For complete information, please view our Brochure and Application for Fellowship (PDF)
- Inpatient Experience (4 months)
- Outpatient Experience (4 months)
- Consultation Service (2 months)
- Bone Marrow Transplantation (BMT) Unit (1 month)
- Practicum Month (1 month)
All new fellows participate in an initial onemonth sub-specialty-focused orientation lecture series. A wide range of topics is covered, including in-depth reviews of the diagnosis and management of the major diseases that confront the pediatric hematologist-oncologist, discussion of the principles of experimental design and clinical trial implementation, an overview of epidemiology, and topics related to clinical investigation in pediatric hematology-oncology. In addition to this month-long orientation program, organized by training program faculty, fellows also participate in a Fundamentals of Clinical Investigation course. This course involves 32 hours of presentations, covering topics on clinical investigation, statistics, ethics, medical literature appraisal, pharmacokinetics, molecular medicine and gene therapy. Fellows are expected to pass a written examination at the end of this course.Top
The subsequent 12 months of training focus primarily on the clinical aspects of pediatric hematology-oncology. Fellows are trained in the principles of evaluation, diagnosis and management of pediatric hematologic and oncologic disorders. The clinical experience includes primary patient care in both the inpatient and ambulatory settings, providing consultations in both settings and participation in teaching pediatric residents. As outlined above, first-year fellows have 12 one-month rotations between the inpatient and outpatient services. These include spending four months on the 36-bed inpatient unit at Texas Children’s Hospital, four months in the outpatient clinic, two months on the Consultation Service and one month on the 15-bed Bone Marrow Transplantation Unit. The remaining month is spent in a rotation designated the Practicum Month. Focused learning experiences in coagulation, hematopathology, blood banking, radiation oncology, immunophenotyping, cytogenetics, and DNA diagnostics are provided during this period. Trainees are given a list of specific procedures and learning goals for each activity.
It is important to emphasize that the Pediatric Hematology-Oncology Training Program emphasizes one-onone supervision in the education of the trainees. In every phase of the Program, the fellow works closely with members of the faculty in learning to deliver quality patient care.Top
- Inpatient Experience - On the inpatient service (four months total), the first-year fellows oversee the care of 15-20 patients. These include new patients with possible or established oncology or hematology diagnoses, patients on scheduled admissions for therapy or other elective procedures, and patients who are unscheduled admissions with complications of their disease and/or treatment. There are two inpatient teams each month. Each team consists of a fellow and a supervising attending physician. Each team works with and supervises first-year and upper-level house officers. The two teams admit patients on alternate days and are responsible for the care of patients admitted to their service every other weekend. Night call on these admission days is taken from home. The fellows make daily work and teaching rounds with the attending physicians and house officers, and every patient is reviewed, discussed and evaluated. The supervising physician is available to the fellow 24 hours a day. Fellows have no other clinical responsibilities during this month so that they can devote all of their time to patient care and teaching.
- Outpatient Experience - In the outpatient clinic rotation (four months total), fellows are involved in evaluating new patients and following established patients. Fellows perform the initial history and physical examination and formulate the initial management plan. Duties include ordering and assessing the results of laboratory and imaging studies on patients seen in the clinic. Faculty review each case with the fellow. Depending upon their experience, fellows are involved in or actually give diagnostic and management presentations to the families and patients where appropriate. They also see established patients, including their continuity clinic patients. There are focused learning experiences in neuroradiology and in Long Term Survivorship scheduled during the outpatient rotations in the latter part of the year. While continuity patients comprise less of the clinic experience in the first year of training, they constitute a significant portion of the fellows’ outpatient responsibilities in the second and third year of the Program.
- Consultation Service - On the Consultation Service (two months total), the fellow, working closely with a specific attending physician, performs consultations on new referrals in the Texas Children’s Hospital (TCH), including the Emergency Center. Fellows on Consultation Service are called upon to assist in making the initial diagnosis for a variety of hematologic and oncologic problems in infants, children and adolescents. Fellows provide the initial encounter for these patients and their families to our service and develop the recommendations for evaluation, eventual diagnosis and subsequent management. Fellows on the consult service follow an average of 10-15 patients at any one time. Consultations are also performed in the nurseries at St. Luke’s Episcopal Hospital and Methodist Hospital, both adjacent to TCH. Also, there are occasional consults at the Children’s Center of the Ben Taub General Hospital in the Texas Medical Center. Every consultation is seen and reviewed with the supervising physician. The Consultation Service is available from 8:00 am to 5:00 p.m. Monday through Friday. After hours, emergency consultations are seen by the fellow on call for the inpatient service and turned over to the consultation team in the morning.
- Bone Marrow Transplantation (BMT) Unit - This rotation (one month/year) involves the care of patients in the state-of-the-art 15-bed BMT unit, with the assistance of an advanced nurse practitioner, a bone marrow transplant fellow, and a supervising physician. The fellow and the attending physician make rounds on patients daily. There is one month of BMT training and responsibility during each of the three years of the fellow’s training (total of three months). The first-year fellow is paired with a third-year fellow/mentor for the month, and the second-year fellow does the rotation with night call support from the fellow on the Consultation Service and with the assistance of the inpatient advanced nurse practitioner.
- Practicum Month - The remaining month is spent in a rotation designated the “practicum month.” During this month, fellows are provided with focused learning experiences in coagulation, hematopathology, blood banking, radiation oncology, immunophenotyping, cytogenetics, and DNA diagnostics. They are given a list of specific procedures and learning goals for each activity.
Continuity of Care
Longitudinal patient follow-up is an extremely important aspect of oncology training. As a general practice, newly diagnosed patients who are evaluated by the fellow in the outpatient clinic and on the ward are followed by that same fellow when on the outpatient rotation. In the first year of the program, fellows have somewhat limited opportunity to see patients they have initially managed due to the requirements of the inpatient services. However, the outpatient unit employs an electronic medical record system that allows the fellows to track their patients even when not on an outpatient rotation. During the last quarter of their first year, fellows identify a cohort of patients as their formal continuity patients. Subsequently, during the second and third years of training, fellows follow their continuity patients during their weekly clinic time. By working closely with the attending physician and a primary pediatric nurse practitioner, the fellow can closely monitor the patient’s course even if the fellow is not available for every outpatient encounter. Whenever possible, the fellow is involved in major decision-making that relates to the primary continuity patients.Top
Scholarship Oversight Committee
Each first year fellow has a committee of three individuals who meet with the fellow early in the first year and provide guidance in their career development and selection of a research field and mentor. One of the Committee members is a clinical mentor selected by the fellow. At the end of the first year, the committee membership changes to include the research mentor and additional members expert in the fellow’s chosen research field.Top
Psychosocial Aspects of Pediatric Hematology-Oncology
Fellows receive training in addressing psychosocial issues in caring for children and adolescents with life-threatening illnesses. Working with an experienced attending physician in the day-to-day care of patients in stressful clinical circumstances, fellows learn how to provide optimal psychosocial support to patients and their families. In addition, the service has a full-time psychologist who directs the Psychosocial Support Program and who provides support and advice to fellows. There are also organized multidisciplinary conferences on patient and family management issues, as well as a fellows’ seminar series that focuses on recognizing and dealing with the psychosocial aspects of care.Top
The fellowship program acknowledges that a prerequisite for success in an academic medical career is leadership ability. An academic physician is expected to guide the patient and family as they adapt to serious illness, supervise the health care team in the care of the patient, direct laboratory and clinical research efforts, teach trainees at all levels and, potentially, lead as the head of a program, department or institution. Leadership is taught implicitly, as in most programs, by a gradual increase in responsibility throughout the fellow's training, including the opportunity for the fourth-year fellow to function as an attending. Fellows are routinely invited to participate in formal faculty development activities (e.g., workshops on grantsmanship, career planning, etc.). In addition, the program teaches leadership through a unique, twice-monthly Fellows’ Seminar.Top
This twice-monthly seminar, required for the first-year fellows and optional thereafter, focuses on what we call "reflective practice" and leadership. Fellows are encouraged to discuss any challenging circumstances encountered in their role. These diverse topics include issues such as the difficulty of dealing with a dying patient, the complexities of leading a health care team, and the strain of balancing the demands of a young family with the commitments associated with participating in an academic training program. Selected senior faculty facilitate discussions by framing thought-provoking questions and, at times, relating their own experience. The method enhances fellows’ understanding of these complex issues and broadens their base of experience through input from their colleagues and mentors. There is a systematic effort made to help fellows develop skill in analyzing situations and translating reflection into effective action as leaders in academic medicine.Top