of alterations in morphology and quantity of formed elements in the blood. 4. The indications for and interpretation of common hematologic tests. 5. The principles underlying transfusion and hyper-transfusion of blood and blood products in infancy, childhood and adolescence. 6. The characteristics and principles of investigation of leukemias, lymphomas and other common solid tumors. 7. The infectious complications in patients with cancer and non-malignant hematologic disorders. The pediatric resident must demonstrate the ability to assess and investigate patients with cancer or non-malignant hematologic disorders appropriate for age, including: 1. The ability to establish a professional relationship and to interact with infants, toddlers, children or adolescents and their caregivers in order to obtain relevant history. 2. Communicate effectively and discuss appropriate information with patients and families and all members of the interdisciplinary health care team. 3. Understand the psychosocial aspects of caring for children with life threatening and/or chronic disorders, and their families.

2 2 4. Understand the biomedical ethics involved in the investigation and care of children and adolescents with hematological disorders, including the appropriate treatment of patients whose families hold religious or other beliefs that preclude the use of "standard medical treatments". COLLABORATOR 1. Consult effectively with other physicians and health care professionals. 2. Contribute effectively to other interdisciplinary team activities. 1. Contribute clinically useful hematological opinions on patients referred for consultation, including ordering and arranging for specific testing, administering required therapy and conveying the results of the hematological opinion to referring physicians. 2. Consult and collaborate with physicians and other health care professionals, and contribute effectively to interdisciplinary team activities within and between hospitals, other health care facilities and collaborative groups. MANAGER 1. Utilize resources effectively to balance patient care, learning needs and outside activities. 2. Allocate finite health care resources wisely. 3. Work effectively with and efficiently in a health care organization. 4. Utilize information technology to optimize patient care, life-long learning and other activities. 1. Demonstrate knowledge of the definitions and role of audits, quality improvement, risk management and incident reporting in a hospital and ambulatory setting. 2. Demonstrate understanding of cost/benefit ratios of diagnostic and therapeutic interventions, cost containment and efficacy as they relate to quality assurance.

3 3 HEALTH ADVOCATE 1. Identify the important determinants of health affecting patients. 2. Contribute effectively to improved health of patients and communities. 3. Recognize and respond to those issues where advocacy is appropriate. A. Specific Requirements 1. Demonstrate an appreciation of the health care needs of children with hematologic/oncologic disorders. 2. Encourage the promotion of active family involvement in decision-making and continuing management of the child with hematological/oncologic disorders. SCHOLAR 1. Develop, implement and monitor a personal continuing education strategy. 2. Critically appraise sources of medical information. 3. Facilitate learning of patients, house staff/students and other health professionals. 4. Contribute to the development of new knowledge. The hematology resident should: 1. Deliver highest quality care with integrity, honesty and compassion. 2. Exhibit appropriate personal and interpersonal professional behavior. 3. Practice medicine ethically consistent with obligation of a physician. RESPONSIBILITIES OF THE RESIDENT It is expected that the trainee will function as a junior consultant within the regional service, which provides expertise to other pediatric facilities within the city. Accordingly, the resident has supervised responsibility for out-patient clinics and the care of inpatients. In addition, the trainee participates in the education of pediatric residents and of the numerous medical undergraduates who pursue electives in Pediatric Hematology/Oncology.

4 4 The trainee will actively participate in teaching rounds, at least once weekly, during which essential topics in pediatric hematology are discussed. A file containing references of important review articles and highlights of major advances in the field of pediatric hematology is available to residents as an academic resource. This resource is updated from time-to-time to keep abreast with developments in the field. The residents participate in out-of- hospital weekend consultant call (one in 3-4) with back-up from a faculty member. FACULTY The members of the Division of Hematology/Oncology in the Department of Pediatrics are: Dr. U. Athale Dr. R. Barr, Division Chair Dr. A. Chan Dr. M. Greenberg (PT) Dr. I. Hodson (PT) Dr. I Odame, Rotation Supervisor Dr. C. Portwine Dr. A Whitton (PT) RESOURCES The annual recruitment of new children with cancer averages 55 with approximately 4,500 total clinic visits per year (some 90% by children with malignant disease). About 2,000 procedural events are performed annually in the out-patient area. The service is supported by one clinical nurse specialist; 5 dedicated nurses; 2.7 fulltime social workers; 2 full-time pharmacists; one FTE from each of child life, nutrition, and psychometry; and 0.5 FTE from OT/PT and psychology. RESIDENT EVALUATION Residents are provided with feedback during the rotation concerning their proficiency in managing clinical problems and their performance in informal and formal teaching sessions. The faculty member working with the resident, particularly when they share weekend on call duties, provides feedback for on-call duties. The resident meets with the rotation supervisor at the mid-point of the rotation to provide two-way feedback on the rotation. At the mid-point of the rotation the goals for the remainder of the rotation are discussed. A formal evaluation is completed at the end of the rotation by the rotation supervisor, with feedback from the other staff members. Final evaluations are discussed with the resident.

5 5 EVALUATION OF THE RESIDENT Residents are encouraged to provide feedback on how the rotation and teaching are structured. Resident input has been enthusiastically received. As with all hematology rotations, a formal evaluation of the rotation is handled by the Postgraduate Medical Education Office. Teaching faculty are evaluated separately, as for other rotations. Separate from these evaluations, hematology residents have met every year to compile a collective rotation and faculty evaluation, respecting anonymity. With the size of our program, this has been important in maintaining feedback. TOPICS FOR RESIDENTS Developmental hematology and normal values for age Neonatal hematology: o Developmental hematology in the fetus o Bilirubin metabolism o Consequences of maternal-fetal incompatibility o Pathophysiology of hemostasis in the newborn o Transfusion practice in the newborn o Neonatal thrombocytopenia Diagnostic approach to anemia Mechanisms and management of purpura Sickle cell anemia Thalassemia syndromes - molecular and clinical pathogenesis Aplastic anemia Inherited marrow failure syndromes Granulocytopenia and disorders of granulocyte function Leukemia in childhood: o ALL o AML/MDS o CML o JMML Malignant lymphomas in childhood Splenomegaly and disorders of the spleen Disorders of histiocytes: o Langerhans cell histiocytosis o Hemophagocytic syndromes Immunodeficiency and cancer Late effects of treatment of childhood cancer The HLA system

6 Solid tumors in childhood: o Neuroblastoma o Wilm s tumor o Bone tumors o Rhabdomyosarcoma o Brain tumors 6 Modified: August 10, 2007