The fellowship is divided into 18 months of clinical time and 18 months of research. The clinical portion of the fellowship includes inpatient consults at one of the 3 teaching hospitals, outpatient rotations with disease-specific experts at the Moores Cancer Center, as well as a half-day per week in an outpatient continuity clinic at the VA Medical Center where the fellow has their own panel of patients that they follow.
Key clinical rotations include:
- Inpatient benign and malignant hematology consults
- Inpatient oncology consults
- Inpatient and Outpatient Bone Marrow Transplant
- Outpatient benign hematology, malignant hematology, and solid tumor oncology clinics at UC San Diego Moores Cancer Center.
- Radiation Oncology clinics
- Gynecologic Oncology clinics
- Hemophilia Clinic at the San Diego
Hemophilia and Thrombosis Treatment Center
- Lab rotations in transfusion medicine, special coagulation, flow cytometry, and hematopathology
While on the consult services, the Fellow is the primary contact for all matters related to hematology and oncology. Patients are evaluated and diagnostic and treatment plans are developed. Attending rounds are held daily with the Fellow and one or more faculty to review and revise treatment plans, as needed, and to provide teaching around disease processes and management. There are hematology/oncology consult services at the Jacobs Medical Center, Hillcrest Medical Center, and the San Diego VA.
See below for descriptions of the experience at the 3 different sites.
Jacobs Medical Center (including Thornton Pavilion), La Jolla
Jacobs Medical Center, located near the main UC San Diego campus in La Jolla, is one of the two UC San Diego hospitals. There is a separate hematology and oncology consult service. Consults here are focused on the treatment of malignant diseases, including management of therapy-related complications and side effects. Moores Cancer Center, with outpatient clinics and research labs, is within an easy 3-minute walk from Jacobs Medical Center. This proximity allows close contact between admitted patients and their outpatient oncology teams.
Also, located at Jacobs Medical Center is the Bone Marrow Transplantation (BMT) Program, which includes patients with hematologic malignancies (including leukemia and lymphoma) undergoing chemotherapy. Cancer care is emphasized at Jacobs Medical Center with floors dedicated to medical oncology, BMT, inpatient hospice, surgical oncology, and a separate medical, surgical, and neurologic ICU.
Hillcrest Medical Center
UC San Diego Medical Center in Hillcrest, close to downtown San Diego, is the other main hospital of the UC San Diego health system and serves a diverse population of patients. The hospital is a Level III trauma center and has a burn unit.
At the Hillcrest Medical Center, fellows rotate on a combined hematology/oncology consult service and staff new consults with a separate medical oncology and hematology attending. Hillcrest serves a large underserved population in San Diego and patients present with a variety of hematologic or oncologic disorders, frequently in an advanced state. Many patients are seen who come north from Mexico and who may not have access to medical care prior to presentation. Hematologic complications of trauma and/or burns are not uncommon, as are complicated bleeding and clotting disorders.
VA Medical Center - La Jolla
The VA Medical Center is located adjacent to the main UCSD campus and is only 3 minutes by car or convenient campus bus connection to the Jacobs Medical Center and the UC San Diego Moores Cancer Center.
The VA Medical Center is a 400-bed general medicine and surgery hospital with an advanced Spinal Cord Injury Center. The inpatient and outpatient services are busy, with the majority of patients being seen for oncologic problems.
In addition to rotating in a yearly continuity clinic at the VA, fellows also rotate through the combined hematology/oncology consult service. Fellows usually have a Medicine resident and/or a medical student on the consult team. While on consult service, fellows regularly attends VA Hematopathology Rounds and VA Tumor Boards.
The outpatient clinical rotations are occur at the VA Medical Center and Moores Cancer Center.
The VA Medical Center Hematology-Oncology clinics are an excellent opportunity for patients to learn firsthand the ins and outs of oncology in the clinic, as they serve as the primary oncologist for a panel of patients. Here, the Fellows will see both new consults as well as follow their own group of patients with a diverse set of pathology ranging from benign hematology to solid tumor. Clinics are staffed by both Hematology and Oncology faculty who offer their own subspecialty experience in breast cancer, skin cancers, lung cancer, malignant hematology, etc. Fellows switch their VA continuity clinic panel after the first year to ensure they have breadth of experience with regards to their patient panels and attending clinical expertise. Fellows often note that while continuity clinic is hard work, it is a tremendous source of learning and was formative to their development as an independent clinical hematologist/oncologist.
As a 3rd year, fellows rotate primary at Moores Cancer Center with a regular continuity clinic with their research mentor. In addition to this, 3rd year fellows have hematology and oncology continuity clinics in hematology and breast cancer.
In addition to the continuity clinics, fellows rotate through the outpatient oncology clinics at UC San Diego Moores Cancer Center as part of their core rotations. These rotations are designed to expose Fellows to all of the organ–specific oncologic disciplines (e.g., lung, GI, GU, BMT, GynOnc, etc.) and introduce them to the setting where most of the clinical trial work is being done.
On the weekends, one Fellow takes call for all services, but a back-up Fellow is also on the schedule to be available should the need arise. The weekend Fellow is responsible for seeing any new consults that come into the system, while the attending faculty are responsible for rounding on established consult patients at the various hospitals. On average, fellows do 9-10 call weekends in 3 years and fellows have the majority of weekends off.