Hematology Oncology Fellowship Goals

Over the course of training the fellow should be able to meet the following specific objectives:

• Demonstrate understanding of cancer pathogenesis and implications of cancer prevention.
• Demonstrate proficiency in the diagnosis, staging, and management of solid tumors/hematologic malignancies.
• Demonstrate proficiency in the recognition and management of benign hematological conditions.
• Demonstrate understanding in the respective roles of surgery, radiation, chemotherapy, targeted therapy, and immunotherapies in the management of early and advanced stage malignancies.
• Demonstrate the palliative role of localized and systemic therapies in cancer management.
• Demonstrate effective understanding of complex psycho-social issues influencing cancer care and apply principles to providing compassionate patient care.
• Exhibit effective and professional communication with partnering health care staff, including aids, nurses, mid-level providers, and referring/consulting physicians.
• Demonstrate compassion, integrity, and respect for others
• Demonstrate sensitivity to a diverse patient population regardless of, and not limited to, gender, age, culture, race, religion, disabilities, and sexual orientation.
• Demonstrate the ability to identify strengths, deficiencies, and limits in their knowledge and expertise.
• Demonstrate technical competency with various procedures, including reliable physical examinations, interpretation of bone smears, molecular studies, chemotherapy administration, bone marrow aspiration and biopsy, therapeutic phlebotomy, performing lumbar punctures with administration of chemotherapy, and selecting appropriate patients for cellular therapies.
• Demonstrate competency in the role of an effective consultant.
• Demonstrate ability to appraise the medical literature and utilize evidence-based practices to provide cutting-edge care to cancer patients.
• Demonstrate reliable participation in educational activities, including attending and giving lectures, bedside teaching, and informal mentoring of junior trainees and peers.

Hematology-oncology fellows will be able to exhibit proficiency in the following areas by the end of their training:

• Understand hematopoiesis and the physiologic functions/morphology of blood cells in the pathogenesis of hematologic diseases.
• Interpret peripheral smear and initial laboratory evaluation, including the complete blood count and respective abnormalities, including leukopenia, leukocytosis, anemia, erythrocytosis, thrombocytopenia, and thrombocytosis.
• Understand the appropriate indications for a bone marrow biopsy in the workup of hematologic diseases.
• Accurately generate the differential diagnosis and management of anemias, including microcytic anemias, normocytic anemias, and macrocytic anemias.
• Understand the role of iron, folic acid, and vitamin B12 as it pertains to hematopoiesis and development of cellular disorders.
• Recognize the clinical and laboratory features of intravascular/extravascular hemolysis and generate appropriate management plans.
• Understand and manage hemoglobinopathies, including sickle cell syndromes and thalassemia.
• Identify and manage the acute crises in patients with sickle cell disease.
• Identify stem cell disorders, including aplastic anemia and myelodysplastic syndrome.
• Identify macroangiopathic hemolysis and construct accurate management plans for conditions including TTP/DIC.
• Appropriately evaluate a patient with thrombocytopenia and generate an accurate differential diagnosis with respective management plan.
• Know the differential diagnosis of a leukoerythroblastic peripheral blood smear.
• Know the differential diagnosis of leukopenia, including in cases of lymphopenia and neutropenia.
• Know the differential diagnosis of leukocytosis, including in cases of lymphocytosis, neutrophilia, eosinophilia, and basophilia.
• Know the clinical features, complications and treatment of the chronic myeloproliferative diseases, including polycythemia vera, chronic myelogenous leukemia, idiopathic myelofibrosis, and essential thrombocythemia.
• Understand the clinical features of acute myelogenous leukemia and acute lymphoblastic leukemia, and the therapeutic approach, prognosis, and supportive care.
• Understand the principles of blood component transfusion, including indications for PRBCs, granulocytes, platelets, fresh frozen plasma, and cryoprecipitate.
• Understand the clinical features and therapy of plasma cell disorders/dysproteinemias and specific complications presenting as medical emergencies.
• Understand the clinical and pathologic features of chronic lymphocytic leukemia as well as staging, prognosis, therapies and indications for treatment.
• Understand the clinical and pathologic features of the indolent and aggressive non-Hodgkin lymphomas, including staging, prognosis and therapeutic approaches.
• Understand the clinical and pathologic features of Hodgkin lymphoma and respective clinical and pathologic staging that influence its management/prognosis.
• Understand supportive care needs of patients with hematologic malignancies.
• Understand and evaluate coagulation profile tests (PT, PTT, bleeding time, platelet count) associated with bleeding/clotting disorders.
• Understand the role of mixing studies in evaluating factor deficiency versus mixing studies.
• Exhibit competency in the understanding of thrombophilias and exhibit accurate therapeutic strategies in the management of deep vein thrombosis/pulmonary embolism.
• Understand the pattern of inheritance, the incidence, and the appropriate patients to screen for various thrombophilias including factor V Leiden,
• Antiphospholipid syndrome, protein C, protein S, and antithrombin III deficiencies.
• Understand coagulopathies and the respective management for those, including von Willebrand’s disease, hemophilia, and acquired factor deficiencies/inhibitors.
• Recognize the presence of and employ appropriate management of vitamin K deficiency.
• Understand inherited and acquired platelet disorders as well as their respective laboratory analysis.
• Understand the associations of various viruses associated with various malignancies, including HIV, HCV, HPV, and EBV.
• Diagnose and manage paraneoplastic disorders.
• Understand clinical epidemiology and medical statistics, including clinical study and experimental design, data collection and analysis.
• Understand the role of cellular therapies, including adoptive T cell therapy (CAR T, TCR), allogenic HSCT, autologous HSCT, and DLI in the management of cancer.
• Understand the post-transplant complications associated with allogeneic and autologous HSCT.
• Understand the principles and application of conditioning prior to cellular therapies.
• Understand the utility of radiation, chemotherapy, biologics, and growth factors in the management of hematologic malignancies.
• Understand the genetic implications and molecular mechanisms associated with various hematologic malignancies (e.g. role of bcl2 in non-Hodgkin lymphoma).
• Understand the utility of immunophenotyping, cytochemical stains, cytogenetic and molecular analysis in the diagnosis/prognostication of hematologic malignancies.
• Understand basic molecular mechanisms in the diagnosis and therapy of diseases of blood and disorders of hemostasis and thrombosis.
• Understand the principles of basic immunology, pharmacology, cell biology, tumor immunology, and cancer evasion.
• Understand cancer causation, including chemical, physical, environmental, viral and hormonal factors.
• Understand the appropriate role of genetic testing and counseling in select cases.
• Understand surgical principles of cancer management.
• Understand the palliative/curative role of radiation therapy, including external beam therapy, brachytherapy, stereotactic radiation, proton beam therapy.
• Understand principles of cancer screening.
• Understand the premise of cancer prevention using retinoids, carotenoids, hormones, nonsteroidal anti-inflammatory agents, dietary fiber, and micronutrients.
• Know the epidemiology, staging and prognostic factors (including genetic features), natural history, pathology and therapy for each of the major tumor types, including lung cancer (small and non-small cell), breast cancer, bowel cancer, head and neck, esophagus, stomach, central nervous system, gynecologic malignancies, genitourinary malignancies (testicular, renal cell, bladder), skin (including melanoma), endocrine tumors and tumors of bone and soft tissue (including sarcoma).
• Recognize the immediate to late onset adverse effects of cancer treatment.
• Be equipped to prevent and manage infectious complications in the immunocompromised cancer patient.
• Understand the role of supportive therapies, including management of cancer/treatment-induced complications such as nausea and vomiting, stomatitis, cystitis, pulmonary and cardiotoxicity, alopecia, gonadal dysfunction, cachexia, as well as psychiatric disorders.
• Establish the role of palliative care services in the case of terminal cases.