Lahey Clinic Internal Medicine Residency Program: Curriculum for Hematology

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1 Lahey Clinic Internal Medicine Residency Program: Curriculum for Hematology Faculty representative: Neil Weiner, MD Resident representative: Guiherme Rabinowits, MD Revision date: February 28, 2006 Goals The goal of the program is to teach medical residents how to evaluate and diagnose hematologic disorders. A second goal is to teach the comprehensive care of patients with hematologic disorders. Organization There are four hematologists in the Department of Hematology who are full-time salaried physicians at Lahey Clinic Medical Center and work under the direction of the department chair. Administration The Department of Hematology is administered by the Department Chair, Neil J. Weiner, MD. Relationship to Program Director The department chair will work closely with the residency program director. Responsibilities Residents will see new patients sent for hematologic consultation. They will be responsible for taking a history, performing a physical examination and reviewing laboratory data. Residents will be taught how to review peripheral blood smears and bone marrow aspirates. They will participate in the ongoing comprehensive medical care of patients in the Department of Hematology. Patient Management Rounds Residents will attend hospital rounds with one of the staff attendings. There will be a case-by-case review with one of the staff physicians when the resident is seeing outpatients in the clinic. Teaching Rounds There will be morning rounds with the attending. Ambulatory Medicine

2 The Department of Hematology has a wealth of outpatient clinical material. Patients are seen for the evaluation and treatment of anemia, leukopenia, leukocytosis, thrombocytosis, coagulopathies, myeloproliferative disorders, thrombocytopenia, lymphadenopathy, splenomegaly, acute and chronic leukemia, Hodgkin s disease and non-hodgkin s lymphoma, and multiple myeloma. The department treats patients with a variety of malignancies with high-dose chemotherapy and stem cell transplantation. Residents will be able to participate in the evaluation and treatment of patients having autologous stem cell transplants. They also will learn about stem cells and growth factors. The outpatient department includes an infusion room where patients are given chemotherapy, blood transfusions and other parenteral therapies. The resident will work closely with several highly skilled and highly trained hematology/oncology nurses, a nurse practitioner and hematology/oncology fellows. Didactic Lectures The residents will attend a weekly tumor conference during which interesting and instructive cases are presented and discussed by a multidisciplinary team consisting of surgeons, radiotherapists, radiologists, nurses, hematologists and oncologists. Once a week there is a hematology-hematopathology conference. Cases are presented and peripheral blood smears, bone marrow slides and lymph node biopsies are reviewed with the hematopathologist. Case management is discussed. Clinical pathologists, anatomic pathologists and immunologists attend this conference, and outside speakers are also invited to participate. Research The section of Hematology is affiliated with the Cancer and Leukemia Group B, and residents will have experience with national cooperative group protocol studies. Principle Educational Goals Based on the ACGME General Competencies In the tables below, the principle educational goals of the Hematology curriculum are listed for each of the six ACGME competencies: 1) Patient Care 2) Medical Knowledge 3) Practice-Based Learning and Improvement 4) Interpersonal and Communication Skills 5) Professionalism 6) Systems-Based Practice 1) Patient Care Perform a focused history and physical exam with attention to factors

3 appropriate to the hematology issue Formulate a diagnostic and management plan Clearly document the plan in the medical record Perform a bone marrow biopsy competently 2) Medical Knowledge Learn the differential diagnosis of common hematologic abnormalities Learn the appropriate diagnostic evaluation of common hematologic abnormalities Learn the management of common hematologic diseases 3) Practice-based Learning and Improvement Use literature search to answer clinical questions Be able to interpret laboratory tests and learn what additional tests to order to arrive at a diagnosis Gain exposure to interpreting peripheral blood and bone marrow smears Hematology conferences 4) Interpersonal and Communications Skills Communicate effectively and professionally with team members

4 Communicate compassionately and effectively with patient and family to obtain accurate history and describe treatment and toxicity 5) Professionalism Be respectful of patients, families and colleagues 6) Systems-Based Practice Learn to use diagnostic and therapeutic modalities in a logical, cost-effective manner Learn to consult with other specialties appropriately Hematology Curriculum Checklist Hemochromatosis Hemostasis and thrombosis Abnormal coagulation (abnormal prothrombin and partial thromboplastin times) Anticardiolipin antibody Anticoagulation (therapeutic) fibrinolysis Disseminated intravascular coagulation Hypercoagulable state Hyperviscosity syndrome Leukocyte disorders Immunosuppression Neutropenia Setting: I (inpatient) O (outpatient) Date

5 Leukemoid reaction Myeloproliferative disorders Chronic myelogenous leukemia Polycythemia vera Platelet disorders Thrombocytopenia Platelet dysfunction Thrombocytosis Polycythemia, secondary Red cell disorders Anemia Hemoglobinopathy (e.g., sickle cell disease) Transfusion therapy