ROTATION SUMMARY HEMATOLOGY/ONCOLOGY SELECTIVE Rotation Contacts and Scheduling Details Rotation Director: Jennifer Andrews, MD, MSc jenandre@stanford.edu Administrator: Gretchen Shawver 1000 Welch Road, Suite 300 Palo Alto, CA 94304 gshawver@stanford.edu Phone: 650-723-5535 Introduction The LPCH /Oncology Selective Rotation is designed to increase resident knowledge of the evaluation and management of patients seen in the outpatient Bass Center Clinics (oncology, neuro-oncology, and Health after Therapy clinics) as well as in the ambulatory clinic. This experience will prioritize the evaluation of new oncology patients seen for outpatient consultation, second opinion consultations of clinically challenging cases, as well as exposure to the continuity clinics in oncology and hematology. The resident will be expected to synthesize clinical and laboratory information, develop a differential diagnosis and then assimilate an evaluation and management plan. Residents will also be expected to present a 45-minute case presentation and literature review at Pediatric Tumor Board at the end of their rotation. Weekly Schedule HEMATOLOGY/ONCOLOGY OUTPATIENT SELECTIVE Time Monday Tuesday Wednesday Thursday Friday Morning Neuro-Onc Tumor Board (07:30-09:00) LPCH, Admin. Conference Room * 09:00 12:00 Neuro-Onc Work Rounds (09:00-10:00) 800 Welch Rd., FC180 * 12:00 13:00 Noon Conference, 13:00 17:00 Neuro-Onc Clinic (Partap) Neuro-Oncology Morning report (08:00-08:30) ************** Educational Teaching (08:30-09:00) 1N MD (Lo) Noon Conference, (Lo) Morning report (08:00-08:30) ************** Educational Teaching (08:30-09:00) 1N MD (Aftandilian) Oncology Interesting Patient Conference 1N MD (Spunt) Oncology Morning report (08:00-08:30) ************** Educational Teaching (08:30-09:00) 1N MD (Lacayo) Oncology Noon Conference, (Lacayo) Oncology (13:00-15:00) (Andrews) Pediatric Grand Rounds (08:00-09:00) LPCH Auditorium (Andrews) Noon Conference, Patient Review (15:00-16:00) Outpatient ONC consults (supervised by Team B attending) or new patient evaluations should take priority over routine onc clinics.
Rotation Specifics Orientation Residents will primarily report to the Oncology Team B attending, who is responsible for outpatient oncology consults. The resident should page the Team B attending on the first day of the rotation to find out if any new patients or consults are scheduled for that week. The schedule of all relevant clinics is listed above, with the primary attending(s) responsible for each of those clinics listed. Attendance at these clinics and conferences will be expected, unless there is a new oncology consult available as priority will be given to the work-up of new oncology patients and this experience in general should trump all other ambulatory experiences. Rounds Oncology clinic rounds begin at 9:00AM every morning, and the list of all patients scheduled for appointments and procedures will be reviewed. This is an excellent opportunity to hear a brief overview of each patient who will be coming to clinic that day, in the event that the resident is available to see that patient. Resident Roles and Responsibilities Evaluation of new oncology patients, including dictation of the history & physical/outpatient consult letter Working with the consult attending (and possibly fellow) to help coordinate any radiology or laboratory studies needed for new patient consults Contact the private pediatricians with an update on their patient who is referred for consultation Serve as a point person for the family of the new patient to assure clear communication of diagnostic work-up process Evaluation and Feedback Residents will receive verbal feedback directly from Attendings in real time as well as feedback of his/her cumulative performance at the culmination of the Attending s service time. Each Attending on service with the resident will be asked to complete a Medhub evaluation or the visiting residents local institution evaluation.
Competency-based Goals and Objectives Goal 1. Understand the rationale and strategy of multi-modality therapy in the care of children with cancer. Perform history & physical exam and incorporate laboratory, radiologic, and pathologic data in the evaluation and Written documentation of management plan for new oncology consultation patients seen in consultation. Generate and communicate a comprehensive plan of care for oncology patients. Review notes from referring physicians and/or multidisciplinary consultants, and explain the rationale for treatment plan currently being followed. Present case and literature review at Tumor Board Tumor Board Written documentation of consultation Written documentation of consultation PC - Make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment PC - Make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment Identify major therapies (chemotherapy, radiation therapy, surgery) involved in the care of children with cancer and explain their potential short and long-term side effects. State how cooperative group clinical trial research has increased survival rates for children with cancer. Tumor board Directed reading Attending discussion Directed reading Protocol conference Tumor Board presentation Advocate for quality patient care and assist patients in dealing with system complexities Tumor board Self evaluation and reflection PC - Provide family-centered patient care that is culturally effective and developmentally and ageappropriate SBP - Advocate for quality patient care and assist patients in dealing with system complexities Coordinate and communicate with consulting services for inpatients. Self evaluation and reflection ICS - Communicate effectively with physicians, other health professionals, and health related agencies
Identify the long term complications of multimodality therapies, and the morbidities associated with such therapies HAT clinic Neuro-Onc clinic Clinic note dictations from HAT and Neuro-Onc clinics Recognize the life long need for surveillance of heart, lung, renal, liver, eye, bone, and fertility function after multimodality therapies HAT clinic Neuro-Onc clinic PC - Provide family-centered patient care that is culturally effective and developmentally and ageappropriate Appreciate the psychosocial and cognitive risks associated with multimodality therapy HAT clinic Neuro-Onc clinic PC - Provide family-centered patient care that is culturally effective and developmentally and ageappropriate SBP - Advocate for quality patient care and assist patients in dealing with system complexities Goal 2. Develop competence in communicating to parents of children with life-threatening illnesses. Participate in patient care conferences. PC - Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families P - Demonstrate sensitivity and responsiveness to patients culture, age, gender and disabilities Participate in Bereavement Rounds PC - Interview patients/families about the particulars of the medical condition for which they seek care, with specific attention to behavioral, psychosocial, environmental and family unit correlates of disease P - Demonstrate sensitivity and responsiveness to patients culture, age, gender and disabilities P - Respect for patient privacy and autonomy
Observe either initial diagnosis conference, consent conference, or end of life discussion. P - Respect for patient privacy and autonomy ICS - Create and sustain a therapeutic and ethically sound relationship with patients ICS - Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills Demonstrate communication strategies during new patient evaluations and/or consultations. ICS - Communicate effectively with patients, families, and the public as appropriate, across a broad range of socioeconomic and cultural backgrounds; PC - Counsel and educate patients and their families Goal 3. Understand the approach to a child or young adult with a bone tumor. Generate a differential diagnosis for a child or young adult with a bone tumor Tumor Board Define the laboratory and imaging workup involved in a child or young adult with a bone tumor. Tumor Board Describe the physical exam and radiologic findings in a child with a newly diagnosed bone tumor. Tumor Board
Goal 4. Understand the approach to a child with a brain tumor. Generate a differential diagnosis for a child with a brain tumor Neuro-Onc Tumor Board Define the laboratory and imaging workup involved in a child with a brain tumor Neuro-Onc Tumor Board Describe the physical exam and radiologic findings in a child with a newly diagnosed brain tumor Neuro-Onc Tumor Board PBLI = practice based learning and improvement ICS = interpersonal and communication skills P= professionalism MK= medical knowledge PC= patient care SBP = systems based practice