Clinical and Research Experience 

First Year Curriculum (13 months) includes the following rotations: 

During inpatient rotations the fellow will lead a team of medical trainees to provide care for our hematology oncology patients admitted to our inpatient service. Fellows spend one month at a time on each of the four different services (Hematology, Leukemia & Lymphoma, Solid Tumor/Neuro Oncology, and Bone Marrow Transplant). Fellows work closely with an attending assigned to the same inpatient service. New patients admitted or consulted upon will become the fellow’s primary patients. Each fellow will be in charge of the management and treatment of their primary patients, with the supervision of a primary attending.  During inpatient rotations fellows are responsible for only inpatient clinical issues. All outpatient calls are fielded by case managers and outpatient physicians. 

During outpatient clinic rotation fellows are introduced to ambulatory hematology oncology. Fellows will perform bone marrow biopsies and aspirations, lumbar punctures and intrathecal chemotherapy administration in the procedure room daily during their clinic month. We have a dedicated anesthesiologist to provide sedation for procedures everyday in our outpatient clinic. Fellows also gain exposure to all of the comprehensive clinics (Sickle Cell/Thalassemia Clinic, Hemophilia, Thriving After Cancer, Cancer Genetics, Neuro Oncology, and BMT) during this month.  While in outpatient clinic fellows will be responsible for fielding all outpatient consults with attending supervision. Outpatient parental calls will be triaged by case managers. 

During the other outpatient month (Radiation Oncology/Clinical Lab), fellows will gain exposure to both proton and photon radiation oncology, as well as the many clinical laboratories that are utilized by hematology oncology providers (flow cytometry, blood banking, UCSD special coagulation lab, pathology, etc). We are one of the few Pediatric hematology oncology centers in the US that provides proton therapy to pediatric oncology patients in partnership with California Protons. 

Fellows participate in a research month during the second half of their first year of fellowship. This month provides time for fellows to explore the multitude of research opportunities, and to finalize a strong research project and plan for their fellowship research years. Fellows do not have clinical duties other than their weekly half day of continuity clinic and calls during that month, to provide them with flexibility to meet potential PIs, attend lab meetings, work on IRB submissions, and prepare for their fellowship scholarly work. 

Procedures

Our fellows have many opportunities to learn and perform procedures that are involved in the care of our hematology oncology patients. In addition to the daily procedures during the outpatient clinic month, fellows perform procedures on their primary patients when needed in coordination with other sedated procedures (imaging or surgery), and will have opportunities to continue to hone their procedure skills during second and third fellowship years while in clinic. Fellows are also invited to participate in bone marrow harvests with the BMT team.

Calls

The night and weekend calls are split mainly between the first and second year fellows, with each fellow taking one weeknight call per week, and one weekend call per month. Fellows always have an attending back-up scheduled with them, who is always available for any questions or assistance. The third year fellows are scheduled only 2 weekend calls to allow more time to complete their research project.

Performance Evaluations

We strive to provide our fellows with timely, continuous feedback through many different channels. The attending on service sits down for one-on-one feedback sessions with the fellow through their inpatient rotations to provide informal feedback. Each attending completes an evaluation of the fellow with whom they have worked on service, which helps to guide our twice yearly milestone evaluations. Each fellow has a formal evaluation meeting with the fellowship program directors twice a year to review these written evaluations. The first year fellows also go through a 360 degree evaluation process, in which they perform a self-assessment, and receive feedback from not only faculty, but also nursing staff, case managers, patients and families. We also frequently elicit fellow feedback on the fellowship program to make changes and improvements to optimize each fellows’ experience. We offer a feedback training program for pediatric fellows, run by Dr. Jennifer Yu, in which fellows can learn and practice methods to give and receive feedback.

Fellows receive training to address psychosocial issues in the care of children and adolescents with life-threatening illnesses. Working with an experienced attending physician in the day-to-day care of patients, fellows learn how to provide optimal psychosocial support to patients and their families. In addition, the service has two-psychologists who are a resource for patients and families and provide support and advice to the fellows. We have a supportive care nurse, Joanne “Jo” Auger, and a palliative care team who are integral for families and patients with difficult situations or at the end of life. Our supportive care team organizes multidisciplinary conferences on patient and family management issues, debriefing sessions after difficult situations, as well as a fellows’ seminar that focuses on recognizing and dealing with the psychosocial aspects of care.

At UCSD, trainees and faculty alike have access to the Healer Education Assessment and Referral (HEAR) Program. The HEAR program was created to offer confidential support and resources to those healthcare providers in need. The UCSD Pediatric Hematology Oncology Fellowship requires all fellows to undergo the confidential online assessment of burnout, depression and stress, and there are counselors that provide confidential services to those in need, free of charge.

Our fellows participate in a unique informed consent curriculum with the goal of enhancing communication skills. The workshop is led by our faculty members, Drs. Paula Aristizabal and Nicholas Gloude, and the UCSD Education, Simulation and Standardized Patient program. Our simulation-based curriculum has significantly increased our fellows’ self-reported confidence and skills in informed consent performance, and addresses research-related content and also management of parental emotional needs during the informed consent discussion. Our curriculum has been supported by the ASPHO Clinician-Educator Award.