Resident/Medical Student Education >> Goals and objectives



Description and Curriculum



At the end of their 3-year training program, residents will be able to identify, diagnose and treat most of the hematology/oncology problems that they will encounter in their practice. Many of these goals will be accomplished during the PL 2 elective rotation by in-depth review of commonly encountered hematological and oncological problems.

Residents or fourth year medical students rotating on Pediatric Hematology/Oncology elective will focus on practical aspects of common conditions. Basic knowledge of the etiology and pathogenesis of common disorders, as well as some uncommon conditions that illustrate essential elements of disease pathophysiology, is essential and is reviewed in detail with the faculty.

Residents receive a copy of the goals and objectives and a syllabus of selected reviews and relevant articles. They actively participate in a busy academic schedule that includes didactic lectures, grand rounds and informal discussions.

Much of the learning is case based and takes place in the office, at the microscope and at the bedside. Interesting cases will serve as the basis to direct their reading during the rotation. At the beginning of the rotation, several important topics will be chosen by the attending and the rotating resident for special emphasis. In addition, the resident/student will be asked to review a particular subject for subsequent presentation in front of the division or department at the end of the rotation.

Typically the resident or student reviews the case, elicits a focused history, examines the patient and then presents their findings, differential diagnosis and plan to the Attending Physician. S/he may also review the literature for interesting consults, and will write the consult note. This is discussed with the Attending Physician and placed in the chart after the physician has examined and discussed the case and written a note in the consult.

Residents are highly encouraged to observe and perform weekly procedures (spinal tap, bone marrow aspirate and biopsy) with the attending physician. Review of bone marrow and peripheral blood morphology is conducted once a week with an attending physician.



Pediatric Hematology/Oncology Curriculum



The Pediatric Hematology experience consists of exposure to patients throughout the residency training. The training at each level consists of the following:

The PL1 resident on the floor/nursery is in charge of the patient when they are admitted to the Pediatric Floor and nursery and are closely supervised by the senior residents and the Attendings. Patients are also seen in the General Pediatric clinic.

The PL 2 resident has a one month block rotation in Pediatric Hematology/Oncology and provides first line of coverage for consultations, participates in the ordering of tests to diagnose, stage and manage patients.

The PL 3 residentis in charge of the patients when they are admitted. They also participate in the management of patients when they are admitted in the PICU for complications and for procedures.

All residents also evaluate and manage patients when they present in the emergency room.

Primary Goals of this rotation is to expose the resident to Pediatric hematology and oncology patients and ensure that the resident will gain an understanding of common hematologic or oncologic conditions, and can distinguish normal from pathologic states. The resident should be able to evaluate and initiate management in common hematological conditions but also diagnose and initiate management of patients with hematological or oncological disorders that generally need referrals. In addition, the resident is expected to be able to understand the impact of a chronic illness and a life threatening illness on the families.

Patient Care


Goal


Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.


Competencies


Residents are expected to:

  1. Demonstrate how to gather essential and accurate information about the patient.
  2. Make a informed diagnostic and therapeutic decisions
  3. Develop and carry out management plans.

Objectives


The resident is expected to:

  1. Perform complete histories, physical exams, discuss a differential diagnosis, participate in the ordering of tests to diagnose, stage and manage patients, come up with different management suggestions. Perform spinal taps, bone marrow aspirations, intrathecal chemotherapy, intravenous chemotherapy under complete supervision of the Attending.
  2. Assist with conscious sedation protocols.
  3. Respond to sick patients who walk in for emergencies, learn to make decisions in an out patient setting.

    Participate in writing orders for transfusions, exchange transfusions, chemotherapy infusions, pain management and factor infusions.

  4. Gain familiarity with the Children’s Oncology Group protocols and learn the mechanisms of following these protocols.
  5. Coordinating care and obtaining all consults.

Medical Knowledge


Goal


Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:


Competencies


  1. Prevention, Counseling and Screening : Understand the role of the pediatrician in preventing hematologic or oncologic conditions, and in counseling and screening individuals at risk for these diseases.
  2. Normal Vs. Abnormal : Distinguish normal from pathologic states of the hematologic and lymphatic systems.
  3. Understand neonatal hematology and be able to distinguish normal from abnormal and methods of evaluating abnormal results.
  4. Undifferentiated Signs and Symptoms: Evaluate, treat, and/or refer patients with presenting signs and symptoms that may indicate a hematologic or oncologic disease process.
  5. Common Conditions Not Referred: Diagnose and manage patients with hematological disorders that generally do not need referral.
  6. Conditions Generally Referred: Diagnose and initiate management of patients with hematological or oncological disorders that generally need referrals.
  7. Common Malignancies. Discuss the presentation, pathophysiology, and prognosis of important malignancies in children and adolescents.
  8. Iron Disorders. Discuss the appropriate methods of diagnosis and management of a patient with iron disorders.
  9. Blood Products. Understand indications for and complications related to the use of blood products.
  10. Sickle Cell Disease. Understand the general pediatrician's role in the diagnosis and management of patients with sickle cell disease

Objectives


  1. Recognize the differential diagnosis, provide initial evaluation and management, and provide appropriate referral of the child presenting with these conditions:

    • Anemia (exclusive of common iron deficiency or transient erythropenia)
    • Abnormal bruising or bleeding (inherited and acquired)
    • Major complications of inherited bleeding disorders
    • Hemoglobinopathies (sickle cell and other sickling disorders), including severe pain crisis, fever, stroke, sequestration, and aplastic crises
    • Urgent conditions in children under treatment for cancer, including fever while on chemotherapy, chicken pox exposure or illness, bleeding
    • Neutropenia
    • Thrombocytopenia
    • An abdominal mass
    • A mediastinal mass
    • Conditions that might predispose to malignancy (eg. Neurofibromatosis, Bloom’s syndrome, retinoblastoma, and familial cancer)

  2. Identify the presenting complaints, principles of current therapy, prognosis, and long term complications due to the disease or therapy for these conditions:

    • Leukemia (ALL, AML)
    • Brain tumor
    • Hodgkin’s and Non-Hodgkin’s lymphoma
    • Neuroblastoma
    • Wilm’s tumor
    • Soft tissue sarcomas
    • Bone tumors (Osteosarcoma and Ewing’s sarcoma)
    • Retinoblastoma
    • Langerhans cell histiocytosis
    • Fever, Neutropenia in patients on chemotherapy

  3. Be able to evaluate patients referred for consultation in the hematology/oncology clinics, formulate a differential diagnosis and plan tests and treatment. Especially for these common pediatric signs and symptoms, describe clinical findings that would referral for Hematology/Oncology evaluation .

    • Adenopathy, Bruising, Bleeding
    • Headache
    • Limb pain/Limp, gait disturbances
    • Lymphadenopathy
    • Hepatomegaly and/or splenomegaly
    • Persistent fever and malaise, fatigue
    • Seizures
    • Weight loss, Abdominal pain, vomiting
    • Lytic lesions
    • Dizziness
    • Nevi

  4. Perform the role of first line contact as a Pediatric subspecialist for consultations on the Pediatric floor, nursery and the ER.
  5. Learn to evaluate peripheral blood smears in conjunction with the Attending.
  6. Perform bone marrow aspirations, biopsy, spinal taps for intrathecal chemotherapy, intravenous chemotherapy and exchange transfusions in conjunction with the Attending.
  7. Become familiar with Chemotherapy protocols, road maps used in Children’s Oncology Group patients. Evaluate and be involved in outpatient treatments in patients.
  8. Be able to describe common acute side effects of commonly used chemotherapy.
  9. Be able to describe common late complications of children cancer.
  10. Understand the indications and complications related to the use of blood products.

    • List the appropriate indications, doses and potential risks of various blood products (red blood cell products, platelet concentrates, coagulation factors).
    • Summarize the signs and symptoms of a transfusion reaction and develop an effective treatment plan to manage its effects.
    • Be aware of alternatives to blood transfusions, e.g., erythropoietin and other cytokines.
    • Discuss the reasons for leukofiltration and/or irradiation of blood products.

  11. Understand the appropriate methods of diagnosis and management of a child with disorders relating to iron.Describe the normal requirements, Identify the features of iron deficiency. Describe and use appropriately laboratory tests to screen for, treat, and manage the therapy of iron deficiency.
  12. Understand the various hematological/oncological problems in the neonate including neonatal thrombocytopenia, neutropenia, leucocytosis, thrombocytosis, polycythemia, anemia, hyperbilirubinemia, purpura, bleeding disorders and evaluation of mass lesions.
  13. Understand the impact of a chronic and/ or serious illness on the patient and family.
  14. Play an active role in the multi-disciplinary management of patients by participating in division meetings and care conferences

    • Attend community fairs, PTA meetings and make presentations in conjunction with division staff.
    • Participate actively in the presentations in the community
    • Participate in the support groups and Seminars conducted by the division for patients and their families.

  15. Understand the pediatrician’s role in the prevention of hematologic and oncologic disorders by counseling.

    • Provide dietary counseling to parents about the prevention of iron deficiency.
    • Counsel patients who have a sickle hemoglobinopathy about the importance of antibiotic prophylaxis and urgency of evaluation for fever.
    • Genetic counseling for hemoglobinopathies.

  16. Technical and Therapeutic procedures: Describe the following procedures, including how they work and when they should be used; competently perform those commonly used by the pediatrician in practice. Bone marrow aspiration and biopsy, central line: use and care, Lumbar puncture, Medication delivery (I/V) and familiarity with Cancer protocols and road maps.

Contact


The Brookdale University Hospital and Medical Center


Division of Pediatric Hematology/Oncology
One Brookdale Plaza
Suite 346 CHC
Brooklyn, NY 11212-3198

Phone: (718) 240-5904

Fax: (718) 240-6730

Emergency Beeper Number
(917) 433-7764