Hematology/Oncology Inpatient Rotation (Gold) PL2 Residents

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1 PL2 Residents The Gold team at Comer Children s Hospital at the University of Chicago is comprised of 4 residents who care exclusively for inpatients suffering from hematologic and oncologic conditions. Residents take call every fourth night. Although the levels of experience of residents varies from month to month, in general the team is comprised solely of 2 PL2 and 2 PL3 residents. The residents are supervised by an attending physician and a hematology/oncology fellow at all times. The resident physicians serve a very important role. In particular, they will provide direct care for patients admitted to the Gold service. While in general they do not provide care for most patients admitted only for chemotherapy, they may be asked to provide care for patients getting chemotherapy for the first time, those receiving medications with a high risk of side effects or investigational drugs, or patients with additional medical problems. This distinction is at the discretion of the attending physician. Senior residents are expected to assist interns and students, evaluate and discuss their patients each morning prior to AM rounds. Additionally, if the service is of particularly large size or high acuity, which is quite frequently the case, senior residents will also primarily follow individual patients. Residents are expected to evaluate and examine their patients each morning prior to rounds, at which time they will provide a succinct, accurate, and complete synopsis of events that transpired over the evening, an assessment of clinical problems, and the plans for the day. Resident progress notes will be placed on the chart after morning rounds, and can be updated as needed throughout the day (e.g., the addition of laboratory results as an addendum). Following rounds, interns will work closely with the senior residents, fellow, and attending to implement the plans. At the end of each day, they are to sign-out to the night-call team. A. Patient Care: 1. Gather accurate, essential information from all sources, including medical interviews and medical records 2. Demonstrate the ability to perform a comprehensive physical examination for children of all age 3. Develop, negotiate and implement effective patient management plans B. Medical Knowledge: 1. Describe a stepwise approach for the evaluation and management of patients with anemia, neutropenia, and/or thrombocytopenia, including: a. The clinical signs associate with particular cytopenias b. The interpretation of a complete blood cell count and differential c. The various etiologies of individual cytopenias d. The differential diagnosis of each type of cytopenia e. The laboratory studies that may be required to diagnose and manage each type of cytopenia f. The initial/emergent management of various types of cytopenias 2. Describe a stepwise approach for the evaluation and management of patients with coagulation disorders, including: a. The different clinical presentations of patients with platelet disorders, factor deficiencies, and thrombophilic disorders b. The interpretation of basic coagulation screening tests c. The indication to order coagulation tests such as factor assays, d-dimer, fibrin split products, and platelet function assays Updated

2 PL2 Residents d. The different treatment approaches (prophylactic versus episodic treatment) of patients with hemophilia 3. Describe a stepwise approach for the initial evaluation and management of leukemia and lymphoma including: a. The clinical signs and symptoms of leukemia and lymphoma b. The difference between acute and chronic leukemia c. The different treatment strategies and prognosis of childhood acute lymphoblastic leukemia (ALL) versus acute myeloblastic leukemia (AML) d. An appropriate diagnostic differential for patients who present with lymphadenenopathy and/or heptosplenomegaly e. The laboratory and radiologic abnormalities that are typically present in patients who present with leukemia or lymphoma f. The basic clinical differences between Hodgkin s Lymphoma and Non-Hodgkin s Lymphoma 4. Describe a stepwise approach for the initial evaluation and management of solid tumors, including brain tumors, soft tissue masses and bone masses including: a. The clinical signs of solid tumors, particularly small blue cell tumors and brain tumors b. The prognosis of the various kinds of solid tumors, small blue cell tumors, and brain tumors c. The basic initial laboratory and radiologic studies that are required to evaluate a solid tumor d. The initial/emergent management of different solid tumors particularly small blue cell tumors and brain tumors 5. Describe a stepwise approach to the comprehensive care for the child with sickle cell disease including: a. Susceptibility to life threatening bacterial illnesses b. The management of patients with sickle cell disease and fever c. Identification and management of acute veno-occlusive crises including pain crisis, acute chest syndrome, stroke, splenic sequestration, priapism or hyperhemolytic crisis d. Identification and management of aplastic crisis 6. Describe a stepwise approach to the child with fever and neutropenia 7. Describe a stepwise approach to the child at risk for tumor lysis syndrome 8. Describe a reasonable therapeutic approach to chemotherapy-induced nausea and vomiting 9. Demonstrate knowledge of pain management in patients with hematologic and/or oncologic conditions 10. Demonstrate knowledge of acute and chronic side effects of commonly used chemotherapeutic agents 11. Discuss oncologic emergencies specifically fever and neutropenia, tumor, lysis, spinal cord compressions, mediastinal mass 12. Demonstrate a clear knowledge of basic concepts of approaches to the diagnosis of childhood cancers, including laboratory tests, medical imaging, tissue pathology, and molecular diagnostics 13. Demonstrate knowledge of indications of hematopoietic stem cell transplantation and the additional risks and management strategies in these patients C. Practice-Based Learning and Improvement: 1. Critically read and discuss the pertinent hematologic/oncologic literature 2. Evaluate their own performance, identify gaps in their own knowledge, and target their selfdirected learning to fill those gaps 3. Demonstrate a willingness to learn from errors and use errors to improve the system of processes Updated

3 PL2 Residents of care 4. Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education 5. Provide, request, and accept feedback D. Interpersonal and Communication Skills: 1. Observe the communication of a new diagnosis to a child and his/her family 2. Observe the process of delivery of bad news to a family and patient 3. Discuss the coordination of care of complex patients with outpatient health including, home health, hospice care, laboratories, physical therapy, psychological therapy, family, and community pediatricians 4. Observe and describe the communication with the care for a dying child and his/her family 5. Observe the approach to a family for autopsy consent 6. Discuss the importance of seeking consolation for one s self after being present for a child s death E. Professionalism: 1. Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families and colleagues 2. Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues 3. Adhere to principles of confidentiality/scientific/academic integrity F. Systems-Based Practice: 1. Demonstrate an understanding of, access and utilize the resources, providers, and systems necessary to provide optimal care 2. Demonstrate the application of evidence-based, cost-conscious strategies to prevention, diagnosis and disease management 3. Demonstrate the ability to collaborate with other members of the health care team to assist patients in dealing effectively with complex systems 4. Describe available community resources for children with malignancy 5. Describe available community resources for families who children have sickle cell anemia or other hematologic conditions Updated

4 PL3/4 Residents The Gold team at Comer Children s Hospital at the University of Chicago is comprised of 4 residents who care exclusively for inpatients suffering from hematologic and oncologic conditions. Residents take call every fourth night. Although the levels of experience of residents varies from month to month, in general the team is comprised solely of 2 PL2 and 2 PL3 residents. The residents are supervised by an attending physician and a hematology/oncology fellow at all times. The resident physicians serve a very important role. In particular, they will provide direct care for patients admitted to the Gold service. While in general they do not provide care for most patients admitted only for chemotherapy, they may be asked to provide care for patients getting chemotherapy for the first time, those receiving medications with a high risk of side effects or investigational drugs, or patients with additional medical problems. This distinction is at the discretion of the attending physician. Senior residents are expected to assist interns and students, evaluate and discuss their patients each morning prior to AM rounds. Additionally, if the service is of particularly large size or high acuity, which is quite frequently the case, senior residents will also primarily follow individual patients. Residents are expected to evaluate and examine their patients each morning prior to rounds, at which time they will provide a succinct, accurate, and complete synopsis of events that transpired over the evening, an assessment of clinical problems, and the plans for the day. Resident progress notes will be placed on the chart after morning rounds, and can be updated as needed throughout the day (e.g., the addition of laboratory results as an addendum). Following rounds, interns will work closely with the senior residents, fellow, and attending to implement the plans. At the end of each day, they are to sign-out to the night-call team. A. Patient Care: 1. Gather accurate, essential information from all sources, including medical interviews and medical records 2. Demonstrate the ability to perform a comprehensive physical examination for children of all age 3. Develop, negotiate and implement effective patient management plans B. Medical Knowledge: 1. Describe a stepwise approach for the evaluation and management of patients with anemia, neutropenia, and/or thrombocytopenia, including: a. The clinical signs associate with particular cytopenias b. The interpretation of a complete blood cell count and differential c. The various etiologies of individual cytopenias d. The differential diagnosis of each type of cytopenia e. The laboratory studies that may be required to diagnose and manage each type of cytopenia f. The initial/emergent management of various types of cytopenias 2. Describe a stepwise approach for the evaluation and management of patients with coagulation disorders, including: a. The different clinical presentations of patients with platelet disorders, factor deficiencies, and thrombophilic disorders b. The interpretation of basic coagulation screening tests c. The indication to order coagulation tests such as factor assays, d-dimer, fibrin split products, and platelet function assays Updated

5 PL3/4 Residents d. The different treatment approaches (prophylactic versus episodic treatment) of patients with hemophilia 3. Describe a stepwise approach for the initial evaluation and management of leukemia and lymphoma including: a. The clinical signs and symptoms of leukemia and lymphoma b. The difference between acute and chronic leukemia c. The different treatment strategies and prognosis of childhood acute lymphoblastic leukemia (ALL) versus acute myeloblastic leukemia (AML) d. An appropriate diagnostic differential for patients who present with lymphadenenopathy and/or heptosplenomegaly e. The laboratory and radiologic abnormalities that are typically present in patients who present with leukemia or lymphoma f. The basic clinical differences between Hodgkin s Lymphoma and Non-Hodgkin s Lymphoma 4. Describe a stepwise approach for the initial evaluation and management of solid tumors, including brain tumors, soft tissue masses and bone masses including: a. The clinical signs of solid tumors, particularly small blue cell tumors and brain tumors b. The prognosis of the various kinds of solid tumors, small blue cell tumors, and brain tumors c. The basic initial laboratory and radiologic studies that are required to evaluate a solid tumor d. The initial/emergent management of different solid tumors particularly small blue cell tumors and brain tumors 5. Describe a stepwise approach to the comprehensive care for the child with sickle cell disease including: a. Susceptibility to life threatening bacterial illnesses b. The management of patients with sickle cell disease and fever c. Identification and management of acute veno-occlusive crises including pain crisis, acute chest syndrome, stroke, splenic sequestration, priapism or hyperhemolytic crisis d. Identification and management of aplastic crisis 6. Describe a stepwise approach to the child with fever and neutropenia 7. Describe a stepwise approach to the child at risk for tumor lysis syndrome 8. Describe a reasonable therapeutic approach to chemotherapy-induced nausea and vomiting 9. Demonstrate knowledge of pain management in patients with hematologic and/or oncologic conditions 10. Demonstrate knowledge of acute and chronic side effects of commonly used chemotherapeutic agents 11. Discuss oncologic emergencies specifically fever and neutropenia, tumor, lysis, spinal cord compressions, mediastinal mass 12. Demonstrate a clear knowledge of basic concepts of approaches to the diagnosis of childhood cancers, including laboratory tests, medical imaging, tissue pathology, and molecular diagnostics 13. Demonstrate knowledge of indications of hematopoietic stem cell transplantation and the additional risks and management strategies in these patients C. Practice-Based Learning and Improvement: 1. Critically read and discuss the pertinent hematologic/oncologic literature 2. Evaluate their own performance, identify gaps in their own knowledge, and target their selfdirected learning to fill those gaps 3. Demonstrate a willingness to learn from errors and use errors to improve the system of processes Updated

6 PL3/4 Residents of care 4. Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education 5. Provide, request, and accept feedback D. Interpersonal and Communication Skills: 1. Observe the communication of a new diagnosis to a child and his/her family 2. Observe the process of delivery of bad news to a family and patient 3. Discuss the coordination of care of complex patients with outpatient health including, home health, hospice care, laboratories, physical therapy, psychological therapy, family, and community pediatricians 4. Observe and describe the communication with the care for a dying child and his/her family 5. Observe the approach to a family for autopsy consent 6. Discuss the importance of seeking consolation for one s self after being present for a child s death E. Professionalism: 1. Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families and colleagues 2. Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues 3. Adhere to principles of confidentiality/scientific/academic integrity F. Systems-Based Practice: 1. Demonstrate an understanding of, access and utilize the resources, providers, and systems necessary to provide optimal care 2. Demonstrate the application of evidence-based, cost-conscious strategies to prevention, diagnosis and disease management 3. Demonstrate the ability to collaborate with other members of the health care team to assist patients in dealing effectively with complex systems 4. Describe available community resources for children with malignancy 5. Describe available community resources for families who children have sickle cell anemia or other hematologic conditions Updated

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