MD Anderson – Orlando has several weekly conferences focused on both patient care and research interactions. Fellows actively participate in these conferences, which are one of the major activities of the teaching program:
- Breast Cancer Conference
- Gastrointestinal Oncology Conference
- Thoracic Oncology Conference
- Cancer Center Research Conference
- Oncology Journal Club
- Hematology Journal Club
- Core Lecture Series
- Tumor Biology Seminar Series
- Brain & Spine Tumor Conference
- Head & Neck Tumor Conference
- Palliative Care Conference
- Benign Hematology Conference
MD Anderson – Orlando supports travel to one national meeting during the second and third fellowship years such as the American Society of Clinical Oncology or the American Society of Hematology.
Description of Clinical Duties
- M. D. Anderson – Orlando: Outpatient Clinic
The clinic operates Monday through Friday. First year oncology fellows are assigned to groups of attending physicians (also called an attending) and see patients in clinic all week for six months. To ensure continuity of care, fellows rotate in two-month blocks. Second year hematology fellows are in clinic for a total of four half-days per week for six months, including one year long continuity clinic. Third year fellows have four half-days clinic per week for 8 months. All fellows will start a continuity clinic at the beginning of their training that continues for three years.
Each fellow is assigned a group of patients at the beginning of each two-month clinic rotation. These patients are yours, and you should work with the nursing staff and attendings in all aspect of their care. This team approach will give you a sense of responsibility for your patients as well as one-to-one contact with attendings, each of whom will provide assistance when you need it. Each attending focuses on a specialized aspect of oncology/hematology, and a fundamental goal of this fellowship is to give you the opportunity to gain as much knowledge as possible. Even though the clinic can become hectic, it represents an unparalleled opportunity for spontaneous instruction in the clinical and research aspects of oncology. The more you learn, the more trust and confidence the attendings will have in you, and the more independence you will be given in patient care.
Fellows play an important role in ensuring the smooth and efficient operation of the clinic. The fellow and attending assignments are posted one day in advance. It is strongly advised that you review charts, update flow sheets, obtain necessary laboratory or radiology results, and/or write chemotherapy orders the day before a patient’s actual clinic visit. This will allow you and your attending physician to deliver efficient patient care without detracting from your educational experience.
The mechanics of the clinic are fairly straightforward. Follow-up patients are scheduled every 15-20 minutes. Most follow-up patients routinely have blood work drawn in the clinic laboratory before a scheduled appointment. The clinic nurse will bring the patient into an examination room, take his/her vital signs, and collect any necessary paperwork.
You will then evaluate the patient, formulate an assessment and plan, and present the case to the attending. After the discussion, you and the attending will return to the patient’s room to answer questions and discuss your final recommendations. All pertinent information, including a detailed physical exam and review of systems, should be documented in the patient’s chart. Most follow up notes can be dictated by the fellow and the attending physician. A dictated note to the patient’s referring physician is sometimes required and appreciated.
New patient visits are much more involved and are therefore allotted 60 to 90 minutes. Fellows review medical records, radiology studies, and pathology slides before they evaluate the patient and formulate an assessment plan. Ultimately, your presentation to the attending physician should include a summary of the patient’s pertinent past medical history, laboratory and radiographic data, and physical findings.
After reviewing all of the information and discussing the treatment plan, you and the attending will return to the patient’s room to discuss your final recommendations and plans for future treatment and follow-up visits. Documentation of this discussion should include a brief handwritten summary in the chart as well as a full dictated history and physical. The handwritten summary is to provide basic information until the final dictation is filed in the chart.
Patients – who present by telephone or in person – with symptoms requiring immediate evaluation should be triaged to the appropriate place (i.e. clinic, inpatient floor, or closest emergency department). Either the patient’s case manager or clinic coordinator can assist in making proper arrangements for clinic and/or inpatient admission. If a patient is directed to an emergency department, the emergency room physician should be notified with the patient’s name, pertinent medical history and presenting complaint. In addition, all contact with patients should be recorded promptly in the patient’s medical chart for future reference.
Fellows are required by ACGME to complete a one-month rotation in gynecologic oncology. This rotation includes participation in an outpatient clinic, inpatient work rounds, and weekly teaching conferences. The fellow is invited to observe in the operation room for interesting cases.
- Chemotherapy Infusion Unit
Outpatient chemotherapy and blood component therapy is administered through the Ambulatory Treatment Center on the fifth floor. Patients on active outpatient treatments are first evaluated in the clinic, where their counts are checked, flow sheets are updated, and chemotherapy orders are written. Please note that the attending physician must review and co-sign all chemotherapy orders. Ideally, this should be the attending that has primary responsibility for the patient. In addition, all patients must sign an informed consent prior to each new chemotherapy regimen, and a copy of this consent should always be on the patient’s outpatient clinic chart.
Patients with walk-in emergencies requiring intravenous medications, hydration, or close nursing supervision are occasionally referred to the fifth floor unit; again, both the clinic coordinator and nursing staff must first clear these visits. As a rule, the hematology or medical oncology fellow covering inpatient wards should be notified upon the patient’s arrival to the fifth floor so he/she can assist in medical follow-up. This is the same fellow who will be paged if an emergent situation develops on the fifth floor. Despite the excellent triage capabilities available on this unit, however, a patient who appears hemodynamically unstable should be referred directly to the emergency room for comprehensive emergent care.
- Medical Oncology and Hematology Ward Services
The inpatient ward fellow is responsible for supervising day-to-day care of patients as well as providing chemotherapy orders and consent forms when appropriate. Admission notes and daily progress notes are required on all patients. Admission notes should be written by the clinic fellow if the patient is admitted through the outpatient clinic; by the fellow on-call if the patient is admitted over the weekend or between 5 p.m. and 8 a.m. on weekdays; or by the ward fellow if the patient is admitted through the emergency room or as a direct admission between 8 a.m. and 5 p.m. on weekdays. Daily progress notes are the sole responsibility of the inpatient ward fellow.
Inpatient fellows must be available to present patient information when the fellows’ attending completes rounds.
The inpatient services are often active rotations. The seventh floor is the only dedicated hematology/oncology unit, but there is often overflow onto other medical floors. It is the ward fellow’s responsibility to prioritize and approve scheduled admissions. This requires constant communication between the inpatient ward attending, patient’s outpatient attending and case manager, charge nurses on the floors, and the admissions officers. Patients requiring chemotherapy must be admitted to the hematology/oncology unit as they will require specialized care of nurses trained in chemotherapy administration and morbidity. All other patients should be triaged and placed accordingly.
- Medical Oncology and Hematology Inpatient Consult Services
The medical oncology consult service is covered by the inpatient oncology fellow; the hematology consult service is covered by the hematology inpatient fellow. These teams must promptly respond to new consults received on weekdays from 8 a.m. to 5 p.m. Attending physicians and fellows on call, on the other hand, are responsible for emergent consults received during on-call hours. As with the other services, the fellow has the primary responsibility for seeing patients, reviewing records and films and presenting data to the consult attending. Frequently patients are also admitted to the hospitalist service, with which fellows should establish a close working relationship as we function as a consult service to patients admitted under their care.
- Bone Marrow Transplant Unit
One hematology fellow is assigned to BMT for two months, which includes coverage of inpatient and outpatient BMT services, as well as participation in bone marrow harvests.
It is expected that each fellow will spend the rotation for bone marrow transplant at The University of Texas MD Anderson Cancer Center Orlando in Houston. This time will be scheduled as consecutive months. Travel and housing arrangements will be planned in advance with the help of administrators at both centers.
Many patients are scheduled at routine intervals for inpatient systemic chemotherapy. These patients are commonly evaluated in the clinic immediately before the day of admission. Ideally, the admission note and chemotherapy orders are written by the clinic fellow, co-signed by the patient’s outpatient attending, and forwarded to the inpatient ward fellow after the visit. If the admitting process proceeds in an organized fashion, the pharmacy should receive signed chemotherapy orders 24 hours prior to a patient’s arrival on the inpatient unit.
Also, the inpatient fellow is responsible for coordinating direct admissions from home, transfers from other medical facilities, and urgent admissions from either the outpatient clinic or the fifth floor chemotherapy unit.
- Responsibilities of the Third Year Fellows
The senior year of fellowship is dedicated toward research, self-development and outpatient care consisting of four half-days of clinic per week. Each fellow is expected to develop a project and select one of the attendings in the division as a research mentor. Individual third year schedules are developed with the assistance of the fellowship director, who will ensure all of these requirements are met with satisfaction.
On-Call Coverage for Hematology/ Oncology
While on call, fellows cover both hematology and oncology services from home. Fellows are responsible for triaging patient telephone calls as well as answering medical issues on in-patient service when the staff requires assistance. The hematology and oncology on-call attendings are available all the time to provide assistance to fellows as needed.
Calls are divided into two categories, weekday (Monday – Thursday) and weekend (Friday – Sunday) calls.
Vacation and Sick Leave
Each fellow is entitled to three weeks paid vacation. All vacations must be scheduled in advance with the chief fellow and program director to provide appropriate coverage. No two fellows in the same year may take vacation at the same time. No vacations should be scheduled during inpatient or consult rotations.
In the event of illness, it is the fellow’s responsibility to inform the chief fellow of the problem. Coverage arrangements for inpatients and outpatients will be made on an ad-hoc basis for unexpected absences.
Faculty Preceptors/Performance Evaluations
Each fellow will be assigned or can choose one faculty member as a preceptor; the fellow can either select one himself/herself or be assigned one by the fellowship director. This person will meet periodically to discuss his/her progress, job-related problems, career decisions and academic projects. In addition, the fellowship director will meet with all fellows twice a year to evaluate performance and discuss plans. Fellows, in turn, are asked to evaluate faculty members and the program on a routine basis.
MD Anderson – Orlando is a comprehensive cancer center with extensive ancillary services available. Patients are assigned to a specific outpatient attending who possesses expertise in the area of the patient's disease. Attendings guide overall management decisions; however, it is the primary fellow who assumes responsibility for many of the day-to-day care issues. Other resources include case managers, research nurses, outpatient chemotherapy nurses, and nurse practitioners. A triage nurse is available in the outpatient clinic for all walk-in emergencies, and the clinic coordinator serves as the fellows’ liaison by assisting with phone messages and routine patient requests. There is also an extensive network for patients who need a stronger psychosocial support.
What You Need to Know to Apply
The Application Process
You should apply for the Hematology-Oncology Fellowship Program through ERAS (Electronic Residency Application Service). ERAS is an Internet-based application process developed by the Association of American Medical Colleges to transmit fellowship applications, letters of recommendation, program director letters, medical transcripts and other supporting credentials from applicants, residency programs and medical schools to fellowship program directors using the Internet. For information about the process or to register for ERAS online, visit www.aamc.org/eras.
Matching with the Hematology/Oncology Fellowship Program
The Hematology/Oncology program participates in the National Residency Match Program’s Medical Specialties Matching Program (MSMP) in Hematology/Oncology. This is a computerized venue for matching applicant’s preferences for fellowship programs with program directors’ preferences for applicants. For information about NRMP or to register online participate in NRMP, go to www.nrmp.org.
Note: All qualified applicants are considered for interviews. However, the volume of applicants precludes us from offering interviews to all qualified candidates.