Clinical Rotations For First-Year Pediatric Fellows
The first year is devoted to 12 months of clinical training in pediatric hematology and oncology with exposure to pediatric hematology/oncology, clinical hematopoietic cell transplantation (HCT) and to general clinical research. A combination of patient types and treatment modalities are offered to provide fellows with a solid foundation in pediatric hematology and oncology care.
Core rotations are divided among three sites of practice, as follows:
Children's Hospital and Regional Medical Center (CHRMC)
Six inpatient rotation blocks occur at CHRMC for a total of six months. The general Hematology/ Oncology Inpatient Service (Heme/Onc Inpatient Service) is headed by Dr. J. Russell Geyer. The Hematopoietic Cell Transplantation Inpatient Unit (HCT Inpatient Unit) is headed by Dr. Jean Sanders.
CHRMC Heme/Onc Inpatient Service (four month-long rotations)
This is a month-long inpatient rotation providing care for general pediatric hematology and oncology patients, including initial evaluation, treatment with chemotherapy and/or radiotherapy, management of disease and/or treatment-related complications and disposition. The Heme/Onc Inpatient Team consists of one attending, one fellow, and three pediatric R-1 residents and one Advanced Practice Nurse or Physician Assistant. In conjunction with the attending, the fellow will plan the evaluation and treatment of patients including protocol enrollment, diagnostic procedures, chemotherapy orders, supportive care and appropriate follow-up at discharge. The daily patient census for each team averages from 18-20 patients. Most of the oncology patients are hospitalized on a multidisciplinary 38-bed oncology ward. The fellow and attending make work rounds every morning with his/her team including floor charge RN and each patient's RN. The fellow provides the medical team with direction in oncologic treatment and regular medical care. Night call occurs from home approximately six times per month. The inpatient fellow is responsible for presenting the service at a multi-disciplinary clinic conference each Monday morning and for presenting newly diagnosed patients at weekly Tumor Board on Tuesday afternoons.
CHRMC HCT Inpatient Service (three month-long rotations)
This month-long inpatient rotation allows fellows to develop the skills and knowledge required in Hematopoietic Stem Cell transplantation. Primary care for the HCT patients is provided by the pediatric oncology fellows, physician assistants, and occasionally visitors from many centers throughout the world who wish to gain clinical training in the area of HCT. The fellow makes work rounds every morning with the attending physician and physician assistants. Night call is generally provided by the physician assistants, although the fellow takes in-house overnight call two Saturdays each on the monthly HCT rotations. The remainder of the month the fellow takes call from home overseeing the general Hematology/Oncology Inpatient Service.
CHRMC Outpatient Service (four month-long rotations)
This is a month-long inpatient rotation providing ambulatory care for general pediatric hematology and oncology patients, including initial evaluation, treatment with chemotherapy and/or radiotherapy, management of disease and/or treatment-related complications and disposition. The fellow works directly with an attending physician providing care to newly diagnosed children, ongoing chemotherapy and supportive care for patients undergoing therapy for cancer or hematologic disorders. The fellow receives formal training to perform lumbar punctures and bone marrow biopsies. The fellow is responsible for consultation requests from community physicians and in-hospital physicians and reviews these consultations with the assigned outpatient attending physician. During the outpatient clinic rotation the fellow attends weekly sub-specialty clinics in bone tumor (Tuesday afternoon), neuro-oncology (Wednesday afternoon), hematology (Thursday morning and afternoon) and Late Effects clinic (Wednesday mornings). The fellow also attends a comprehensive Sickle Cell clinic one ½ day during each outpatient clinic rotation.
Seattle Cancer Care Alliance (SCCA)
SCCA HCT Outpatient Service (one month-long rotation)
The ambulatory care facilities for HCT outpatient patients are located at the SCCA adjacent to the Fred Hutchinson Cancer Research Center (FHCRC) campus. In 2001 the SCCA was formed to take advantage of the strengths of the local medical institutions, the UWMC, FHCRC, and CHRMC. Transplant patients formerly treated at the FHCRC are now seen under the auspices of the SCCA. Dr. Jean Sanders heads the pediatric HCT ambulatory care activities at the SCCA. This is one-month ambulatory care rotation. Planned admissions are scheduled based on the dates and types of preparative regimen as coordinated by the Clinical Coordinator's office. Fellows will participate in pre-transplant consultations and coordination of transplant regimen. Fellows will develop an understanding of donor identification/selection, preparative regimens, transplantation options including autologous, allogeniec, cord blood and non-myeloablative transplants and prophylaxis and treatment of acute and chronic graft versus host disease. HCT patients are followed pre- and post-transplant for a period of approximately 100 days, after which they are referred back to their referring physician. Fellows will also participate in long-term follow-up clinic to develop knowledge of diagnosis and treatment of chronic graft versus host disease and long-term toxicities of HCT.
Pediatric Hematology/Oncology Clinical Trials
Clinical trials are often performed under the auspices of SCCA protocols, national protocols from the Childrens Oncology Group (COG), Pediatric Brain Tumor Consortium (PBTC), New Approaches to Neuroblastoma Therapy (NANT) and in-house protocols. New agents in cancer treatment are being investigated through pharmaceutical company studies, COG, PBTC, and NANT. The continuing focus of clinical research is an attempt to improve therapy studying new approaches to chemotherapy, improving supportive care or through biochemical modulation. Our CHRMC and FHCRC-based pediatric faculty are active participants in SCCA, COG, PBTC and NANT protocols with national leadership roles in areas of HCT, AML, neuro-oncology, Ewings sarcoma, rhabdomyosarcoma, neuroblastoma, Non-Hodgkins lymphoma, Hodgkins disease, and late effects of cancer therapy.
